Measuring antimicrobial use in hospitalized patients: a systematic review of available measures applicable to paediatrics.
OBJECTIVE
The optimal measure to use for surveillance of antimicrobial usage in hospital settings, especially when including paediatric populations, is unknown. This systematic review of literature aims to list, define and compare existing measures of antimicrobial use that have been applied in settings that included paediatric inpatients, to complement surveillance of resistance.


METHODS
We identified cohort studies and repeated point-prevalence studies presenting data on antimicrobial use in populations of inpatients or validations/comparisons of antimicrobial measures through a systematic search of literature using MEDLINE, EMBASE, CINAHL and LILACS (1975-2011) and citation tracking. Study populations needed to include hospitalized paediatric patients. Two reviewers independently extracted data on study characteristics and results.


RESULTS
Overall, 3878 records were screened and 79 studies met selection criteria. Twenty-six distinct measures were found, the most frequently used being defined daily doses (DDD)/patient-days and exposed patients/patients. Only two studies compared different measures quantitatively, showing (i) a positive correlation between proportion of exposed patients and antimicrobial-days/patient-days and (ii) a strong correlation between doses/patient-days and agent-days/patient-days (r = 0.98), with doses/patient-days correlating more with resistance rates (r = 0.80 versus 0.55).


CONCLUSIONS
The measure of antimicrobial use that best predicts antimicrobial resistance prevalence and rates, for surveillance purposes, has still not been identified; additional evidence on this topic is a necessity.
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec and Montréal, Canada.
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E
Fortin
Department of Pediatrics, The Montreal Children's Hospital, McGill University, Montréal, Canada.
P S
PS
Fontela
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada School of Population and Public Health, University of British Columbia, Vancouver, Canada.
A R
AR
Manges
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada.
R W
RW
Platt
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada.
D L
DL
Buckeridge
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec and Montréal, Canada Department of Pediatrics, The Montreal Children's Hospital, McGill University, Montréal, Canada caroline.quach@mcgill.ca.
C
C
Quach
D000890:Anti-Infective Agents / Q000627:therapeutic use; D002648:Child; D011307:Drug Prescriptions; D004352:Drug Resistance, Microbial; D006801:Humans; D007297:Inpatients; D010372:Pediatrics
D000890:Anti-Infective Agents
antimicrobial resistance; correlation; daily doses; days of therapy; surveillance