title: Australia-wide point prevalence survey of the use and appropriateness of antimicrobial prescribing for children in hospital.
abstract: OBJECTIVE
  To describe antimicrobial use in hospitalised Australian children and to analyse the appropriateness of this antimicrobial use.
  
  
  METHODS
  Multicentre single-day hospital-wide point prevalence survey, conducted in conjunction with the Antimicrobial Resistance and Prescribing in European Children study.
  
  
  METHODS
  Eight children's hospitals across five Australian states, surveyed during late spring and early summer 2012.
  
  
  METHODS
  Children and adolescents who were inpatients at 8 am on the day of the survey.
  
  
  METHODS
  Quantity and quality of antimicrobial prescribing.
  
  
  RESULTS
  Of 1373 patients, 631 (46%) were prescribed at least one antimicrobial agent, 198 (31%) of whom were < 1 year old. The highest antimicrobial prescribing rates were in haematology and oncology wards (76% [95/125]) and paediatric intensive care units (55% [44/80]). Of 1174 antimicrobial prescriptions, 550 (47%) were for community-acquired infections, 175 (15%) were for hospital-acquired infections and 437 (37%) were for prophylaxis. Empirical treatment accounted for 72% of antimicrobial prescriptions for community-acquired infections and 58% for hospital-acquired infections (395 and 102 prescriptions, respectively). A total of 915 prescriptions (78%) were for antibacterials; antifungals and antivirals were predominantly used for prophylaxis. The most commonly prescribed antibacterials were narrow-spectrum penicillins (18% [164 prescriptions]), β-lactam-β-lactamase inhibitor combinations (15% [136]) and aminoglycosides (14% [128]). Overall, 957 prescriptions (82%) were deemed appropriate, but this varied between hospitals (range, 66% [74/112]) to 95% [165/174]) and specialties (range, 65% [122/187] to 94% [204/217]). Among surgical patients, 65 of 187 antimicrobial prescriptions (35%) were deemed inappropriate, and a common reason for this was excessive prophylaxis duration.
  
  
  CONCLUSIONS
  A point prevalence survey is a useful cross-sectional method for quantifying antimicrobial use in paediatric populations. The value is significantly augmented by adding assessment of prescribing quality.
authors.affiliation: Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia. joshua.osowicki@rch.org.au.
authors.forename: Joshua
authors.initials: J
authors.lastname: Osowicki
authors.affiliation: Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Gwee
authors.affiliation: Department of Paediatric Infectious Diseases, Monash Children's Hospital, Melbourne, VIC, Australia.
authors.forename: Jesuina
authors.initials: J
authors.lastname: Noronha
authors.affiliation: Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, NSW, Australia.
authors.forename: Pamela
authors.initials: P
authors.lastname: Palasanthiran
authors.affiliation: Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, NSW, Australia.
authors.forename: Brendan
authors.initials: B
authors.lastname: McMullan
authors.affiliation: Infectious Diseases Department and Microbiology Department, Children's Hospital at Westmead, Sydney, NSW, Australia.
authors.forename: Philip N
authors.initials: PN
authors.lastname: Britton
authors.affiliation: Infectious Diseases Department and Microbiology Department, Children's Hospital at Westmead, Sydney, NSW, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Isaacs
authors.affiliation: Pharmacy Department, Children's Hospital at Westmead, Sydney, NSW, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Lai
authors.affiliation: Infection Management and Prevention Service, Lady Cilento Children's Hospital, Brisbane, QLD, Australia.
authors.forename: Clare
authors.initials: C
authors.lastname: Nourse
authors.affiliation: Mater Pharmacy, Mater Health Services, Brisbane, QLD, Australia.
authors.forename: Minyon
authors.initials: M
authors.lastname: Avent
authors.affiliation: Infection Management and Prevention Service, Lady Cilento Children's Hospital, Brisbane, QLD, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Moriarty
authors.affiliation: Infection Management and Prevention Service, Lady Cilento Children's Hospital, Brisbane, QLD, Australia.
authors.forename: Julia
authors.initials: J
authors.lastname: Clark
authors.affiliation: Department of General Paediatrics, Princess Margaret Hospital for Children, Perth, WA, Australia.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Francis
authors.affiliation: Department of General Paediatrics, Princess Margaret Hospital for Children, Perth, WA, Australia.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Blyth
authors.affiliation: SA Pathology, Women's and Children's Hospital, Adelaide, SA, Australia.
authors.forename: Celia M
authors.initials: CM
authors.lastname: Cooper
authors.affiliation: Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Bryant
mesh_terms: D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D002648:Child; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence
chemical_list: D000890:Anti-Infective Agents