Opportunities to improve antimicrobial use in paediatric intensive care units: a nationwide survey in Spain.
Improving antimicrobial use is a complex process that requires an accurate assessment of ongoing problems and barriers. Paediatric intensive care units (PICU) have seldom been assessed from this perspective. Two Internet-based, self-administered surveys were conducted nationwide in Spain between January and February 2014. The first survey aimed to assess those characteristics of Spanish PICUs that could influence antimicrobial prescribing or antimicrobial stewardship. The second survey targeted Spanish PICU physicians and pursued to assess their attitudes and perceptions regarding antimicrobial resistance and antimicrobial use. Information about 29/39 contacted PICUs was obtained. A total of 114/206 (55.3%) paediatric intensivists responded. PICUs were heterogeneous regarding years since foundation, number of beds, type of patients admitted and staffing. Only 11 (37.9%) PICUs had available e-prescribing systems. Procalcitonin was available in 24 (89.1%) PICUs, but there were no procalcitonin-based protocols in 14 (60.9%) of them. Half of surveyed PICUs had implemented antimicrobial stewardship activities. Ninety-eight of the 114 PICU physicians (86%) who participated considered that antimicrobial resistance was a significantly relevant problem for their daily and that improving antimicrobial use in their PICU should be a priority (103; 90.4%). The main perceived problems regarding antimicrobial use were the excessive use of antimicrobials in patients with nonconfirmed infections and excessive use of broad-spectrum antimicrobials. The most valued antimicrobial stewardship interventions were the implementation of protocols to guide antimicrobial therapy. Spanish PICU doctors are aware of the relevance of the problem of antimicrobial resistance and the need to improve antimicrobial use. Targeted interventions should take into account their difficulties and preferences when feasible.
Division of Infectious Diseases, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain; Instituto de Investigación Sanitaria (IIS) de Aragón, Aragón, Spain.
J R
JR
Paño-Pardo
Paediatric Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain. Electronic address: cschuffelmann@yahoo.es.
C
C
Schüffelmann-Gutiérrez
Paediatric Tropical and Infectious Diseases, Department of Paediatrics, Hospital Universitario La Paz, Madrid, Spain.
L
L
Escosa-García
Paediatric Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain.
M
M
Laplaza-González
Pharmacy Department, Hospital Universitario La Paz, Madrid, Spain.
F
F
Moreno-Ramos
Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain.
R
R
Gómez-Gil
Paediatric Intensive Care Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
J D
JD
López
Paediatric Intensive Care Unit, Hospital Sant Joan de Deu, Barcelona, Spain.
I
I
Jordán
Paediatric Intensive Care Unit, Hospital Virgen de la Arrixaca, Murcia, Spain.
C
C
Téllez
Paediatric Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain; Department of Paediatrics, Medical School, Universidad Autónoma, Madrid, Spain.
P
P
de la Oliva
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D002648:Child; D024881:Drug Resistance, Bacterial; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D010818:Practice Patterns, Physicians'; D013030:Spain
D000890:Anti-Infective Agents
Antimicrobial stewardship; multidrug resistant bacteria; paediatric infectious diseases; paediatric intensive care; survey