title: Identifying priorities to improve paediatric in-hospital antimicrobial use by cross-sectional evaluation of prevalence and appropriateness of prescription.
abstract: BACKGROUND
  Information about paediatric in-hospital antimicrobial usage and prescribing patterns to guide improvement strategies is scant. We aim to use an evaluation of the prevalence and appropriateness of antimicrobial prescription to identify antimicrobial stewardship priorities in children.
  
  
  METHODS
  A cross-sectional point study was performed on hospitalised paediatric patients in a Spanish tertiary hospital, assessing the prevalence of antimicrobial prescription (PAP) and appropriateness of antimicrobial prescription (AAP). AAP was defined as a correct indication plus an appropriate prescribing pattern (dose, spectrum and interval). Evaluation was performed using established antimicrobial guidelines. Other factors that may have a bearing on antimicrobial prescription were also analysed.
  
  
  RESULTS
  A total of 171 patients were included. PAP was 49.7% (85/171) and AAP was 60.9% (91/161). The most common indications for antimicrobial use were antimicrobial prophylaxis (28.3%, 32/113) and pneumonia (8.2%, 8/113). Overall, 161 antimicrobials were prescribed (1.9 antimicrobials per patient): 55.3% (89/161) were empiric, 16.1% (26/161) were targeted and 28.6% (46/161) were prophylactic. Amoxicillin/clavulanate (8.2%, 14/171) and sulfamethoxazole/trimethoprim (8.2%, 14/171) were the most prescribed antimicrobials. The prescription of antifungals (11.7%, 20/171) and antivirals (1.8%, 3/171) was analysed. Major causes of inappropriate antibiotic use were prolonged prescriptions (21.7%, 35/161) and use of agents with an excessively broad coverage spectrum (21.1%, 34/161). PAP and AAP varied between wards and antimicrobials.
  
  
  CONCLUSIONS
  Measurement of PAP and AAP offers valuable information for detecting priorities in hospital settings and monitoring antimicrobial usage prior to the development of antimicrobial stewardship programmes. In our setting, the main areas for improvement are duration of therapy and proper use of broad-spectrum antimicrobials.
authors.affiliation: Departamento de Enfermedades Infecciosas Pediátricas, Hospital Universitario La Paz, Madrid, Spain. Electronic address: alfgova@gmail.com.
authors.forename: Walter Alfredo
authors.initials: WA
authors.lastname: Goycochea-Valdivia
authors.affiliation: Departamento de Farmacia, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Moreno-Ramos
authors.affiliation: Departamento de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario La Paz, Madrid, Spain; División de Enfermedades Infecciosas, Hospital Clínico Universitario "Lozano Blesa"-IIS Aragón, Zaragoza, Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Paño-Pardo
authors.affiliation: Departamento de Enfermedades Infecciosas Pediátricas, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Aracil-Santos
authors.affiliation: Departamento de Enfermedades Infecciosas Pediátricas, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Baquero-Artigao
authors.affiliation: Departamento de Enfermedades Infecciosas Pediátricas, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Del Rosal-Rabes
authors.affiliation: Departamento de Enfermedades Infecciosas Pediátricas, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Mellado-Peña
authors.affiliation: Departamento de Enfermedades Infecciosas Pediátricas, Hospital Universitario La Paz, Madrid, Spain; Coordinador por Pediatría del Programa para la Optimización del Uso de Antibióticos de la Unidad Pediátrica de Cuidados Intensivos, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Escosa-García
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000073602:Antimicrobial Stewardship / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000592:standards*; D006292:Health Priorities; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007239:Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prescription; Antibiotic usage; Antimicrobial management; Hospital; Manejo de antimicrobianos; Paediatrics; Pediatría; Prescripción antibiótica; Uso de antibióticos