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Intensive Care Medicine

, Volume 26, Issue 7, pp 959–966 | Cite as

Use of antibiotics in pediatric intensive care and potential savings

  • J. E. Fischer
  • M. Ramser
  • S. Fanconi
NEONATAL AND PEDIATRIC INTENSIVE CARE

Abstract

Objective: Minimizing unwarranted prescription of antibiotics remains an important objective. Because of the heterogeneity between units regarding patient mix and other characteristics, site-specific targets for reduction must be identified. Here we present a model to address the issue by means of an observational cohort study.¶Setting: A tertiary, multidisciplinary, neonatal, and pediatric intensive care unit of a university teaching hospital.¶Patients: All newborns and children present in the unit (n = 456) between September 1998 and March 1999. Reasons for admission included postoperative care after cardiac surgery, major neonatal or pediatric surgery, severe trauma, and medical conditions requiring critical care.¶Methods: Daily recording of antibiotics given and of indications for initiation. After discontinuation, each treatment episode was assessed as to the presence or absence of infection.¶Results: Of the 456 patients 258 (56.6 %) received systemic antibiotics, amounting to 1815 exposure days (54.6 %) during 3322 hospitalization days. Of these, 512 (28 %) were prescribed as prophylaxis and 1303 for suspected infection. Treatment for suspected ventilator-associated pneumonia accounted for 616 (47 %) of 1303 treatment days and suspected sepsis for 255 days (20 %). Patients were classified as having no infection or viral infection during 552 (40 %) treatment days. The average weekly exposure rate in the unit varied considerably during the 29-week study period (range: 40–77/100 hospitalization days). Patient characteristics did not explain this variation.¶Conclusion: In this unit the largest reduction in antibiotic treatment would result from measures assisting suspected ventilator-associated pneumonia to be ruled out and from curtailing extended prophylaxis.

Key words Antibiotics Utilisation Pediatric intensive care Ventilator-associated pneumonia 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2000

Authors and Affiliations

  • J. E. Fischer
    • 1
  • M. Ramser
    • 1
  • S. Fanconi
    • 1
  1. 1.Department of Neonatology and Pediatric Intensive Care, University Children's Hospital, Steinweisstrasse 75, 8032 Zurich, Switzerland e-mail: joachim.fischer@kispi.unizh.ch Tel.: + 41-1-6 32 58 53 Fax: + 41-1-2 66 71 71CH

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