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Influencing the use of antibiotics in a Chinese pediatric intensive care unit

Pharmacy World & Science volume 30, pages 787–793 (2008)Cite this article

Abstract

Objectives To demonstrate the effectiveness of an intervention in antibiotics prescribing, and evaluate the use of antibiotics in the pediatric intensive care unit (PICU) at the Beijing Children’s Hospital. Methods Our interventions included (1) educating the pediatricians on antibiotics prescribing, (2) applying an antimicrobial spectrum chart, and (3) controlling the prescription of specific antibiotics with the use of a guideline. Nine hundred clinical records, including clinical information and antibiotic usage data, were selected retrospectatively from the PICU admissions during the pre- and post-intervention periods. Results In this 5-year survey, the mean rate of antibiotic prescribing was greater than 95% in the PICU. More than 76% of the prescriptions were started empirically. The most frequently used antibiotics were third-generation cephalosporins. After the intervention, we found a reduction in the rate of antibiotic cost/patient/day (P < 0.05); a decrease in the prescription rate of third-generation cephalosporins and macrolides (P < 0.01); an increase in the prescription rate of β-lactam/β-lactamase inhibitors and second-generation cephalosporins (P < 0.01); a reduction in the empiric treatment (P < 0.01); and a significant reduction in the incidence rates of bacterial resistance for imipenem-, cefepime-, and ceftazidime-resistant Pseudomonas aeruginosa (P < 0.05), and cefepime-resistant Escherichia coli and Klebsiella pneumoniae (P < 0.01). Conclusion Our interventions led to a significant reduction of broad-spectrum antibiotic prescribing associated with the significant reduction in bacterial resistance in the PICU. The implementation of the antibiotics guideline appeared to be effective.

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References

  1. Foglia EE, Fraser VJ, Elward AM. Effect of nosocomial infections due to antibiotic-resistant organisms on length of stay and mortality in the pediatric intensive care unit. Infect Control Hosp Epidemiol. 2007;28(3):299–306.

    PubMed  Article  Google Scholar 

  2. Alberti C, Brun-Buisson C, Burchardi H, Martin C, Goodman S, Artigas A, et al. Epidemiology of sepsis and infection in ICU patients from an international multicentre cohort study. Intensive Care Med. 2002;28(2):108–21.

    PubMed  Article  Google Scholar 

  3. Resi D, Milandri M, Moro ML. Antibiotic prescriptions in children. J Antimicrob Chemother. 2003;52(2):282–6.

    PubMed  Article  CAS  Google Scholar 

  4. Apisarnthanarak A, Danchaivijitr S, Bailey TC, Fraser VJ. Inappropriate antibiotic use in a tertiary care center in Thailand: an incidence study and review of experience in Thailand. Infect Control Hosp Epidemiol. 2006;27(4):416–20.

    PubMed  Article  Google Scholar 

  5. Bantar C, Sartori B, Vesco E, Heft C, Saul M, Salamone F, et al. A hospitalwide intervention program to optimize the quality of antibiotic use: impact on prescribing practice, antibiotic consumption, cost savings, and bacterial resistance. Clin Infect Dis. 2003;37(2):180–6.

    PubMed  Article  Google Scholar 

  6. Katragkou A, Kotsiou M, Antachopoulos C, Benos A, Sofianou D, Tamiolaki M, et al. Acquisition of imipenem-resistant Acinetobacter baumannii in a pediatric intensive care unit: a case-control study. Intensive Care Med. 2006;32(9):1384–91.

    PubMed  Article  Google Scholar 

  7. Makedou KG, Tsiakiri EP, Bisiklis AG, Chatzidimitriou M, Halvantzis AA, Ntoutsou K, et al. Changes in antibiotic resistance of the most common Gram-negative bacteria isolated in intensive care units. J Hosp Infect. 2005;60(3):245–8.

    PubMed  Article  CAS  Google Scholar 

  8. Kollef MH. Is there a role for antibiotic cycling in the intensive care unit? Crit Care Med. 2001;29(4 Suppl):N135–42.

    PubMed  Article  CAS  Google Scholar 

  9. Niederman MS. Impact of antibiotic resistance on clinical outcomes and the cost of care. Crit Care Med. 2001;29(4 Suppl):N114–20.

    PubMed  Article  CAS  Google Scholar 

  10. Armenian SH, Singh J, Arrieta AC. Risk factors for mortality resulting from bloodstream infections in a pediatric intensive care unit. Pediatr Infect Dis J. 2005;24(4):309–14.

    PubMed  Article  Google Scholar 

  11. Zhou Hong LF. Analysis of usage of antibiotics and bacterial drug resistance in infected infants of pediatrics in Changchun (in Chinese). J Appl Clin Pediatr. 2006;21:1528–30.

    Google Scholar 

  12. Hu S, Liu X, Peng Y. Assessment of antibiotic prescription in hospitalised patients at a Chinese university hospital. J Infect. 2003;46(3):161–3.

    PubMed  Article  Google Scholar 

  13. Ministry of Public Health. Guidelines to use of antibiotics in clinic (in Chinese). Natl Med J China. 2004;84(23):2026–56.

    Google Scholar 

  14. Grohskopf LA, Huskins WC, Sinkowitz-Cochran RL, Levine GL, Goldmann DA, Jarvis WR. Use of antimicrobial agents in United States neonatal and pediatric intensive care patients. Pediatr Infect Dis J. 2005;24(9):766–73.

    PubMed  Article  Google Scholar 

  15. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128–40.

    PubMed  Article  CAS  Google Scholar 

  16. Tunger O, Dinc G, Ozbakkaloglu B, Atman UC, Algun U. Evaluation of rational antibiotic use. Int J Antimicrob Agents. 2000;15(2):131–5.

    PubMed  Article  CAS  Google Scholar 

  17. Dos Santos EF, Silva AE, Pinhati HM, Maia Mde O. Effectiveness of the actions of antimicrobial control in the intensive care unit. Braz J Infect Dis. 2003;7(5):290–6.

    PubMed  Google Scholar 

  18. Razon Y, Ashkenazi S, Cohen A, Hering E, Amzel S, Babilsky H, et al. Effect of educational intervention on antibiotic prescription practices for upper respiratory infections in children: a multicentre study. J Antimicrob Chemother. 2005;56(5):937–40.

    PubMed  Article  CAS  Google Scholar 

  19. Kolar M, Urbanek K, Latal T. Antibiotic selective pressure and development of bacterial resistance. Int J Antimicrob Agents. 2001;17(5):357–63.

    PubMed  Article  CAS  Google Scholar 

  20. Raymond DP, Pelletier SJ, Crabtree TD, Gleason TG, Hamm LL, Pruett TL, et al. Impact of a rotating empiric antibiotic schedule on infectious mortality in an intensive care unit. Crit Care Med. 2001;29(6):1101–8.

    PubMed  Article  CAS  Google Scholar 

  21. Sandiumenge A, Diaz E, Rodriguez A, Vidaur L, Canadell L, Olona M, et al. Impact of diversity of antibiotic use on the development of antimicrobial resistance. J Antimicrob Chemother. 2006;57(6):1197–204.

    PubMed  Article  CAS  Google Scholar 

  22. Chait R, Craney A, Kishony R. Antibiotic interactions that select against resistance. Nature 2007;446(7136):668–71.

    PubMed  Article  CAS  Google Scholar 

  23. Monnet DL, Molstad S, Cars O. Defined daily doses of antimicrobials reflect antimicrobial prescriptions in ambulatory care. J Antimicrob Chemother. 2004;53(6):1109–11.

    PubMed  Article  CAS  Google Scholar 

  24. Erbay A, Bodur H, Akinci E, Colpan A. Evaluation of antibiotic use in intensive care units of a tertiary care hospital in Turkey. J Hosp Infect. 2005;59(1):53–61.

    PubMed  Article  CAS  Google Scholar 

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Acknowledgements

This study was supported by a grant from the Ministry of Science and Technology of China (No. 2004BA720A09-01). We would like to thank all the participating pediatricians for their support.

Funding

MW was funded by a grant from Ministry of Science and Technology of China (No. 2004BA720A09-01).

Conflicts of interest

None.

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Affiliations

  1. Beijing Children’s Hospital, Capital Medical University, 56 South Lishi Road, Beijing, 100045, People’s Republic of China

    Hui Ding, Yonghong Yang, Jinghai Wei, Shaozhen Fan, Sangjie Yu, Kaihu Yao, Aihua Wang & Xuzhuang Shen

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  1. Hui Ding
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  2. Yonghong Yang
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  3. Jinghai Wei
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  4. Shaozhen Fan
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  7. Aihua Wang
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  8. Xuzhuang Shen
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Correspondence to Xuzhuang Shen.

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Ding, H., Yang, Y., Wei, J. et al. Influencing the use of antibiotics in a Chinese pediatric intensive care unit. Pharm World Sci 30, 787–793 (2008). https://doi.org/10.1007/s11096-008-9220-9

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  • DOI: https://doi.org/10.1007/s11096-008-9220-9

Keywords

  • Antibiotic use
  • China
  • Intervention study
  • Pediatric intensive care unit (PICU)
  • Prescribing