7 research outputs found
Thyreoideastimulerende antistoffer hos gravide med Graves´sygdom og neonatal tyreotoksikose
Surveillance of extreme hyperbilirubinaemia in Denmark. A method to identify the newborn infants
The worldwide antibiotic resistance and prescribing in european children (ARPEC) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children
Objectives: Previously, web-based tools for cross-sectional antimicrobial point prevalence surveys (PPSs) have been used in adults to develop indicators of quality improvement. We aimed to determine the feasibility of developing similar quality indicators of improved antimicrobial prescribing focusing specifically on hospitalized neonates and children worldwide. Methods: A standardized antimicrobial PPS method was employed. Included were all inpatient children and neonates receiving an antimicrobial at 8:00 am on the day of the PPS. Denominators included the total number of inpatients. A web-based application was used for data entry, validation and reporting. We analysed 2012 data from 226 hospitals (H) in 41 countries (C) from Europe (174H; 24C), Africa (6H; 4C), Asia (25H; 8C), Australia (6H), Latin America (11H; 3C) and North America (4H). Results: Of 17 693 admissions, 6499 (36.7%) inpatients received at least one antimicrobial, but this varied considerably between wards and regions. Potential indicators included very high broad-spectrum antibiotic prescribing in children of mainly ceftriaxone (ranked first in Eastern Europe, 31.3%; Asia, 13.0%; Southern Europe, 9.8%), cefepime (ranked third in North America, 7.8%) and meropenem (ranked first in Latin America, 13.1%). The survey identified worryingly high use of critically important antibiotics for hospital-acquired infections in neonates (34.9%; range from 14.2% in Africa to 68.0% in Latin America) compared with children (28.3%; range from 14.5% in Africa to 48.9% in Latin America). Parenteral administration was very common among children in Asia (88%), Latin America (81%) and Europe (67%). Documentation of the reasons for antibiotic prescribing was lowest in Latin America (52%). Prolonged surgical prophylaxis rates ranged from 78% (Europe) to 84% (Latin America). Conclusions: Simple web-based PPS tools provide a feasible method to identify areas for improvement of antibiotic use, to set benchmarks and to monitor future interventions in hospitalized neonates and children. To our knowledge, this study has derived the first global quality indicators for antibiotic use in hospitalized neonates and children
High Rates of Prescribing Antimicrobials for Prophylaxis in Children and Neonates: Results From the Antibiotic Resistance and Prescribing in European Children Point Prevalence Survey
Background. This study was conducted to assess the variation in
prescription practices for systemic antimicrobial agents used for
prophylaxis among pediatric patients hospitalized in 41 countries
worldwide.
Methods. Using the standardized Antibiotic Resistance and Prescribing in
European Children Point Prevalence Survey protocol, a cross-sectional
point-prevalence survey was conducted at 226 pediatric hospitals in 41
countries from October 1 to November 30, 2012.
Results. Overall, 17 693 pediatric patients were surveyed and 36.7% of
them received antibiotics (n = 6499). Of 6818 inpatient children, 2242
(32.9%) received at least 1 antimicrobial for prophylactic use. Of 11
899 prescriptions for antimicrobials, 3400 (28.6%) were provided for
prophylactic use. Prophylaxis for medical diseases was the indication in
73.4% of cases (2495 of 3400), whereas 26.6% of prescriptions were for
surgical diseases (905 of 3400). In approximately half the cases (48.7%
[1656 of 3400]), a combination of 2 or more antimicrobials was
prescribed. The use of broad-spectrum antibiotics (BSAs), which included
tetracyclines, macrolides, lincosamides, and sulfonamides/trimethoprim,
was high (51.8% [1761 of 3400]). Broad-spectrum antibiotic use for
medical prophylaxis was more common in Asia (risk ratio [RR], 1.322;
95% confidence interval [CI], 1.202-1.653) and more restricted in
Australia (RR, 0.619; 95% CI, 0.521-0.736). Prescription of BSA for
surgical prophylaxis also varied according to United Nations region.
Finally, a high percentage of surgical patients (79.7% [721 of 905])
received their prophylaxis for longer than 1 day.
Conclusions. A high proportion of hospitalized children received
prophylactic BSAs. This represents a clear target for quality
improvement. Collectively speaking, it is critical to reduce total
prophylactic prescribing, BSA use, and prolonged prescription