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1. The worldwide Antibiotic Resistance and Prescribing in European Children (ARPEC) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children

Author

Versporten A1, Bielicki J2, Drapier N1, Sharland M2, Goossens H3, ARPEC project group. Calle GM, Garrahan JP, Clark J, Cooper C, Blyth CC, Francis JR, Alsalman J, Jansens H, Mahieu L, Van Rossom P, Vandewal W, Lepage P, Blumental S, Briquet C, Robbrecht D, Maton P, Gabriels P, Rubic Z, Kovacevic T, Nielsen JP, Petersen JR, Poorisrisak P, Jensen LH, Laan M, Tamm E, Matsinen M, Rummukainen ML, Gajdos V, Olivier R, Le Maréchal F, Martinot A, Dubos F, Lagrée M, Prot-Labarthe S, Lorrot M, Orbach D, Pagava K, Hufnagel M, Knuf M, Schlag SA, Liese J, Renner L, Enimil A, Awunyo M, Syridou G, Spyridis N, Critselis E, Kouni S, Mougkou K, Ladomenou F, Gkentzi D, Iosifidis E, Roilides E, Sahu S, Murki S, Malviya M, Kalavalapalli DB, Singh S, Singhal T, Garg G, Garg P, Kler N, Soltani J, Jafarpour Z, Pouladfar G, Nicolini G, Montagnani C, Galli L, Esposito S, Tenconi R, Lo Vecchio A, Dona' D, Giaquinto C, Borgia E, D'Argenio P, De Luca M, Centenari C, Raka L, Raka D, Omar A, Al-Mousa H, Mozgis D, Sviestina I, Burokiene S, Usonis V, Tavchioska G, Hargadon-Lowe A, Zarb P, Borg MA, González Lozano CA, Zárate Castañon P, Cancino ME, McCullagh B, McCorry A, Gormley C, Al Maskari Z, Al-Jardani A, Pluta M, Rodrigues F, Brett A, Esteves I, Marques L, Ali AlAjmi J, Claudia Cambrea S, Rashed AN, Mubarak Al Azmi AA, Chan SM, Isa MS, Najdenov P, Čižman M, Unuk S, Finlayson H, Dramowski A, Maté-Cano I, Soto B, Calvo C, Santiago B, Saavedra-Lozano J, Bustinza A, Escosa-García L, Ureta N, Lopez-Varela E, Rojo P, Tagarro A, Barrero PT, Rincon-Lopez EM, Abubakar I, Aston J, Heginbothom M, Satodia P, Garbash M, Johnson A, Sharpe D, Barton C, Menson E, Arenas-Lopez S, Luck S, Doerholt K, McMaster P, Caldwell NA, Lunn A, Drysdale SB, Howe R, Scorrer T, Gahleitner F, Gupta R, Nash C, Alexander J, Raman M, Bell E, Rajagopal V, Kohlhoff S, Cox E, Zaoutis T., Mahieu, Ludo, ARPEC Project Grp, ARPEC project group, Versporten, A1, Bielicki, J2, Drapier, N1, Sharland, M2, Goossens, H3, ARPEC project group., Calle GM, Garrahan, Jp, Clark, J, Cooper, C, Blyth, Cc, Francis, Jr, Alsalman, J, Jansens, H, Mahieu, L, Van Rossom, P, Vandewal, W, Lepage, P, Blumental, S, Briquet, C, Robbrecht, D, Maton, P, Gabriels, P, Rubic, Z, Kovacevic, T, Nielsen, Jp, Petersen, Jr, Poorisrisak, P, Jensen, Lh, Laan, M, Tamm, E, Matsinen, M, Rummukainen, Ml, Gajdos, V, Olivier, R, Le Maréchal, F, Martinot, A, Dubos, F, Lagrée, M, Prot-Labarthe, S, Lorrot, M, Orbach, D, Pagava, K, Hufnagel, M, Knuf, M, Schlag, Sa, Liese, J, Renner, L, Enimil, A, Awunyo, M, Syridou, G, Spyridis, N, Critselis, E, Kouni, S, Mougkou, K, Ladomenou, F, Gkentzi, D, Iosifidis, E, Roilides, E, Sahu, S, Murki, S, Malviya, M, Kalavalapalli, Db, Singh, S, Singhal, T, Garg, G, Garg, P, Kler, N, Soltani, J, Jafarpour, Z, Pouladfar, G, Nicolini, G, Montagnani, C, Galli, L, Esposito, S, Tenconi, R, Lo Vecchio, A, Dona', D, Giaquinto, C, Borgia, E, D'Argenio, P, De Luca, M, Centenari, C, Raka, L, Raka, D, Omar, A, Al-Mousa, H, Mozgis, D, Sviestina, I, Burokiene, S, Usonis, V, Tavchioska, G, Hargadon-Lowe, A, Zarb, P, Borg, Ma, González Lozano, Ca, Zárate Castañon, P, Cancino, Me, Mccullagh, B, Mccorry, A, Gormley, C, Al Maskari, Z, Al-Jardani, A, Pluta, M, Rodrigues, F, Brett, A, Esteves, I, Marques, L, Ali AlAjmi, J, Claudia Cambrea, S, Rashed, An, Mubarak Al Azmi, Aa, Chan, Sm, Isa, M, Najdenov, P, Čižman, M, Unuk, S, Finlayson, H, Dramowski, A, Maté-Cano, I, Soto, B, Calvo, C, Santiago, B, Saavedra-Lozano, J, Bustinza, A, Escosa-García, L, Ureta, N, Lopez-Varela, E, Rojo, P, Tagarro, A, Barrero, Pt, Rincon-Lopez, Em, Abubakar, I, Aston, J, Heginbothom, M, Satodia, P, Garbash, M, Johnson, A, Sharpe, D, Barton, C, Menson, E, Arenas-Lopez, S, Luck, S, Doerholt, K, Mcmaster, P, Caldwell, Na, Lunn, A, Drysdale, Sb, Howe, R, Scorrer, T, Gahleitner, F, Gupta, R, Nash, C, Alexander, J, Raman, M, Bell, E, Rajagopal, V, Kohlhoff, S, Cox, E, and Zaoutis, T.

Subjects
0301 basic medicine, Male, Pediatrics, Latin Americans, Cross-sectional study, Prevalence, Psychological intervention, Drug resistance, Global Health, infectious diseases, 0302 clinical medicine, Global health, Medicine, 030212 general & internal medicine, Child, antibiotics, children, Drugs -- Prescribing, Pharmacology. Therapy, Hospitals -- Europe, Drug Resistance, Microbial, Hospitals, Anti-Bacterial Agents, Europe, Child, Preschool, Anti-infective agents, Female, medicine.drug, Microbiology (medical), medicine.medical_specialty, Cefepime, 030106 microbiology, Drug Prescriptions, 03 medical and health sciences, Surgical prophylaxis, pharmacology, pharmacology (medical), Environmental health, Humans, Biology, Quality Indicators, Health Care, business.industry, Health status indicators -- Europe, Infant, Drug Utilization, Cross-Sectional Studies, Health Care Surveys, Human medicine, business
Abstract

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 17693 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., peer-reviewed

Published
2018

2. The antibiotic resistance and prescribing in European Children project: a neonatal and pediatric antimicrobial web-based point prevalence survey in 73 hospitals worldwide

Author

Versporten, A, Sharland, M, Bielicki, J, Drapier, N, Vankerckhoven, V, Goossens, H, ARPEC Project Group Members, Cooper, C, Lee, Ly, Whitehouse, J, Bryant, Pa, Haeusler, G, Curtis, N, Starr, M, Vergison, A, Léon, V, Delestrait, M, Huza, C, Lepage, P, Mahieu, L, Boiy, T, Jansens, H, Van der Linden, D, Briquet, C, Allegaert, K, Smits, A, Lutsar, I, Tamm, E, Larionova, A, Orbach, D, Lorrot, M, Angoulvant, F, Doit, C, Prot-Labarthe, S, Dubos, F, Lagree, M, Biscardi, S, Decobert, F, Hau, I, Madhi, F, Durrmeyer, X, Bojang, K, Abubakr, I, Okomo, U, Awe, R, Anderson, S, Akwara, I, Ideh, Rc, Pagava, K, Hufnagel, M, Schuster, K, Henneke, P, Enimil, A, Osei-Akoto, A, Nguah, Sb, Ansong, D, Iosifidis, E, Roilides, E, Spyridis, N, Syridou, G, Soltani, J, Soleimani, N, Nahedi, S, Khosravi, F, Pouladfar, G, Jafarpour, Z, Giacquinto, C, Longo, G, Donà, D, Mion, T, D'Argenio, P, Ciofi Degli Atti ML, De Luca, M, Ciliento, G, Esposito, S, Danieli, E, Montinaro, V, Tenconi, R, Centenari, C, Nicolini, G, Mozgis, D, Sviestina, I, Pavare, J, Rasnaca, K, Gardovska, D, Grope, I, Usonis, V, Gurksniene, V, Eidukaite, A, Biver, A, Bennett, A, O'Hare, B, Kennedy, N, Brett, A, Rodrigues, F, Esteves, I, Cambrea, Sc, Craiu, M, Tomescu, E, Al Shehri MA, Al Shahrani, D, Cizman, M, Babnik, J, Kenda, R, Vidmar, I, Finlayson, H, Rabie, H, Cotton, M, Dramowski, A, Rodrigo, C, Mendez, M, Rojo, P, López-Varela, E, Ureta, N, Mosqueda, R, Pérez-López, A, Orta, L, Santos, M, Navarro, M, Santiago, B, Hernández-Sampelayo, T, Saavedra, J, Bustinza, A, Gil, J, Valls, A, Santesteban, E, Baumann, P, Berger, C, Gifford, A, Menson, E, Botgros, A, Arenas-Lopez, S, Wade, P, Doerholt, K, Drysdale, Sb, Mcelnay, Jc, Kearney, Mp, Scott, Mg, Magee, Fa, Aldeyab, M, Heginbothom, M, Newland, Jg, Hedican, Eb, Shah, H, Stach, L, and Yu, D

Subjects
Microbiology (medical), Pediatrics, medicine.medical_specialty, medicine.drug_class, Antibiotics, MEDLINE, Drug resistance, Drug Prescriptions, point prevalence survey, antibiotic use, Antibiotic resistance, Intensive care, Drug Resistance, Bacterial, Medicine, Humans, Child, Electronic Data Processing, Internet, business.industry, Health services research, Antimicrobial, antimicrobial use, Confidence interval, Drug Utilization, Hospitals, Anti-Bacterial Agents, Europe, Infectious Diseases, Pediatrics, Perinatology and Child Health, surveillance, hospitalized children, Health Services Research, business, Public Health Administration
Abstract

Background The neonatal and pediatric antimicrobial point prevalence survey (PPS) of the Antibiotic Resistance and Prescribing in European Children project (http://www.arpecproject.eu/) aims to standardize a method for surveillance of antimicrobial use in children and neonates admitted to the hospital within Europe. This article describes the audit criteria used and reports overall country-specific proportions of antimicrobial use. An analytical review presents methodologies on antimicrobial use. Methods A 1-day PPS on antimicrobial use in hospitalized children was organized in September 2011, using a previously validated and standardized method. The survey included all inpatient pediatric and neonatal beds and identified all children receiving an antimicrobial treatment on the day of survey. Mandatory data were age, gender, (birth) weight, underlying diagnosis, antimicrobial agent, dose and indication for treatment. Data were entered through a web-based system for data-entry and reporting, based on the WebPPS program developed for the European Surveillance of Antimicrobial Consumption project. Results There were 2760 and 1565 pediatric versus 1154 and 589 neonatal inpatients reported among 50 European (n = 14 countries) and 23 non-European hospitals (n = 9 countries), respectively. Overall, antibiotic pediatric and neonatal use was significantly higher in non-European (43.8%; 95% confidence interval [CI]: 41.3-46.3% and 39.4%; 95% CI: 35.5-43.4%) compared with that in European hospitals (35.4; 95% CI: 33.6-37.2% and 21.8%; 95% CI: 19.4-24.2%). Proportions of antibiotic use were highest in hematology/oncology wards (61.3%; 95% CI: 56.2-66.4%) and pediatric intensive care units (55.8%; 95% CI: 50.3-61.3%). Conclusions An Antibiotic Resistance and Prescribing in European Children standardized web-based method for a 1-day PPS was successfully developed and conducted in 73 hospitals worldwide. It offers a simple, feasible and sustainable way of data collection that can be used globally.

Published
2013

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