Summary
The United Nations and the World Health Organization have designated antimicrobial
resistance (AMR) as a major health priority and developed action plans to reduce AMR
in all healthcare settings. Establishment of institutional antimicrobial stewardship
programmes (ASPs) is advocated as a key intervention to reduce antibiotic consumption
in hospitals and address high rates of multi-drug-resistant (MDR) bacteria. PUBMED
and the Cochrane Database of Systematic Reviews (January 2007–March 2017) were searched
to identify studies reporting the effectiveness of ASPs in general paediatric wards
and paediatric intensive care units (PICUs) for reducing antibiotic consumption, use
of broad-spectrum/restricted antibiotics, and antibiotic resistance and healthcare-associated
infections (HAIs). Neonatal units and antifungal agents were excluded. Of 2509 titles
and abstracts, nine articles were eligible for inclusion in the final analysis. All
studies reported a reduction in the use of broad-spectrum/restricted antibiotics or
antibiotic consumption. One study reported a reduction in HAIs in a PICU, and another
study evaluated bacterial resistance, showing no effect following ASP implementation.
Prospective audit on antibiotic use was the most common ASP core component (eight
of nine studies). Antibiotic pre-authorization was described in two studies. Other
described interventions were the provision of guidelines or written information (five
of nine studies), and training of healthcare professionals (one study). There is limited
evidence for a reduction in antibiotic consumption and use of broad-spectrum/restricted
agents following ASP implementation specifically in PICUs. Data evaluating the impact
of ASPs on HAIs and AMR in PICUs are lacking. In addition, there is limited information
on effective components of a successful ASP in PICUs.
Keywords
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Article info
Publication history
Published online: August 11, 2017
Accepted:
August 4,
2017
Received:
June 14,
2017
Identification
Copyright
© 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
