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Intensive Care Med. 2000 Jul;26(7):959-66.

Use of antibiotics in pediatric intensive care and potential savings.

Author information

1
Department of Neonatology and Pediatric Intensive Care, University Children's Hospital, Zurich, Switzerland. joachim.fischer@kispi.unizh.ch

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.

PMID:
10990113
[Indexed for MEDLINE]

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