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J Antimicrob Chemother. 2019 Nov 7. pii: dkz474. doi: 10.1093/jac/dkz474. [Epub ahead of print]

Antibiotic appropriateness and guideline adherence in hospitalized children: results of a nationwide study.

McMullan BJ1,2,3, Hall L4, James R5, Mostaghim M6, Jones CA7,8,9, Konecny P10,11, Blyth CC7,8,9,12,13,14,15, Thursky KA5,16.

Author information

1
National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia.
2
Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia.
3
School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
4
School of Public Health, University of Queensland, Brisbane, Australia.
5
National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
6
Department of Pharmacy, Sydney Children's Hospital, Randwick, Sydney, Australia.
7
Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
8
Murdoch Children's Research Institute, Melbourne, Australia.
9
Department of Paediatrics, University of Melbourne, Melbourne, Australia.
10
Department of Infectious Diseases, Immunology & Sexual Health, St George Hospital, Kogarah, Sydney, Australia.
11
St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia.
12
School of Medicine, University of Western Australia, Perth, Australia.
13
Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.
14
Department of Paediatric Infectious Diseases, Perth Children's Hospital, Perth, Australia.
15
Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Australia.
16
Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.

Abstract

BACKGROUND:

Information on the nature and appropriateness of antibiotic prescribing for children in hospitals is important, but scarce.

OBJECTIVES:

To analyse antimicrobial prescribing and appropriateness, and guideline adherence, in hospitalized children across Australia.

PATIENTS AND METHODS:

We analysed data from the National Antimicrobial Prescribing Survey (NAPS) from 2014 to 2017. Surveys were performed in hospital facilities of all types (public and private; major city, regional and remote). Participants were admitted children <18 years old. Risk factors associated with inappropriate prescribing were explored using logistic regression models.

RESULTS:

Among 6219 prescriptions for 3715 children in 253 facilities, 19.6% of prescriptions were deemed inappropriate. Risk factors for inappropriate prescribing included non-tertiary paediatric hospital admission [OR 1.37 (95% CI 1.20-1.55)] and non-major city hospital location [OR 1.52 (95% CI 1.30-1.77)]. Prescriptions for neonates, immunocompromised children and those admitted to an ICU were less frequently inappropriate. If a restricted antimicrobial was prescribed and not approved, the prescription was more likely to be inappropriate [OR 12.9 (95% CI 8.4-19.8)]. Surgical prophylaxis was inappropriate in 59% of prescriptions.

CONCLUSIONS:

Inappropriate antimicrobial prescribing in children was linked to specific risk factors identified here, presenting opportunities for targeted interventions to improve prescribing. This information, using a NAPS dataset, allows for analysis of antimicrobial prescribing among different groups of hospitalized children. Further exploration of barriers to appropriate prescribing and facilitators of best practice in this population is recommended.

PMID:
31697335
DOI:
10.1093/jac/dkz474

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