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Abstract：
BACKGROUND: We aimed to analyze the effects of an antimicrobial stewardship program (ASP) on the proportion of antimicrobial-resistant pathogens in bacteremia, antimicrobial use, and mortality in pediatric patients.
METHODS: A retrospective single-center study was performed on pediatric inpatients under 19 years old who received systemic antimicrobial treatment from 2001 to 2019. A pediatric infectious disease attending physician started ASP in January 2008. The study period was divided into the pre-intervention (2001-2008) and the post-intervention (2009-2019) periods. The amount of antimicrobial use was defined as days of therapy per 1,000 patient-days, and the differences were compared using delta slope (= changes in slopes) between the two study periods by an interrupted time-series analysis. The proportion of resistant pathogens and the 30-day overall mortality rate were analyzed by the χ².
RESULTS: The proportion of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia increased from 17% (39 of 235) in the pre-intervention period to 35% (189 of 533) in the post-intervention period (P < 0.001). The total amount of antimicrobial use significantly decreased after the introduction of ASP (delta slope value = -16.5; 95% confidence interval [CI], -30.6 to -2.3; P = 0.049). The 30-day overall mortality rate in patients with bacteremia did not increase, being 10% (55 of 564) in the pre-intervention and 10% (94 of 941) in the post-intervention period (P = 0.881).
CONCLUSIONS: The introduction of ASP for pediatric patients reduced the delta slope of the total antimicrobial use without increasing the mortality rate despite an increased incidence of ESBL-producing gram-negative bacteremia.
METHODS: A retrospective single-center study was performed on pediatric inpatients under 19 years old who received systemic antimicrobial treatment from 2001 to 2019. A pediatric infectious disease attending physician started ASP in January 2008. The study period was divided into the pre-intervention (2001-2008) and the post-intervention (2009-2019) periods. The amount of antimicrobial use was defined as days of therapy per 1,000 patient-days, and the differences were compared using delta slope (= changes in slopes) between the two study periods by an interrupted time-series analysis. The proportion of resistant pathogens and the 30-day overall mortality rate were analyzed by the χ².
RESULTS: The proportion of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia increased from 17% (39 of 235) in the pre-intervention period to 35% (189 of 533) in the post-intervention period (P < 0.001). The total amount of antimicrobial use significantly decreased after the introduction of ASP (delta slope value = -16.5; 95% confidence interval [CI], -30.6 to -2.3; P = 0.049). The 30-day overall mortality rate in patients with bacteremia did not increase, being 10% (55 of 564) in the pre-intervention and 10% (94 of 941) in the post-intervention period (P = 0.881).
CONCLUSIONS: The introduction of ASP for pediatric patients reduced the delta slope of the total antimicrobial use without increasing the mortality rate despite an increased incidence of ESBL-producing gram-negative bacteremia.
摘要：
背景：我们旨在分析抗菌药物管理计划（ASP）对菌血症中耐药病原体比例的影响，抗菌药物的使用，儿科患者的死亡率。
方法：对2001年至2019年接受全身抗菌治疗的19岁以下儿科住院患者进行了回顾性单中心研究。一位儿科传染病主治医师于2008年1月开始ASP。研究期间分为干预前（2001-2008年）和干预后（2009-2019年）。抗菌药物的使用量定义为每1000名患者的治疗天数，通过中断的时间序列分析，使用两个研究期之间的delta斜率（=斜率的变化）比较了差异。用χ²分析耐药病原体的比例和30天总死亡率。
结果：产超广谱β-内酰胺酶(ESBL)的大肠埃希菌和肺炎克雷伯菌菌血症的比例从干预前的17%(39/235)增加到干预后的35%(189/533)(P<0.001)。引入ASP后，抗菌药物的使用总量显着下降(δ斜率值=-16.5；95%置信区间[CI]，-30.6至-2.3；P=0.049）。菌血症患者的30天总死亡率没有增加，干预前为10%（564个中的55个），干预后为10%（941个中的94个）（P=0.881）。
结论：尽管产生ESBL的革兰氏阴性菌血症的发生率增加，但在儿科患者中引入ASP降低了总抗菌药物使用的δ斜率，而没有增加死亡率。
方法：对2001年至2019年接受全身抗菌治疗的19岁以下儿科住院患者进行了回顾性单中心研究。一位儿科传染病主治医师于2008年1月开始ASP。研究期间分为干预前（2001-2008年）和干预后（2009-2019年）。抗菌药物的使用量定义为每1000名患者的治疗天数，通过中断的时间序列分析，使用两个研究期之间的delta斜率（=斜率的变化）比较了差异。用χ²分析耐药病原体的比例和30天总死亡率。
结果：产超广谱β-内酰胺酶(ESBL)的大肠埃希菌和肺炎克雷伯菌菌血症的比例从干预前的17%(39/235)增加到干预后的35%(189/533)(P<0.001)。引入ASP后，抗菌药物的使用总量显着下降(δ斜率值=-16.5；95%置信区间[CI]，-30.6至-2.3；P=0.049）。菌血症患者的30天总死亡率没有增加，干预前为10%（564个中的55个），干预后为10%（941个中的94个）（P=0.881）。
结论：尽管产生ESBL的革兰氏阴性菌血症的发生率增加，但在儿科患者中引入ASP降低了总抗菌药物使用的δ斜率，而没有增加死亡率。
