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Abstract：
BACKGROUND: Bacterial infections (BIs) are widespread in ICUs. The aims of this study were to assess compliance with antibiotic recommendations and factors associated with non-compliance.
METHODS: We conducted an observational study in eight French Paediatric and Neonatal ICUs with an antimicrobial stewardship programme (ASP) organised once a week for the most part. All children receiving antibiotics for a suspected or proven BI were evaluated. Newborns < 72 h old, neonates < 37 weeks, age ≥ 18 years and children under surgical antimicrobial prophylaxis were excluded.
RESULTS: 139 suspected (or proven) BI episodes in 134 children were prospectively included during six separate time-periods over one year. The final diagnosis was 26.6% with no BI, 40.3% presumed (i.e., not documented) BI and 35.3% documented BI. Non-compliance with antibiotic recommendations occurred in 51.1%. The main reasons for non-compliance were inappropriate choice of antimicrobials (27.3%), duration of one or more antimicrobials (26.3%) and length of antibiotic therapy (18.0%). In multivariate analyses, the main independent risk factors for non-compliance were prescribing ≥ 2 antibiotics (OR 4.06, 95%CI 1.69-9.74, p = 0.0017), duration of broad-spectrum antibiotic therapy ≥ 4 days (OR 2.59, 95%CI 1.16-5.78, p = 0.0199), neurologic compromise at ICU admission (OR 3.41, 95%CI 1.04-11.20, p = 0.0431), suspected catheter-related bacteraemia (ORs 3.70 and 5.42, 95%CIs 1.32 to 15.07, p < 0.02), a BI site classified as \"other\" (ORs 3.29 and 15.88, 95%CIs 1.16 to 104.76, p < 0.03), sepsis with ≥ 2 organ dysfunctions (OR 4.21, 95%CI 1.42-12.55, p = 0.0098), late-onset ventilator-associated pneumonia (OR 6.30, 95%CI 1.15-34.44, p = 0.0338) and ≥ 1 risk factor for extended-spectrum β-lactamase-producing Enterobacteriaceae (OR 2.56, 95%CI 1.07-6.14, p = 0.0353). Main independent factors for compliance were using antibiotic therapy protocols (OR 0.42, 95%CI 0.19-0.92, p = 0.0313), respiratory failure at ICU admission (OR 0.36, 95%CI 0.14-0.90, p = 0.0281) and aspiration pneumonia (OR 0.37, 95%CI 0.14-0.99, p = 0.0486).
CONCLUSIONS: Half of antibiotic prescriptions remain non-compliant with guidelines. Intensivists should reassess on a day-to-day basis the benefit of using several antimicrobials or any broad-spectrum antibiotics and stop antibiotics that are no longer indicated. Developing consensus about treating specific illnesses and using department protocols seem necessary to reduce non-compliance. A daily ASP could also improve compliance in these situations.
BACKGROUND: ClinicalTrials.gov: number NCT04642560. The date of first trial registration was 24/11/2020.
METHODS: We conducted an observational study in eight French Paediatric and Neonatal ICUs with an antimicrobial stewardship programme (ASP) organised once a week for the most part. All children receiving antibiotics for a suspected or proven BI were evaluated. Newborns < 72 h old, neonates < 37 weeks, age ≥ 18 years and children under surgical antimicrobial prophylaxis were excluded.
RESULTS: 139 suspected (or proven) BI episodes in 134 children were prospectively included during six separate time-periods over one year. The final diagnosis was 26.6% with no BI, 40.3% presumed (i.e., not documented) BI and 35.3% documented BI. Non-compliance with antibiotic recommendations occurred in 51.1%. The main reasons for non-compliance were inappropriate choice of antimicrobials (27.3%), duration of one or more antimicrobials (26.3%) and length of antibiotic therapy (18.0%). In multivariate analyses, the main independent risk factors for non-compliance were prescribing ≥ 2 antibiotics (OR 4.06, 95%CI 1.69-9.74, p = 0.0017), duration of broad-spectrum antibiotic therapy ≥ 4 days (OR 2.59, 95%CI 1.16-5.78, p = 0.0199), neurologic compromise at ICU admission (OR 3.41, 95%CI 1.04-11.20, p = 0.0431), suspected catheter-related bacteraemia (ORs 3.70 and 5.42, 95%CIs 1.32 to 15.07, p < 0.02), a BI site classified as \"other\" (ORs 3.29 and 15.88, 95%CIs 1.16 to 104.76, p < 0.03), sepsis with ≥ 2 organ dysfunctions (OR 4.21, 95%CI 1.42-12.55, p = 0.0098), late-onset ventilator-associated pneumonia (OR 6.30, 95%CI 1.15-34.44, p = 0.0338) and ≥ 1 risk factor for extended-spectrum β-lactamase-producing Enterobacteriaceae (OR 2.56, 95%CI 1.07-6.14, p = 0.0353). Main independent factors for compliance were using antibiotic therapy protocols (OR 0.42, 95%CI 0.19-0.92, p = 0.0313), respiratory failure at ICU admission (OR 0.36, 95%CI 0.14-0.90, p = 0.0281) and aspiration pneumonia (OR 0.37, 95%CI 0.14-0.99, p = 0.0486).
CONCLUSIONS: Half of antibiotic prescriptions remain non-compliant with guidelines. Intensivists should reassess on a day-to-day basis the benefit of using several antimicrobials or any broad-spectrum antibiotics and stop antibiotics that are no longer indicated. Developing consensus about treating specific illnesses and using department protocols seem necessary to reduce non-compliance. A daily ASP could also improve compliance in these situations.
BACKGROUND: ClinicalTrials.gov: number NCT04642560. The date of first trial registration was 24/11/2020.
摘要：
背景：细菌感染（BI）在ICU中普遍存在。这项研究的目的是评估对抗生素建议的依从性以及与不依从性相关的因素。
方法：我们在8个法国儿科和新生儿ICU中进行了一项观察性研究，其中大部分每周组织一次抗菌药物管理计划（ASP）。对所有接受抗生素治疗的可疑或证实的BI的儿童进行评估。新生儿<72小时，新生儿<37周，年龄≥18岁和接受外科抗菌药物预防的儿童被排除在外.
结果：在一年的六个不同时间段内，前瞻性纳入了134名儿童的139例可疑（或已证实）BI发作。最终诊断为26.6%，无BI，40.3%假定(即，未记录）BI和35.3%记录BI。51.1%的患者不遵守抗生素建议。不依从的主要原因是抗菌药物的选择不当(27.3%),一种或多种抗生素的持续时间（26.3％）和抗生素治疗的长度（18.0％）。在多变量分析中，不依从的主要独立危险因素是处方≥2种抗生素(OR4.06,95CI1.69-9.74,p=0.0017),广谱抗生素治疗的持续时间≥4天（OR2.59，95CI1.16-5.78，p=0.0199），入住ICU时的神经系统损害（OR3.41，95CI1.04-11.20，p=0.0431），疑似导管相关性菌血症(ORs3.70和5.42,95CI=1.32至15.07,p<0.02),分类为“其他”的BI网站(ORs3.29和15.88，95CI=1.16至104.76，p<0.03)，脓毒症伴≥2个器官功能障碍（OR4.21，95CI1.42-12.55，p=0.0098），晚发性呼吸机相关性肺炎(OR6.30,95CI1.15-34.44,p=0.0338)和产超广谱β-内酰胺酶肠杆菌科的≥1个危险因素(OR2.56,95CI1.07-6.14,p=0.0353).依从性的主要独立因素是使用抗生素治疗方案（OR0.42，95CI0.19-0.92，p=0.0313），ICU入院时呼吸衰竭(OR0.36,95CI0.14-0.90,p=0.0281)和吸入性肺炎(OR0.37,95CI0.14-0.99,p=0.0486)。
结论：一半的抗生素处方仍不符合指南。强化专家应每天重新评估使用几种抗菌剂或任何广谱抗生素的益处，并停止不再指示的抗生素。就治疗特定疾病和使用部门协议达成共识似乎有必要减少不遵守情况。在这些情况下，每日ASP也可以提高合规性。
背景：ClinicalTrials.gov：编号NCT04642560。第一次试用注册的日期是24/11/2020。
方法：我们在8个法国儿科和新生儿ICU中进行了一项观察性研究，其中大部分每周组织一次抗菌药物管理计划（ASP）。对所有接受抗生素治疗的可疑或证实的BI的儿童进行评估。新生儿<72小时，新生儿<37周，年龄≥18岁和接受外科抗菌药物预防的儿童被排除在外.
结果：在一年的六个不同时间段内，前瞻性纳入了134名儿童的139例可疑（或已证实）BI发作。最终诊断为26.6%，无BI，40.3%假定(即，未记录）BI和35.3%记录BI。51.1%的患者不遵守抗生素建议。不依从的主要原因是抗菌药物的选择不当(27.3%),一种或多种抗生素的持续时间（26.3％）和抗生素治疗的长度（18.0％）。在多变量分析中，不依从的主要独立危险因素是处方≥2种抗生素(OR4.06,95CI1.69-9.74,p=0.0017),广谱抗生素治疗的持续时间≥4天（OR2.59，95CI1.16-5.78，p=0.0199），入住ICU时的神经系统损害（OR3.41，95CI1.04-11.20，p=0.0431），疑似导管相关性菌血症(ORs3.70和5.42,95CI=1.32至15.07,p<0.02),分类为“其他”的BI网站(ORs3.29和15.88，95CI=1.16至104.76，p<0.03)，脓毒症伴≥2个器官功能障碍（OR4.21，95CI1.42-12.55，p=0.0098），晚发性呼吸机相关性肺炎(OR6.30,95CI1.15-34.44,p=0.0338)和产超广谱β-内酰胺酶肠杆菌科的≥1个危险因素(OR2.56,95CI1.07-6.14,p=0.0353).依从性的主要独立因素是使用抗生素治疗方案（OR0.42，95CI0.19-0.92，p=0.0313），ICU入院时呼吸衰竭(OR0.36,95CI0.14-0.90,p=0.0281)和吸入性肺炎(OR0.37,95CI0.14-0.99,p=0.0486)。
结论：一半的抗生素处方仍不符合指南。强化专家应每天重新评估使用几种抗菌剂或任何广谱抗生素的益处，并停止不再指示的抗生素。就治疗特定疾病和使用部门协议达成共识似乎有必要减少不遵守情况。在这些情况下，每日ASP也可以提高合规性。
背景：ClinicalTrials.gov：编号NCT04642560。第一次试用注册的日期是24/11/2020。
