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Abstract：
Introduction: Actions to reduce and optimize antimicrobial use are crucial in the management of infectious diseases to counteract the emergence of short- and long-term resistance. This is particularly important for pediatric patients due to the increasing incidence of serious infections caused by resistant bacteria in this population. The aim of this study was to evaluate the impact of a pediatric antimicrobial stewardship program (PROA-NEN) implemented in a Spanish tertiary hospital by assessing the use of systemic antimicrobials, clinical indicators, antimicrobial resistance, and costs. Methods: In this quasi-experimental, single-center study, we included pediatric patients (0-18 years) admitted to specialized pediatric medical and surgical units, as well as pediatric and neonatal intensive care units, from January 2015 to December 2019. The impact of the PROA-NEN program was assessed using process (consumption trends and prescription quality) and outcome indicators (clinical and microbiological). Antibiotic prescription quality was determined using quarterly point prevalence cross-sectional analyses. Results: Total antimicrobial consumption decreased during the initial three years of the PROA-NEN program, followed by a slight rebound in 2019. This decrease was particularly evident in intensive care and surgical units. Antibiotic use, according to the WHO Access, Watch and Reserve (AWaRe) classification, remained stable during the study period. The overall rate of appropriate prescription was 83.2%, with a significant increase over the study period. Clinical indicators did not substantially change over the study period. Direct antimicrobial expenses decreased by 27.3% from 2015 to 2019. Conclusions: The PROA-NEN program was associated with reduced antimicrobial consumption, improved appropriate use, and decreased costs without compromising clinical and/or microbiological outcomes in patients.
摘要：
简介：减少和优化抗菌药物使用的行动对于传染病的管理至关重要，以抵消短期和长期耐药性的出现。这对于儿科患者尤其重要,因为在该人群中由耐药细菌引起的严重感染的发生率增加。这项研究的目的是通过评估系统性抗菌药物的使用来评估在西班牙三级医院实施的儿科抗菌药物管理计划（PROA-NEN）的影响。临床指标,抗菌素耐药性，和成本。方法：在这个准实验中，单中心研究,我们纳入了儿科患者（0-18岁），以及儿科和新生儿重症监护病房，2015年1月至2019年12月。使用过程（消费趋势和处方质量）和结果指标（临床和微生物学）评估PROA-NEN计划的影响。使用季度点患病率横断面分析确定抗生素处方质量。结果：在PROA-NEN计划的最初三年中，抗菌药物的总消费量有所下降，随后在2019年小幅反弹。这种减少在重症监护和外科病房中尤为明显。抗生素的使用，根据世卫组织准入，手表和储备（AWARE）分类，在研究期间保持稳定。总的适宜处方率为83.2%,在研究期间显着增加。临床指标在研究期间没有实质性变化。2015年至2019年直接抗菌费用下降27.3%。结论：PROA-NEN计划与减少抗菌药物消耗有关，改善适当使用，在不影响患者临床和/或微生物学结果的情况下降低了成本。
