Rational utilisation of antibiotic treatment in critically ill children

Background: The high risks associated with untreated infection in criticall y ill newborns or children lower the threshold for prescription of antibiot ic treatment. Inappropriate use of antibiotic therapy promotes the emergenc e of resistant strains. This study had three aims: to identify sources of i nappropriate antibiotic utilisation, to develop revised guidelines and to i mplement changes. Methods: An observational study was performed in a tertiary, multidisciplin ary, neonatal and paediatric intensive care unit (PICU) of a university tea ching hospital during a 7-month period (456 admissions). Guidelines address ing one of the identified sources of inappropriate utilisation (prophylaxis following surgery) were developed according to published evidence and impl emented, and the effect on prescription patterns was assessed during a seco nd observation period. Results: Patients received systemic antibiotics during 54.6% of all hospita lisation days. Antibiotics prescribed for suspected or proven infection wer e often continued 1-2 days beyond the intended duration. Prophylaxis accoun ted for 28% of all systemic antibiotics given, and postsurgical prophylaxis accounted for 14.6% of all exposure days. The literature search revealed l ittle evidence to support this practice. After new guidelines were introduc ed with the aim of restricting surgical prophylaxis to a single dose prior to surgery, the rate of postsurgical prophylaxis dropped from 14.6 to 11.2% of all exposure da)is, accompanied by a significant decline in the overall exposure rate from 54.6 to 50.2% of all hospitalisation days. Conclusion: Several sources of inappropriate antibiotic utilisation were id entified. These include failure to discontinue treatment and prolonged prop hylaxis after surgery, Implementation of new guidelines reduced antibiotic utilisation.