The worldwide antibiotic resistance and prescribing in european children (ARPEC) point prevalence survey: Developing hospital-quality indicators of antibiotic prescribing for children

Ann Versporten, Julia Bielicki, Nico Drapier, Mike Sharland, Hermanon Goossens, Graciela Maria Calle, Julia Clark, Celia Cooper, Christopher C. Blyth, Joshua Reginald Francis, Jameela Alsalman, Hilde Jansens, Ludo Mahieu, Paul Van Rossom, Wouter Vandewal, Philippe Lepage, Sophie Blumental, Caroline Briquet, Dirk Robbrecht, Pierre MatonPatrick Gabriels, Zana Rubic, Tanja Kovacevic, Jens Peter Nielsen, Jes Reinholdt Petersen, Porntiva Poorisrisak, Lise Heilmann Jensen, Mari Laan, Eda Tamm, Maire Matsinen, Maija Liisa Rummukainen, Vincent Gajdos, Romain Olivier, Flore Le Maréchal, Alain Martinot, Sonia Prot-Labarthe, Mathie Lorrot, Daniel Orbach, Karaman Pagava, Markus Hufnagel, Markus Knuf, Stephanie A A Schlag, Johannes Liese, Lorna Renner, Anthony Enimil, Marah Awunyo, Garyfallia Syridou, Nikos Spyridis, Elena Critselis, Sofia Kouni, Katerina Mougkou, Fani Ladomenou, Despoina Gkentzi, Elias Iosifidis, Emmanuel Roilides, Suneeta Sahu, Srinivas Murki, Manoj Malviya, Durga Bhavani Kalavalapalli, Sanjeev Singh, Tanu Singhal, Garima Garg, Pankaj Garg, Neelam Kler, Jafar Soltani, Zahra Jafarpour, Gholamreza Pouladfar, Giangiacomo Nicolini, Carlotta Montagnani, Luisa Galli, Susanna Esposito, Andrea Lo Vecchio, Daniele Dona', Carlo Giaquinto, Eleonora Borgia, Patrizia D'Argenio, Maia De Luca, Chiara Centenari, Lul Raka, Abeer Omar, Haifaa Al-Mousa, Dzintars Mozgis, Inese Sviestina, Sigita Burokiene, Vytautas Usonis, Gabriela Tavchioska, Antonia Hargadon-Lowe, Peter Zarb, Michael A. Borg, Carlos Agustín González Lozano, Patricia Zárate Castañon, Martha E. Cancino, Bernadette McCullagh, Ann McCorry, Cairine Gormley, Zaina Al Maskari, Amina Al-Jardani, Magdalena Pluta, Fernanda Rodrigues, Ana Brett, Isabel Esteves, Laura Marques, Jameela Ali AlAjmi, Simona Claudia Cambrea, Asia N. Rashed, Aeshah Abdu Mubarak Al Azmi, Si Min Chan, Mas Suhaila Isa, Peter Najdenov, Milan Čižman, Sibila Unuk, Heather Finlayson, Angela Dramowski, Irene Maté-Cano, Beatriz Soto, Cristina Calvo, Begoña Santiago, Jesus Saavedra-Lozano, Amaya Bustinza, Luis Escosa-García, Noelia Ureta, Alfredo Tagarro, Pedro Terol Barrero, Elena Maria Rincon-Lopez, Ismaela Abubakar, Jeff Aston, Maggie Heginbothom, Prakash Satodia, Mehdi Garbash, Alison Johnson, David Sharpe, Christopher Barton, Esse Menson, Sara Arenas-Lopez, Suzanne Luck, Katja Doerholt, Paddy McMaster, Neil A. Caldwell, Andrew Lunn, Simon B. Drysdale, Rachel Howe, Tim Scorrer, Florian Gahleitner, Richa Gupta, Clare Nash, John Alexander, Mala Raman, Emily Bell, Veena Rajagopal, Stephan Kohlhoff, Elaine Cox, Theoklis Zaoutis

Research output: Contribution to journalArticle

Abstract

Objectives: Previously, web-based tools for cross-sectional antimicrobial point prevalence surveys (PPSs) have been used in adults to develop indicators of quality improvement. We aimed to determine the feasibility of developing similar quality indicators of improved antimicrobial prescribing focusing specifically on hospitalized neonates and children worldwide. Methods: A standardized antimicrobial PPS method was employed. Included were all inpatient children and neonates receiving an antimicrobial at 8:00 am on the day of the PPS. Denominators included the total number of inpatients. A web-based application was used for data entry, validation and reporting. We analysed 2012 data from 226 hospitals (H) in 41 countries (C) from Europe (174H; 24C), Africa (6H; 4C), Asia (25H; 8C), Australia (6H), Latin America (11H; 3C) and North America (4H). Results: Of 17 693 admissions, 6499 (36.7%) inpatients received at least one antimicrobial, but this varied considerably between wards and regions. Potential indicators included very high broad-spectrum antibiotic prescribing in children of mainly ceftriaxone (ranked first in Eastern Europe, 31.3%; Asia, 13.0%; Southern Europe, 9.8%), cefepime (ranked third in North America, 7.8%) and meropenem (ranked first in Latin America, 13.1%). The survey identified worryingly high use of critically important antibiotics for hospital-acquired infections in neonates (34.9%; range from 14.2% in Africa to 68.0% in Latin America) compared with children (28.3%; range from 14.5% in Africa to 48.9% in Latin America). Parenteral administration was very common among children in Asia (88%), Latin America (81%) and Europe (67%). Documentation of the reasons for antibiotic prescribing was lowest in Latin America (52%). Prolonged surgical prophylaxis rates ranged from 78% (Europe) to 84% (Latin America). Conclusions: Simple web-based PPS tools provide a feasible method to identify areas for improvement of antibiotic use, to set benchmarks and to monitor future interventions in hospitalized neonates and children. To our knowledge, this study has derived the first global quality indicators for antibiotic use in hospitalized neonates and children.

Original languageEnglish
Article numberdkv418
Pages (from-to)1106-1117
Number of pages12
JournalJournal of Antimicrobial Chemotherapy
Volume71
Issue number4
DOIs
Publication statusPublished - Apr 1 2016

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ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Versporten, A., Bielicki, J., Drapier, N., Sharland, M., Goossens, H., Calle, G. M., Clark, J., Cooper, C., Blyth, C. C., Francis, J. R., Alsalman, J., Jansens, H., Mahieu, L., Van Rossom, P., Vandewal, W., Lepage, P., Blumental, S., Briquet, C., Robbrecht, D., ... Zaoutis, T. (2016). The worldwide antibiotic resistance and prescribing in european children (ARPEC) point prevalence survey: Developing hospital-quality indicators of antibiotic prescribing for children. Journal of Antimicrobial Chemotherapy, 71(4), 1106-1117. [dkv418]. https://doi.org/10.1093/jac/dkv418