Background The analysis of antibacterial consumption in association with patient-specific parameters allows con-clusion on the efficiency of antibiotic treatment and may predict development of antibacterial resistance. Accurate and consistent measures of therapeutically used antibiot-ics are required for meaningful inter-and intra-institutional comparisons. The commonly used algorithm to measure in the adult population is based on the ratio of DDD/PD.
Thus, the consumed amount of a specific antibiotic is quantified by units of defined daily dose (DDD) and relat-ed to number of inpatient days (PD) at a defined hospital setting as denominator.Calculations using DDD/PD do not take into account the individual characteristic and heterogeneity of the paediatric population in terms of weight, age and disease spectrum compared to adults. Alternative calculations, such as days of antibiotic treat-ment (DOT) independent of dose; and prescribed daily dose (PDD), are not applicable at all hospital settings due to lack of specific electronic recording, and don’t allow comparisons across all age groups.This study deals with the development and evaluation of a novel algorithm, allowing intra-institutional comparison of antibiotic con-sumption across all age groups and hospital units repre-senting diverse range of pathologies.
Methods The use of antibiotics was assessed in a large paediatric clinical setting encompassing all relevant wards, such as neonatology, newborns, internal wards, surgery, paediatric oncology and intensive care units. The analysis differentiated the classes of antibiotics dependent on their antimicrobial properties, including antibiotics with activity against MRSA/MRSE, last-resort-and broad spec-trum antibiotics. Several parameters were tested as Nom-inator and Denominator and results were evaluated by relating the consumption of each ward to average age of patients, length of inpatient stay, severity of disease and proportion of parenterally administered antibiotics.
Results An algorithm was identified, able to delineate the usage of antimicrobial medication among the different hospital units in accordance with their estimated vulnerability for infectious disease. The metric is restricted to antibiotics administered by parenteral route, shows a negative correlation with age, and emphasise the antibi-otic consumption of neonatal units.
Conclusion Currently there is no single antibacterial consumption measure for the paediatric populations. Stratifying patients by age and/or weight is required. However, for intra-institutional comparisons at paediatric hospitals, a single metric comprising all the diverse popu-lations would be helpful.
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