Background and aims Antimicrobial drug resistance is a serious threat to public health worldwide. Antimicrobial stewardship program (ASP) information related to the paediatric population is scarce. This study assesses the usefulness of ASP instituted in 2005 in our centre.
Methods Retrospective study in a 214 bed-tertiary care paediatric hospital (52% patients in high-complexity areas), from 2005 to 2012. Variation in admissions, hospital complexity index, mortality rate, bacterial resistance and invasive fungal filamentous infection (IFFI) episodes were recorded. Rates of systemic antibiotics (glycopeptides, aminoglycosides, carbapenems) and intravenous antifungal drugs consumption in admitted patients were assessed, calculated by drug units and related cost.
Results A significant decrease in the number of admissions (-27%) was observe but complexity index and number of transplants increased significantly (+206% and +14%, respectively), as episodes of proven and probable IFFI (+88%). ESBL E.coli and K.pneumoniae increased (5 to 7.6% and 13.8 to 20%) while AmpC hiperproduced Enterobacter cloacae remained stable (29.2 to 29.5%). Multiresistant P. aeruginosa (1.1 to 5%) and MRSA (6.5 to 12.2%) increased moderatelely. Mortality rate showed a decrease of 8%.
The use of aminoglycosides (-24%) and glycopeptides (-3%) decreased while carbapenem and antifungal drug use increased (+45 and +76%, respectively) less than complexity indicators along these years. Global antimicrobial cost slightly increased (+14%).
Conclusions Since ASP implementation a considerable proportional decrease in anti-infective drugs use in comparison to complexity indexes and severe infection episodes was observed without an increase in mortality. ASP should be implemented in all high-complexity paediatric hospitals to optimise patient’s care.