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Open Access Research article

Antibiotic surveillance on a paediatric intensive care unit: easy attainable strategy at low costs and resources

Martin Stocker1*, Eduardo Ferrao2, Winston Banya3, Jamie Cheong4, Duncan Macrae2 and Anke Furck2

Author Affiliations

1 Paediatric and Neonatal Intensive Care Unit, Children’s Hospital Lucerne, Lucerne, Switzerland

2 Paediatric Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK

3 Epidemiology and Biostatistics, Royal Brompton and Harefield NHS Foundation Trust, London, UK

4 Pharmacy Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK

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BMC Pediatrics 2012, 12:196  doi:10.1186/1471-2431-12-196

Published: 21 December 2012

Abstract

Background

Antibiotic surveillance is mandatory to optimise antibiotic therapy. Our objectives were to evaluate antibiotic use in our pediatric intensive care unit (PICU) and to implement a simple achievable intervention aimed at improving antibiotic therapy.

Method

Prospective, 3 months surveillance of antibiotic use on PICU (phase I) and evaluation according to the CDC 12-step campaign with development of an attainable intervention. 3 months surveillance (phase II) after implementation of intervention with comparison of antibiotic use.

Results

Appropriate antibiotic use for culture-negative infection-like symptoms and targeted therapy for proven infections were the main areas for potential improvement. The intervention was a mandatory checklist requiring indication and recording likelihood of infection at start of antibiotic therapy and a review of the continuing need for therapy at 48 h and 5 days, reasons for continuation and possible target pathogen. The percentage of appropriate empiric antibiotic therapy courses for culture-negative infection-like symptoms increased from 18% (10/53) to 74% (42/57; p<0.0001), duration of therapy <3 days increased from 18% (10/53) to 35% (20/57; p=0.05) and correct targeting of pathogen increased from 58% (7/12) to 83% (20/24; p=0.21).

Conclusions

Antibiotic surveillance using the CDC 12-step campaign can help to evaluate institutional antibiotic therapy. Development of an attainable intervention using a checklist can show improved antibiotic use with minimal expense.

Keywords:
Antibiotic surveillance; Paediatric intensive care unit; CDC 12-Step Campaign; Checklist; antimicrobial stewardship program