Compliance with the current recommendations for prescribing antibiotics for paediatric community-acquired pneumonia is improving: data from a prospective study in a French network

BMC Pediatrics

Research Article

Matthieu Hanf¹  Corinne Levy²  Robert Cohen²  François Angoulvant³  Emmanuel Grimprel⁴  Elise Launay⁵  Christèle Gras-Le Guen⁵  François Dubos⁶  Alain Martinot⁶  Bénédicte Vrignaud⁷  Flora Lepage⁷  Karine Levieux⁸ 

[1] Centre d’Investigation Clinique, CHU Nantes, Nantes, France;GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Société Française de Pédiatrie, Paris, France;ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France;Centre Hospitalier Intercommunal de Créteil, Centre de Recherche Clinique, Créteil, France;GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Société Française de Pédiatrie, Paris, France;INSERM CIE5, Clinical Epidemiology Unit, Université Paris Diderot, Sorbonne Paris Cité, Paris, France;Paediatric Emergency Department, AP-HP, Hôpital Robert Debré, Paris, France;GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Société Française de Pédiatrie, Paris, France;Paediatric Department, AP-HP, Trousseau University Hospital, Paris, France;GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Société Française de Pédiatrie, Paris, France;Paediatric Department, CHU Nantes, Hôpital Mère-Enfant, 7 quai Moncousu, 44093, Nantes cedex 1, France;GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Société Française de Pédiatrie, Paris, France;Paediatric Emergency Unit & Infectious Diseases, Lille-2 Nord-de-France University & CHRU Lille, Lille, France;Paediatric Department, CHU Nantes, Hôpital Mère-Enfant, 7 quai Moncousu, 44093, Nantes cedex 1, France;Paediatric Emergency Department, CHU Nantes, Hôpital Mère-Enfant, Nantes, France;

关键词: Pneumonia;    Antibiotic prescription;    Antibiotic stewardship;    Children;   

DOI  :  10.1186/s12887-016-0661-3

 received in 2016-02-25, accepted in 2016-08-02,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundLower respiratory tract infection is a common cause of consultation and antibiotic prescription in paediatric practice. The misuse of antibiotics is a major cause of the emergence of multidrug-resistant bacteria. The aim of this study was to evaluate the frequency, changes over time, and determinants of non-compliance with antibiotic prescription recommendations for children admitted in paediatric emergency department (PED) with community-acquired pneumonia (CAP).MethodsWe conducted a prospective two-period study using data from the French pneumonia network that included all children with CAP, aged one month to 15 years old, admitted to one of the ten participating paediatric emergency departments. In the first period, data from children included in all ten centres were analysed. In the second period, we analysed children in three centers for which we collected additional data. Two experts assessed compliance with the current French recommendations. Independent determinants of non-compliance were evaluated using a logistic regression model. The frequency of non-compliance was compared between the two periods for the same centres in univariate analysis, after adjustment for confounding factors.ResultsA total of 3034 children were included during the first period (from May 2009 to May 2011) and 293 in the second period (from January to July 2012). Median ages were 3.0 years [1.4–5] in the first period and 3.6 years in the second period. The main reasons for non-compliance were the improper use of broad-spectrum antibiotics or combinations of antibiotics. Factors that were independently associated with non-compliance with recommendations were younger age, presence of risk factors for pneumococcal infection, and hospitalization. We also observed significant differences in compliance between the treatment centres during the first period. The frequency of non-compliance significantly decreased from 48 to 18.8 % between 2009 and 2012. The association between period and non-compliance remained statistically significant after adjustment for confounding factors. Amoxicillin was prescribed as the sole therapy significantly more frequently in the second period (71 % vs. 54.2 %, p < 0.001).ConclusionsWe observed a significant increase in the compliance with recommendations, with a reduction in the prescription of broad-spectrum antibiotics, efforts to improve antibiotic prescriptions must continue.

【 授权许可】

CC BY   
© The Author(s). 2016