Naïm Ouldali1,2, Xavier Bellêttre3, Karen Milcent4,5, Romain Guedj6, Loïc de Pontual7, Bogdan Cojocaru8, Valérie Soussan-Banini9, Irina Craiu10, David Skurnik11, Vincent Gajdos4,5, Gérard Chéron12, Robert Cohen13, Corinne Alberti1,2, François Angoulvant2,12. 1. Department of Medicine, Paris Diderot University. 2. Unit of Clinical Epidemiology, ECEVE INSERM UMR1123. 3. Pediatric Emergency Department, Robert Debré University Hospital, Paris. 4. Pediatric Department, Antoine Béclère University Hospital, Paris Sud University, Clamart. 5. CESP Centre for Research in Epidemiology and Population Health, INSERM U1018, Villejuif. 6. Pediatric Emergency Department, Armand Trousseau University Hospital, Pierre et Marie Curie Paris University. 7. Pediatric Department, Jean Verdier University Hospital, Paris 13 University, Bondy. 8. Pediatric Emergency Department, Louis Mourier University Hospital, Colombes. 9. Pediatric Emergency Department, Ambroise Paré University Hospital, Boulogne Billancourt. 10. Pediatric Emergency Department, Bicêtre University Hospital, Kremlin-Bicêtre, France. 11. Harvard Medical School, Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts. 12. Pediatric Department, Necker-Enfants Malades University Hospital, Paris Descartes University. 13. Pediatric Department, Creteil intercommunal Hospital, Paris Est University, Creteil, France.
Abstract
BACKGROUND: Many antibiotics are prescribed inappropriately in pediatric emergency departments (PEDs), but little data are available in these settings about effective interventions based on guidelines that follow the antimicrobial stewardship principle. Our aim was to assess the impact of implementing the 2011 national guidelines on antibiotic prescriptions for acute respiratory tract infection (ARTI) in PEDs. METHOD: We conducted a multicentric, quasiexperimental, interrupted time series analysis of prospectively collected electronic data from 7 French PEDs. We included all pediatric patients who visited a participating PED during the study period from November 2009 to October 2014 and were diagnosed with an ARTI. The intervention consisted of local protocol implementation, education sessions, and feedback. The main outcome was the antibiotic prescription rate of discharge prescriptions for ARTI per 1000 PED visits before and after implementation, analyzed using the segmented regression model. RESULTS: We included 242534 patients with an ARTI. The intervention was associated with a significant change in slope for the antibiotic prescription rate per 1000 PED visits (-0.4% per 15-day period, P = .04), and the cumulative effect at the end of the study was estimated to be -30.9%, (95% CI [-45.2 to -20.1]), representing 13136 avoided antibiotic prescriptions. The broad-spectrum antibiotic prescription relative percentage decreased dramatically (-62.7%, 95% CI [-92.8; -32.7]) and was replaced by amoxicillin. CONCLUSION: Implementation of the 2011 national French guidelines led to a significant decrease in the antibiotic prescription rate for ARTI and a dramatic drop in broad-spectrum antibiotic prescriptions, in favor of amoxicillin.
BACKGROUND: Many antibiotics are prescribed inappropriately in pediatric emergency departments (PEDs), but little data are available in these settings about effective interventions based on guidelines that follow the antimicrobial stewardship principle. Our aim was to assess the impact of implementing the 2011 national guidelines on antibiotic prescriptions for acute respiratory tract infection (ARTI) in PEDs. METHOD: We conducted a multicentric, quasiexperimental, interrupted time series analysis of prospectively collected electronic data from 7 French PEDs. We included all pediatric patients who visited a participating PED during the study period from November 2009 to October 2014 and were diagnosed with an ARTI. The intervention consisted of local protocol implementation, education sessions, and feedback. The main outcome was the antibiotic prescription rate of discharge prescriptions for ARTI per 1000 PED visits before and after implementation, analyzed using the segmented regression model. RESULTS: We included 242534 patients with an ARTI. The intervention was associated with a significant change in slope for the antibiotic prescription rate per 1000 PED visits (-0.4% per 15-day period, P = .04), and the cumulative effect at the end of the study was estimated to be -30.9%, (95% CI [-45.2 to -20.1]), representing 13136 avoided antibiotic prescriptions. The broad-spectrum antibiotic prescription relative percentage decreased dramatically (-62.7%, 95% CI [-92.8; -32.7]) and was replaced by amoxicillin. CONCLUSION: Implementation of the 2011 national French guidelines led to a significant decrease in the antibiotic prescription rate for ARTI and a dramatic drop in broad-spectrum antibiotic prescriptions, in favor of amoxicillin.
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