Revisiting antimicrobial stewardship in the paediatric intensive care unit: insights from an unconventional approach

Background: Patients admitted to the paediatric intensive care unit (PICU) constitute a high-risk group with increased likelihood of receiving inappropriate antimicrobial prescriptions. This study describes an antimicrobial stewardship programme (ASP) in the PICU of a tertiary hospital in Italy. Method: A pre–post quasi-experimental study was conducted between 1st January 2019 and 31st December 2022 in the PICU of the Department for Women's and Children's Health, University Hospital of Padova. The ASP intervention was implemented in February 2021 by a multi-disciplinary team using the ‘handshake’ approach. The population included all patients admitted to the PICU. The primary outcome was antibiotic consumption measured as days of therapy administered (DOTs)/1000 patient-days. An interrupted time series analysis was used to assess trends in antibiotic prescribing before and after the intervention. Results: In total, 616 patients (episodes) were admitted in the pre-intervention phase (January 2019–January 2021) and 602 patients were admitted in the post-intervention phase (February 2021–December 2022). Implementation of the ASP resulted in a significant decrease in overall antibiotic consumption by 3.0% every month (P<0.0001). Monthly reductions in higher consumption antibiotics were: meropenem, 4.9% (P=0.009); glycopeptides, 3.8% (P=0.014); and piperacillin-tazobactam 4.8% (P=0.034). The consumption of third-generation cephalosporins and amikacin did not change significantly. Conclusions: The ASP intervention was effective in reducing the consumption of antimicrobials in this complex setting. These results show the importance of antimicrobial stewardship in the scenario of critically ill children.