Abstract

The United Nations and the World Health Organization have designated antimicrobial resistance (AMR) as a major health priority and developed action plans to reduce AMR in all healthcare settings. Establishment of institutional antimicrobial stewardship programmes (ASPs) is advocated as a key intervention to reduce antibiotic consumption in hospitals and address high rates of multi-drug resistant (MDR) bacteria. We searched PUBMED and the Cochrane database of systematic reviews (1/2007-3/2017) to identify studies reporting about the effectiveness of ASPs in general paediatric wards and paediatric intensive care units (PICU), on reducing antibiotic consumption, on using broad spectrum/restricted antibiotics, and on antibiotic resistance and healthcare-associated infections (HAIs). Neonatal units and antifungal agents were excluded. Of 2509 titles and abstracts, nine articles were eligible to be included in the final analysis. All studies reported on the reduction of broad spectrum/restricted antibiotics or antibiotic consumption. One study reported on the reduction of HAI in a PICU, and another evaluated bacterial resistance, showing no effect following ASP implementation. Prospective audit on antibiotic use was the most common ASP core component (eight of nine studies). Antibiotic pre-authorisation was described in two articles. Other described interventions were providing guidelines or written information (five of nine articles), and training of healthcare professionals (one article). There is limited evidence about reducing antibiotic consumption and broad-spectrum/restricted agents following ASP implementation, specifically in PICU. Data evaluating the impact of ASPs on HAI and AMR in PICU is lacking. In addition, there is limited information on effective components of a successful ASPs in PICUs.