@article{3022450,
    title = "The worldwide antibiotic resistance and prescribing in european children (ARPEC) point prevalence survey: Developing hospital-quality indicators of antibiotic prescribing for children",
    author = "Versporten, A. and Bielicki, J. and Drapier, N. and Sharland, M. and Goossens, H. and Calle, G.M. and Clark, J. and Cooper, C. and Blyth, C.C. and Francis, J.R. and Alsalman, J. and Jansens, H. and Mahieu, L. and Van Rossom, P. and Vandewal, W. and Lepage, P. and Blumental, S. and Briquet, C. and Robbrecht, D. and Maton, P. and Gabriels, P. and Rubic, Z. and Kovacevic, T. and Nielsen, J.P. and Petersen, J.R. and Poorisrisak, P. and Jensen, L.H. and Laan, M. and Tamm, E. and Matsinen, M. and Rummukainen, M.-L. and Gajdos, V. and Olivier, R. and Le Maréchal, F. and Martinot, A. and Prot-Labarthe, S. and Lorrot, M. and Orbach, D. and Pagava, K. and Hufnagel, M. and Knuf, M. and Schlag, S.A.A. and Liese, J. and Renner, L. and Enimil, A. and Awunyo, M. and Syridou, G. and Spyridis, N. and Critselis, E. and Kouni, S. and Mougkou, K. and Ladomenou, F. and Gkentzi, D. and Iosifidis, E. and Roilides, E. and Sahu, S. and Murki, S. and Malviya, M. and Kalavalapalli, D.B. and Singh, S. and Singhal, T. and Garg, G. and Garg, P. and Kler, N. and Soltani, J. and Jafarpour, Z. and Pouladfar, G. and Nicolini, G. and Montagnani, C. and Galli, L. and Esposito, S. and Vecchio, A.L. and Dona', D. and Giaquinto, C. and Borgia, E. and D'Argenio, P. and De Luca, M. and Centenari, C. and Raka, L. and Omar, A. and Al-Mousa, H. and Mozgis, D. and Sviestina, I. and Burokiene, S. and Usonis, V. and Tavchioska, G. and Hargadon-Lowe, A. and Zarb, P. and Borg, M.A. and González Lozano, C.A. and Castañon, P.Z. and Cancino, M.E. and McCullagh, B. and McCorry, A. and Gormley, C. and Al Maskari, Z. and Al-Jardani, A. and Pluta, M. and Rodrigues, F. and Brett, A. and Esteves, I. and Marques, L. and AlAjmi, J.A. and Cambrea, S.C. and Rashed, A.N. and Al Azmi, A.A.M. and Chan, S.M. and Isa, M.S. and Najdenov, P. and Čižman, M. and Unuk, S. and Finlayson, H. and Dramowski, A. and Maté-Cano, I. and Soto, B. and Calvo, C. and Santiago, B. and Saavedra-Lozano, J. and Bustinza, A. and Escosa-García, L. and Ureta, N. and Tagarro, A. and Barrero, P.T. and Rincon-Lopez, E.M. and Abubakar, I. and Aston, J. and Heginbothom, M. and Satodia, P. and Garbash, M. and Johnson, A. and Sharpe, D. and Barton, C. and Menson, E. and Arenas-Lopez, S. and Luck, S. and Doerholt, K. and McMaster, P. and Caldwell, N.A. and Lunn, A. and Drysdale, S.B. and Howe, R. and Scorrer, T. and Gahleitner, F. and Gupta, R. and Nash, C. and Alexander, J. and Raman, M. and Bell, E. and Rajagopal, V. and Kohlhoff, S. and Cox, E. and Zaoutis, T. and ARPEC project group",
    journal = "The Journal of antimicrobial chemotherapy",
    year = "2016",
    volume = "71",
    number = "4",
    pages = "1106-1117",
    publisher = "Oxford University Press",
    doi = "10.1093/jac/dkv418",
    keywords = "amikacin;  amoxicillin;  ampicillin;  azithromycin;  cefazolin;  cefepime;  cefoperazone;  ceforanide;  cefotaxime;  ceftazidime;  ceftriaxone;  cefuroxime;  chloramphenicol;  ciprofloxacin;  clarithromycin;  clindamycin;  cloxacillin;  cotrimoxazole;  flucloxacillin;  gentamicin;  levofloxacin;  meropenem;  metronidazole;  nalidixic acid;  piperacillin;  procaine penicillin;  teicoplanin;  tobramycin;  unindexed drug;  vancomycin;  antiinfective agent, Africa;  antibiotic resistance;  antibiotic therapy;  Article;  Asia;  Australia;  child;  clinical indicator;  clinical practice;  drug utilization;  Europe;  health survey;  hospital admission;  hospital infection;  human;  infection prevention;  medical documentation;  newborn;  North America;  prescription;  prevalence;  South and Central America;  cross-sectional study;  drug utilization;  female;  global health;  health care quality;  health care survey;  hospital;  infant;  male;  preschool child;  prescription;  standards;  statistics and numerical data, Anti-Bacterial Agents;  Child;  Child, Preschool;  Cross-Sectional Studies;  Drug Prescriptions;  Drug Resistance, Microbial;  Drug Utilization;  Europe;  Female;  Global Health;  Health Care Surveys;  Hospitals;  Humans;  Infant;  Male;  Prevalence;  Quality Indicators, Health Care",
    abstract = "Objectives: Previously, web-based tools for cross-sectional antimicrobial point prevalence surveys (PPSs) have been used in adults to develop indicators of quality improvement. We aimed to determine the feasibility of developing similar quality indicators of improved antimicrobial prescribing focusing specifically on hospitalized neonates and children worldwide. Methods: A standardized antimicrobial PPS method was employed. Included were all inpatient children and neonates receiving an antimicrobial at 8:00 am on the day of the PPS. Denominators included the total number of inpatients. A web-based application was used for data entry, validation and reporting. We analysed 2012 data from 226 hospitals (H) in 41 countries (C) from Europe (174H; 24C), Africa (6H; 4C), Asia (25H; 8C), Australia (6H), Latin America (11H; 3C) and North America (4H). Results: Of 17 693 admissions, 6499 (36.7%) inpatients received at least one antimicrobial, but this varied considerably between wards and regions. Potential indicators included very high broad-spectrum antibiotic prescribing in children of mainly ceftriaxone (ranked first in Eastern Europe, 31.3%; Asia, 13.0%; Southern Europe, 9.8%), cefepime (ranked third in North America, 7.8%) and meropenem (ranked first in Latin America, 13.1%). The survey identified worryingly high use of critically important antibiotics for hospital-acquired infections in neonates (34.9%; range from 14.2% in Africa to 68.0% in Latin America) compared with children (28.3%; range from 14.5% in Africa to 48.9% in Latin America). Parenteral administration was very common among children in Asia (88%), Latin America (81%) and Europe (67%). Documentation of the reasons for antibiotic prescribing was lowest in Latin America (52%). Prolonged surgical prophylaxis rates ranged from 78% (Europe) to 84% (Latin America). Conclusions: Simple web-based PPS tools provide a feasible method to identify areas for improvement of antibiotic use, to set benchmarks and to monitor future interventions in hospitalized neonates and children. To our knowledge, this study has derived the first global quality indicators for antibiotic use in hospitalized neonates and children. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved."
}