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4CPS-224 Evaluation of systemic antibiotics and antifungal use in an intensive paediatric care unit: a five-year study in a french university hospital
  1. A Solal1,
  2. C Bouchand1,
  3. A Guerin1,
  4. M Postaire1,
  5. S Cisternino1,
  6. F Moulin2
  1. 1Hôpital Universitaire Necker Enfants Malades, Pharmacie, Paris, France
  2. 2Hôpital Universitaire Necker Enfants Malades, Réanimation Paédiatrique, Paris, France


Background The overuse of antimicrobials and empirical prescriptions are associated with the higher prevalence of antibiotics’ resistance, leading to the longer duration of illness and increased healthcare costs. To preserve their efficacy and prevent the risks of resistance emergence, surveillance of antibiotic consumption is essential. There are limited data published about antibiotics and antifungal consumption in terms of defined daily doses (DDD) in paediatrics.

Purpose To describe and analyse antibiotic and antifungal drug consumption, DDD/1000 bed-days in a paediatric intensive care unit (ICU) over a 5 year period.

Material and methods A retrospective and descriptive study was performed in a university paediatric hospital of 400 beds with 32 ICU beds. According to the French ‘ATB-Raisin’ national network methodology, systemic antibiotics and antifungal dispensation from 2013 to 2018 to the ICU were measured and analysed by a multidisciplinary approach. DDD/1000 bed-days and/or ratios were calculated for each antibiotic and antifungal, and overall.

Results A 0.9-fold decrease (−9%) in the overall number of antibiotics DDD/1000 bed-days from 2792 in 2013 to 2533 in 2018 was measured. The most important decreases were observed for three classes of antibiotics: penicillin M (ratio=0.05), imipenem (ratio=0.17) and imidazole (ratio=0.28). The most important antibiotics’ consumption increases were observed for classes: first- and second-generation cephalosporins (ratio=2.26), levofloxacin (ratio=2.09) and amoxicillin-clavulanique (ratio=1.64). A 0.8-fold (−19%) decrease in the overall number of antifungals DDD/1000 bed-days from 314 in 2013 to 252 in 2018 was measured. The main decreases were observed for amphotericin B (ratio=0.3), voriconazole (ratio=0.50) and caspofungin (ratio=0.59). The most important increases have been shown for: flucytosine (ratio=10.25), micafungin (ratio=2.73) and fluconazole (ratio=1.22). Fluctuation in consumption is linked to several factors: drug shortages, evolution in recommendations and patient profiles. French drug market supplies break of oxacillin/penicillin M increases first- and second-generation cephalosporin prescriptions. A local guideline for transplant patients recently replaces fluconazole by mycafungin in antifungal prophylaxis.

Conclusion Both the overall numbers of antibiotics and antifungals DDD/1000 beds-days decrease over the 5 year study period. A multidisplinary analysis comprehends the consumption evolution in our paediatric ICU. It should be monitored on a continuous basis by pharmacists in healthcare settings.

References and/or acknowledgements

No conflict of interest.

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