Pediatric antibiotic stewardship programs in Europe: a pilot survey among delegates of The European Academy of Pediatrics

Stephen M Reingold; Zachi Grossman; Adamos Hadjipanayis; Stefano Del Torso; Arunas Valiulis; Lukasz Dembinski; Shai Ashkenazi

doi:10.3389/fped.2023.1157542

Pediatric antibiotic stewardship programs in Europe: a pilot survey among delegates of The European Academy of Pediatrics

Front Pediatr. 2023 Jun 5:11:1157542. doi: 10.3389/fped.2023.1157542. eCollection 2023.

Authors

Stephen M Reingold¹, Zachi Grossman^{2

3}, Adamos Hadjipanayis^{4

5}, Stefano Del Torso⁶, Arunas Valiulis^{7

8}, Lukasz Dembinski⁹, Shai Ashkenazi²

Affiliations

¹ Department of Pediatrics, Meuhedet Health Maintenance Organization, Tel Aviv, Israel.
² Adelson School of Medicine, Ariel University, Ariel, Israel.
³ Department of Pediatrics, Maccabi Health Services, Tel Aviv, Israel.
⁴ Medical School, European University Cyprus, Nicosia, Cyprus.
⁵ Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus.
⁶ Department of Pediatrics, ChildCare WorldWide-CCWWItalia OdV, Padova, Italy.
⁷ Clinic of Children's Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania.
⁸ Human Ecology Research Group, Department of Public Health, Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania.
⁹ Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.

Abstract

Background: Antimicrobial resistance (AMR) is one of the leading causes of morbidity and mortality worldwide. Efforts to promote the judicious use of antibiotics and contain AMR are a priority of several medical organizations, including the WHO. One effective way to achieve this goal is the deployment of antibiotic stewardship programs (ASPs). This study aimed to survey the current situation of pediatric ASPs in European countries and establish a baseline for future attempts to harmonize pediatric ASPs and antibiotic use in Europe.

Methods: A web-based survey was conducted among national delegates of the European Academy of Paediatrics (EAP). The survey assessed the presence of pediatric ASPs in the representatives' countries in the inpatient and outpatient settings, the staff included in the programs, and their detailed activities regarding antibiotic use.

Results: Of the 41 EAP delegates surveyed, 27 (66%) responded. Inpatient pediatric ASPs were reported in 74% (20/27) countries, and outpatient programs in 48% (13/27), with considerable variability in their composition and activities. Guidelines for managing pediatric infectious diseases were available in nearly all countries (96%), with those for neonatal infections (96%), pneumonia (93%), urinary tract (89%), peri-operative (82%), and soft tissue (70%) infections being the most common. Pediatric ASPs were reported at the national (63%), institutional (41%), and regional/local (<15%) levels. Pediatricians with infectious disease training (62%) and microbiologists (58%) were the most common members of the program personnel, followed by physician leaders (46%), infectious disease/infection control physicians (39%), pharmacists (31%), and medical director representatives (15%). Activities of the pediatric ASPs included educational programs (85%), monitoring and reporting of antibiotic use (70%) and resistance (67%), periodic audits with feedback (44%), prior approval (44%), and post-prescription review of selected antibiotic agents (33%).

Conclusion: Although pediatric ASPs exist in most European countries, their composition and activities vary considerably across countries. Initiatives to harmonize comprehensive pediatric ASPs across Europe are needed.

Keywords: Europe; antibiotic resistance; antibiotic stewardship; antimicrobial resistance (AMR); infectious diseases; pediatrics.

Grants and funding

The paper is a submission by the European Academy of Paediatrics and as such fee is expected to be waived.