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Master Thesis

Bon usage des carbapénèmes en pédiatrie : évaluation des pratiques professionnelles

Abstract : The increase of carbapenem resistance is a major health problem and improving the use of carbapenem is now crucial. Although the pediatric population is very specific, there still be a lack of data in children. The aim of this study was to assess the compliance of carbapenem prescriptions with guidelines in pediatrics.We carried out a retrospective study over a one-year period (2019) in our university hospital. All children admitted who received at least one dose of carbapenem were included. The use of carbapenem was considered as appropriate when concurrently approved by an infectious disease specialist (ID) or retrospectivly guidelines-concordant or retrospectively approved by two independent ID specialists, one trained in France, the other one trained in Canada. . As a secondary outcome, we analysed the review of carbapenem at 72 hours after initiation.We collected a total of 96 carbapenem prescriptions (80 (83%), 10 (10%) and 6 (6%) for meropenem, imipenem and ertapenem, respectively) in 75 patients (median age 46 months [IQR 4-115], 34 males). In 61 cases, a bacteria was isolated including 19 (29%) extended spectrum β-lactamases (ESBL)-producing Enterobacteriaceae, mostly Escherichia coli (n = 12, 63%) and Klebsiella pneumoniae (n = 6, 32%). Overall, most of carbapenem prescriptions were considered as appropriate at initiation (n = 89, 93%) whether there were empirical (n = 54, 70%) or culture-based (n = 18, 95%). The main reasons for carbapenem prescription according to the physician in charge were the unfavorable evolution while treated by another antibiotic (n=33, 34%), the presence of ESBLs-producing bacteria risk factors (n = 21, 21%), the degree of criticalness (n = 22, 23%) or the presence of neutropenia (n = 19, 20%). The treatments were stepped down at 72h in 31% of prescriptions.There was no alternative to carbapenem given the bacteriological documentation for 39% of prescriptions.We found that most of carpapenem prescriptions were considered as appropriate at initiation in a retrospective pediatric cohort. At 72h after initiation of carbapenem, around two thirds of prescriptions should have been improved with a step down strategy.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03403719
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Submitted on : Tuesday, October 26, 2021 - 11:58:59 AM
Last modification on : Thursday, October 28, 2021 - 3:43:09 AM

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  • HAL Id : dumas-03403719, version 1

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Clara Cebron. Bon usage des carbapénèmes en pédiatrie : évaluation des pratiques professionnelles. Médecine humaine et pathologie. 2021. ⟨dumas-03403719⟩

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