Results of a pilot project of microbial therapy management at the children’s hospital
- Authors: Vlasova A.V.1,2,3, Smirnova E.V.1, Volkova N.N.1, Dymnova L.V.1, Angel A.E.1, Romanova Y.V.1, Rakhalina A.A.1, Sharshakova A.A.1, Gorev V.V.1, Zhuravleva M.V.4,5
-
Affiliations:
- Morozov Children’s Clinical Hospital of the Moscow Healthcare Department
- Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department
- Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation
- Scientific Centre for Expert Evaluation of Medicinal Products
- I.M. Sechenov First Moscow State Medical University
- Issue: Vol 67, No 5 (2023)
- Pages: 397-402
- Section: HEALTH CARE ORGANIZATION
- Submitted: 25.10.2024
- URL: https://hum-ecol.ru/0044-197X/article/view/638054
- DOI: https://doi.org/10.47470/0044-197X-2023-67-5-397-402
- EDN: https://elibrary.ru/ksadzl
- ID: 638054
Cite item
Full Text
Abstract
Introduction. In multidisciplinary pediatric hospitals in Russia, the prerequisite for the formation of principles of antimicrobial therapy management as a medical technology, implemented with the participation of a clinical pharmacologist became possible on the basis of updated clinical and pharmacological tools proposed by the World Health Organization (WHO) in 2019.
Purpose. The project goal is to show the possibilities of control of antimicrobial therapy, as a medical technology in multidisciplinary children’s hospitals to improve adherence to domestic clinical recommendations in the actual clinical practice of implementing antibiotic therapy management programs in children on the profile of «Pediatrics».
Material and methods. The pilot scheme was implemented from 2019 to 2021 on the basis of the Morozov Children’s Clinical Hospital by methods of WHO AWaRe and points estimation of prevalence of antibiotic use according to WHO tool checklist in dynamics. Regulatory documents of medical organization (MO) were formed, which ensured transition from traditional to new approaches within 3 years from 2019 to 2021 to maintain clinical practice of antibiotic use based on clinical guidelines.
Results. A comparative study of clinical antibiotic use in children “before” the project in 2019 and “after” in 2021 showed a 2.7-fold decrease in antibiotic use by absolute DDDs from 65.99 in 2019 to 24.34 in 2021. DDDs per 100 p/d. By WHO AWaRe method for absolute values of antibiotics in the “Tolerance” category, a 2-fold decrease in consumption and a 5-fold decrease in consumption for absolute values of antibiotics in the “Control” category: in 2019. — 41.13% (abs. 27.55 PDT per 100 p/d) and in 2021. — 60.1% (abs. 4.64 PDT per 100 p/d). Consumption of “Reserve” category antibiotics by absolute values has not changed.
Limitations. This publication describes one medical institution in which this project was implemented, which somewhat reduces the value of the results obtained.
Conclusion. As a result of the implementation of the principles of managing antimicrobial therapy, this pilot project was able to reduce the irrational use of antibiotics in the pediatric hospital.
Compliance with ethical standards. The study does not require submission of the opinion of the biomedical ethics committee or other documents.
Contribution of the authors:
Vlasova A.V. — research concept and design of the study, collection and processing of material, writing the text;
Smirnova E.V. — statistical data processing, editing;
Volkova N.N. — compilation of a list of references;
Dymnova L.V. — editing, responsibility for the integrity of all parts of the article;
Romanova Yu.V. — collection and processing of material;
Rakhalina A.A. — collection and processing of material;
Sharshakova A.A. — collection and processing of material;
Angel A.E., Gorev V.V., Zhuravleva M.V. — approval of the final version of the article, responsibility for the integrity of all parts of the article.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.
Acknowledgment. The study had no sponsorship.
Conflict of interest. The authors declare no conflict of interest.
Received: June 22, 2023
Accepted: August 23, 2023
Published: November 3, 2023
Keywords
About the authors
Anna V. Vlasova
Morozov Children’s Clinical Hospital of the Moscow Healthcare Department; Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation
Author for correspondence.
Email: annavlasova75@mail.ru
ORCID iD: 0000-0001-5272-2070
MD, PhD, Head of the Clinical pharmacology department, Morozov Children’s Clinical Hospital of the Moscow Healthcare Department, Moscow, 119049, Russian Federation.
e-mail: annavlasova75@mail.ru
Russian FederationElena V. Smirnova
Morozov Children’s Clinical Hospital of the Moscow Healthcare Department
Email: noemail@neicon.ru
Russian Federation
Nadezda N. Volkova
Morozov Children’s Clinical Hospital of the Moscow Healthcare Department
Email: noemail@neicon.ru
ORCID iD: 0000-0001-5821-9468
Russian Federation
Liliya V. Dymnova
Morozov Children’s Clinical Hospital of the Moscow Healthcare Department
Email: noemail@neicon.ru
ORCID iD: 0000-0002-4815-3204
Russian Federation
Andrey E. Angel
Morozov Children’s Clinical Hospital of the Moscow Healthcare Department
Email: noemail@neicon.ru
ORCID iD: 0000-0003-1287-3039
Russian Federation
Yulia V. Romanova
Morozov Children’s Clinical Hospital of the Moscow Healthcare Department
Email: noemail@neicon.ru
ORCID iD: 0009-0007-1937-8168
Russian Federation
Antonina A. Rakhalina
Morozov Children’s Clinical Hospital of the Moscow Healthcare Department
Email: noemail@neicon.ru
ORCID iD: 0000-0002-3263-5145
Russian Federation
Anastasia A. Sharshakova
Morozov Children’s Clinical Hospital of the Moscow Healthcare Department
Email: noemail@neicon.ru
ORCID iD: 0009-0002-0321-7400
Russian Federation
Valerii V. Gorev
Morozov Children’s Clinical Hospital of the Moscow Healthcare Department
Email: noemail@neicon.ru
ORCID iD: 0000-0001-8272-3648
Russian Federation
Marina V. Zhuravleva
Scientific Centre for Expert Evaluation of Medicinal Products; I.M. Sechenov First Moscow State Medical University
Email: noemail@neicon.ru
ORCID iD: 0000-0002-9198-8661
Russian Federation
References
- Berrington A. Antimicrobial prescribing in hospitals: be careful what you measure. J. Antimicrob. Chemother. 2010; 65(1): 163–8. https://doi.org/10.1093/jac/dkp399
- WHO. Review of antibiotics in National Medicines Selection Lists in eastern Europe and central Asia; 2023. Available at: https://www.who.int/europe/publications/i/item/9789289058582
- WHO. Global action plan on antimicrobial resistance; 2016. Available at: https://www.who.int/publications/i/item/9789241509763
- Natsch S., Hekster Y.A., de Jong R., Heerdink E.R., Herings R.M., van der Meer J.W. Application of the ATC/DDD methodology to monitor antibiotic drug use. Eur. J. Clin. Microbiol. Infect. Dis. 1998; 17(1): 20–4. https://doi.org/10.1007/BF01584358
- WHO. The 2019 WHO AWaRe classification of antibiotics for evaluation and monitoring of use; 2019. Available at: https://iris.who.int/handle/10665/327957
- Romanov B.K., Olefir Yu.V., Alyautdin R.N., Glagolev S.V., Polivanov V.A., Ilienko L.I., et al. Drug safety for children – international monitoring data for 50 years. Bezopasnost’ i risk farmakoterapii. 2019; 7(2): 57–64. https://doi.org/10.30895/2312-7821-2019-7-2-57-64 https://elibrary.ru/clsfrz (in Russian)
- Kolbin A.S., Belousov D.Yu. Brief report of real-world evidence development (RWD/RWE) in 2021: United States, Russia, and the Eurasian Economic Union (EAEU). Real’naya klinicheskaya praktika: dannye i dokazatel’stva. 2022; 2(1): 1–9. https://doi.org/10.37489/2782-3784-myrwd-6 https://elibrary.ru/fzczwc (in Russian)
- Sychev D.A. Polypharmacy in Clinical Practice: Problem and Solutions [Polipragmaziya v klinicheskoy praktike: problema i resheniya]. Moscow; 2016. (in Russian)
- Wang S.V., Pinheiro S., Hua W., Arlett P., Uyama Y., Berlin J.A., et al. STaRT-RWE: structured template for planning and reporting on the implementation of real world evidence studies. BMJ. 2021; 372: m4856. https://doi.org/10.1136/bmj.m4856
- Baker C., Feinstein J.A., Ma X., Bolen S., Dawson N.V., Golchin N., et al. Variation of the prevalence of pediatric polypharmacy: A scoping review. Pharmacoepidemiol. Drug Saf. 2019; 28(3): 275–87. https://doi.org/10.1002/pds.4719
- Hsia Y., Lee B.R., Versporten A., Yang Y., Bielicki J., Jackson C., et al. Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries. Lancet Glob. Health. 2019; 7(7): e861–71. https://doi.org/10.1016/s2214-109x(19)30071-3
Supplementary files
