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Prior antibiotic use and acquisition of multidrug-resistant organisms in hospitalized children: A systematic review

Published online by Cambridge University Press:  30 July 2019

Meghan T. Murray ,
Melissa P. Beauchemin ,
Natalie Neu  and
Elaine L. Larson
Meghan T. Murray*
Affiliation:
School of Nursing, Columbia University Medical Center, New York, New York
Melissa P. Beauchemin
Affiliation:
School of Nursing, Columbia University Medical Center, New York, New York
Natalie Neu
Affiliation:
Department of Pediatrics, Columbia University Medical Center, New York, New York
Elaine L. Larson
Affiliation:
School of Nursing, Columbia University Medical Center, New York, New York
*
Author for correspondence: Meghan T. Murray, Email: mtm2164@cumc.columbia.edu
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Abstract

Objective:

Multidrug-resistant organisms (MDROs) cause ~5%–10% of infections in hospitalized children, leading to an increased risk of death, prolonged hospitalization, and additional costs. Antibiotic exposure is considered a driving factor of MDRO acquisition; however, consensus regarding the impact of antibiotic factors, especially in children, is lacking. We conducted a systematic review to examine the relationship between antibiotic use and subsequent healthcare-associated infection or colonization with an MDRO in children.

Design:

Systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline.

Methods:

We searched PubMed and Embase for all English, peer-reviewed original research studies published before September 2018. Included studies evaluated hospitalized children, antibiotic use as an exposure, and bacterial MDRO as an outcome.

Results:

Of the 535 studies initially identified, 29 met the inclusion criteria. Overall, a positive association was identified in most studies evaluating a specific antibiotic exposure (17 of 21, 81%), duration of antibiotics (9 of 12, 75%), and number of antibiotics received (2 of 3, 67%). Those studies that evaluated any antibiotic exposure had mixed results (5 of 10, 50%). Study sites, populations, and definitions of antibiotic use and MDROs varied widely.

Conclusions:

Published studies evaluating this relationship are limited and are of mixed quality. Limitations include observation bias in recall of antibiotic exposure, variations in case definitions, and lack of evaluation of antibiotic dosing and appropriateness. Additional studies exploring the impact of antibiotic use and MDRO acquisition may be needed to develop effective antibiotic stewardship programs for hospitalized children.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 10 , October 2019 , pp. 1107 - 1115
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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