Use of the World Health Organization Access, Watch, and Reserve Classification to Follow Trends in Prescription of Antibiotic Use in Two Pediatric Intensive Care Units in Rio de Janeiro, Brazil
18 September 2019
10 January 2020
12 February 2020 (online)
Objective The recommended percentage of antibiotic use in pediatric intensive care units (PICUs) using the World Health Organization (WHO) Access, Watch, and Reserve (AWaRE) classification is not known.
Methods We have conducted an interrupted time series analysis in two PICUs in Rio de Janeiro, Brazil, over a period of 18 months. The type of antibiotics used was evaluated using the WHO AWaRE classification, and the amount of antibiotic was measured using days of therapy/1,000 patient-days (DOT/1000PD) after implementation of an antimicrobial stewardship program (ASP). The first and last semesters were compared using medians and the Mann–Whitney's test. The trends of antibiotic consumption were performed using time series analysis in three consecutive 6-month periods.
Results A total of 2,205 patients were admitted, accounting for 12,490 patient-days. In PICU 1, overall antibiotic consumption (in DOT/1000PD) was 1,322 in the first 6 months of analysis and 1,264.5 in the last 6 months (p = 0.81). In PICU 2, the consumption for the same period was 1,638.5 and 1,344.5, respectively (p = 0.031). In PICU 1, the antibiotics classified in the AWaRE groups were used 33.2, 57.9, and 8.4% of the time, respectively. The remaining 0.5% of antibiotics used were not classified in any of these groups. In PICU 2, the AWaRE groups corresponded to 30.2, 60.5, and 9.3% of all antibiotics used, respectively. There was no use of unclassified antibiotics in this unit. The use of all three groups of WHO AWaRE antibiotics was similar in the first and the last semesters, with the exception of Reserve group in PICU 2 (183.5 × 92, p = 0.031).
Conclusion A significant reduction of overall antibiotic use and also in the Reserve group was achieved in one of the PICU units studied. The antibiotics classified in the Watch group were the most used in both units, representing ∼60% of all the antibiotics consumed.
Our research was conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
- 1 Ten threats to global health in 2019. World Health Organization (WHO); Geneva: 2019. . Available at: https://www.who.int/emergencies/ten-threats-to-global-health-in-2019 . Accessed August 27, 2019
- 2 Antimicrobial Resistance. Library of national action plans. World Health Organization (WHO); Geneva: 2019. . Available at: https://www.who.int/antimicrobial-resistance/national-action-plans/library/en/ . Accessed August 25, 2019
- 3 Theuretzbacher U. Global antimicrobial resistance in Gram-negative pathogens and clinical need. Curr Opin Microbiol 2017; 39: 106-112
- 4 Sharland M, Pulcini C, Harbarth S. , et al; 21st WHO Expert Committee on Selection and Use of Essential Medicines. Classifying antibiotics in the WHO Essential Medicines List for optimal use-be AWaRe. Lancet Infect Dis 2018; 18 (01) 18-20
- 5 Hsia Y, Lee BR, Versporten A. , et al; GARPEC and Global-PPS networks. 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 (07) e861-e871
- 6 Hsia Y, Sharland M, Jackson C, Wong ICK, Magrini N, Bielicki JA. Consumption of oral antibiotic formulations for young children according to the WHO Access, Watch, Reserve (AWaRe) antibiotic groups: an analysis of sales data from 70 middle-income and high-income countries. Lancet Infect Dis 2019; 19 (01) 67-75
- 7 Polk RE, Fox C, Mahoney A, Letcavage J, MacDougall C. Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy. Clin Infect Dis 2007; 44 (05) 664-670
- 8 Principi N, Esposito S. Antimicrobial stewardship in paediatrics. BMC Infect Dis 2016; 16 (01) 424
- 9 Arora V, Strunk D, Furqan SH. , et al. Optimizing antibiotic use for early onset sepsis: a tertiary NICU experience. J Neonatal Perinatal Med 2019; 12 (03) 301-312
- 10 Adams SM, Ngo L, Morphew T, Babbitt CJ. Does an antimicrobial time-out impact the duration of therapy of antimicrobials in the PICU?. Pediatr Crit Care Med 2019; 20 (06) 560-567
- 11 Budd E, Cramp E, Sharland M. , et al. Adaptation of the WHO essential medicines list for national antibiotic stewardship policy in England: being AWaRe. J Antimicrob Chemother 2019; 74 (11) 3384-3389