Antimicrobial stewardship programs aim at reducing the overuse of broad-spectrum antibiotics such as carbapenems, but their impact remains unclear. We compared the use of carbapenems between paediatric and adult subjects admitted to a French tertiary hospital and described the intervention of an antibiotic stewardship team (AST). As part of AST routine activity, all adult and paediatric patients receiving carbapenems are identified in real time using a computer-generated alert system and reviewed by the AST. Data associated with carbapenem prescriptions were extracted for 2 years (2014–2015) and were compared between paediatric and adult wards. Prescription appropriateness (i.e. no clinically suitable narrower spectrum alternative to carbapenem for de-escalation) and AST intervention were analysed. In total, 775 carbapenem prescriptions for 291 children and 262 adults were included. Most patients (95%) had a comordity and 52% had known recent carriage of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBLE). Most carbapenem prescriptions came from intensive care units (n = 269, 35%) and were initiated for urinary tract (n = 200, 27%), sepsis (n = 181, 25%), and lung (n = 153, 21%) infections. Carbapenems were initiated empirically in 537 (70%) cases, and an organism was isolated in 523 (67%) cases. Among the isolated organisms, 47% (n = 246) were ESBLE and 90% (n = 468) were susceptible to carbapenems, but an alternative existed in 61% (n = 320) of cases according to antibiotic susceptibility testing. Among prescriptions reviewed by the AST, 39% (n = 255) were considered non-appropriate and led to either antibiotic discontinuation (n = 47, 7%) or de-escalation (n = 208, 32%). Non-appropriate prescriptions were more frequent in paediatric wards (p = 0.01) and in microbiologically documented infections (p = 0.013), and less observed in immunocompromised patients (p = 0.009) or with a known ESBLE carriage (p < 0.001). Tailored stewardship programs are essential to better control carbapenem use and subsequent antimicrobial resistance.

抗菌药物管理计划旨在减少碳青霉烯类等广谱抗生素的过度使用，但其影响尚不清楚。我们比较了法国一家三级医院收治的儿科和成人受试者使用碳青霉烯类药物的情况，并描述了抗生素管理小组 (AST) 的干预措施。作为 AST 常规活动的一部分，所有接受碳青霉烯类药物治疗的成人和儿童患者都会使用计算机生成的警报系统进行实时识别，并由 AST 进行审查。提取了 2 年（2014-2015 年）与碳青霉烯类处方相关的数据，并在儿科病房和成人病房之间进行了比较。对处方的适用性（即没有临床上适合的窄谱碳青霉烯降阶梯替代品）和 AST 干预进行了分析。总共，包括 291 名儿童和 262 名成人的 775 份碳青霉烯类处方。大多数患者 (95%) 有合并症，52% 知道近期携带超广谱 β-内酰胺酶肠杆菌科(ESBLE)。大多数碳青霉烯类处方来自重症监护病房 ( n  = 269, 35%) 并且开始用于泌尿道 ( n  = 200, 27%)、败血症 ( n  = 181, 25%) 和肺 ( n  = 153, 21% ) ）感染。在 537 例 (70%) 病例中凭经验开始使用碳青霉烯类药物，在 523 例 (67%) 病例中分离出一种生物体。在分离出的微生物中，47% ( n  = 246) 是 ESBLE，90% ( n = 468) 对碳青霉烯类药物敏感，但 根据抗生素敏感性测试，61% ( n = 320) 的病例 存在替代物。在 AST 审查的处方中，39% ( n = 255) 被认为是不合适的，导致抗生素停用 ( n  = 47, 7%) 或降级 ( n  = 208, 32%)。不适当的处方在儿科病房 ( p  = 0.01) 和微生物学记录的感染 ( p  = 0.013) 中更为常见，而在免疫功能低下的患者 ( p  = 0.009) 或已知携带 ESBLE 的患者中较少观察到 ( p  < 0.001)。量身定制的管理计划对于更好地控制碳青霉烯类药物的使用和随后的抗菌素耐药性至关重要。