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The Antibiotic Resistance and Prescribing in European Children Project: A Neonatal and Pediatric Antimicrobial Web-based Point Prevalence Survey in 73 Hospitals Worldwide

Versporten, Ann MPH, MEHS*; Sharland, Mike FRCPH; Bielicki, Julia MD, MPH; Drapier, Nico BAI*; Vankerckhoven, Vanessa PhD*; Goossens, Herman MD, PhD*for the ARPEC Project Group Members

The Pediatric Infectious Disease Journal: June 2013 - Volume 32 - Issue 6 - p e242–e253
doi: 10.1097/INF.0b013e318286c612
Antimicrobial Reviews

Background: The neonatal and pediatric antimicrobial point prevalence survey (PPS) of the Antibiotic Resistance and Prescribing in European Children project ( aims to standardize a method for surveillance of antimicrobial use in children and neonates admitted to the hospital within Europe. This article describes the audit criteria used and reports overall country-specific proportions of antimicrobial use. An analytical review presents methodologies on antimicrobial use.

Methods: A 1-day PPS on antimicrobial use in hospitalized children was organized in September 2011, using a previously validated and standardized method. The survey included all inpatient pediatric and neonatal beds and identified all children receiving an antimicrobial treatment on the day of survey. Mandatory data were age, gender, (birth) weight, underlying diagnosis, antimicrobial agent, dose and indication for treatment. Data were entered through a web-based system for data-entry and reporting, based on the WebPPS program developed for the European Surveillance of Antimicrobial Consumption project.

Results: There were 2760 and 1565 pediatric versus 1154 and 589 neonatal inpatients reported among 50 European (n = 14 countries) and 23 non-European hospitals (n = 9 countries), respectively. Overall, antibiotic pediatric and neonatal use was significantly higher in non-European (43.8%; 95% confidence interval [CI]: 41.3–46.3% and 39.4%; 95% CI: 35.5–43.4%) compared with that in European hospitals (35.4; 95% CI: 33.6–37.2% and 21.8%; 95% CI: 19.4–24.2%). Proportions of antibiotic use were highest in hematology/oncology wards (61.3%; 95% CI: 56.2–66.4%) and pediatric intensive care units (55.8%; 95% CI: 50.3–61.3%).

Conclusions: An Antibiotic Resistance and Prescribing in European Children standardized web-based method for a 1-day PPS was successfully developed and conducted in 73 hospitals worldwide. It offers a simple, feasible and sustainable way of data collection that can be used globally.

Supplemental Digital Content is available in the text.

From the *Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; and Infection and Immunity, Division of Clinical Sciences, St. Georges University of London, London, United Kindgom.

Accepted for publication January 08, 2013.

The ARPEC project was cofunded by the European Commission Directorate General for Health and Consumers (DG SANCO) through the Executive Agency for Health and Consumers ( The authors have no other funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Ann Versporten, MPH, MEHS, Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Science, University of Antwerp—CDE, Universiteitsplein 1, Room S6.23, B-2610 Antwerp, Belgium. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.