A Comprehensive Approach to Pediatric Pneumonia: Relationship Between Standardization, Antimicrobial Stewardship, Clinical Testing, and Cost

Rutman, Lori; Wright, Davene R.; O’Callaghan, James P.; Spencer, Suzanne; Lion, K. Casey; Kronman, Matthew P.; Zhou, Chuan; Mangione-Smith, Rita

doi:10.1097/jhq.0000000000000048

Cited by 16 publications

(30 citation statements)

References 20 publications

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“…All included studies measured costs from the hospital perspective and reported either total hospital costs or per patient costs both pre- and post-intervention. Of 22 studies, 17 measured 20 relevant operational cost outcomes, however only 13 studies including 16 of those outcomes measured the change in operational costs from pre- to post-ASP intervention [7, 25, 56, 70, 86, 92, 93, 100–103, 112, 123]. Most of these studies were from large hospitals with > 1000 beds (40%).…”

Section: Resultsmentioning

confidence: 99%

Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review

Nathwani

Varghese

Stephens

et al. 2019

Antimicrob Resist Infect Control

303

209

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BackgroundHospital antimicrobial stewardship programs (ASPs) aim to promote judicious use of antimicrobials to combat antimicrobial resistance. For ASPs to be developed, adopted, and implemented, an economic value assessment is essential. Few studies demonstrate the cost-effectiveness of ASPs. This systematic review aimed to evaluate the economic and clinical impact of ASPs.MethodsAn update to the Dik et al. systematic review (2000–2014) was conducted on EMBASE and Medline using PRISMA guidelines. The updated search was limited to primary research studies in English (30 September 2014–31 December 2017) that evaluated patient and/or economic outcomes after implementation of hospital ASPs including length of stay (LOS), antimicrobial use, and total (including operational and implementation) costs.ResultsOne hundred forty-six studies meeting inclusion criteria were included. The majority of these studies were conducted within the last 5 years in North America (49%), Europe (25%), and Asia (14%), with few studies conducted in Africa (3%), South America (3%), and Australia (3%). Most studies were conducted in hospitals with 500–1000 beds and evaluated LOS and change in antibiotic expenditure, the majority of which showed a decrease in LOS (85%) and antibiotic expenditure (92%). The mean cost-savings varied by hospital size and region after implementation of ASPs. Average cost savings in US studies were $732 per patient (range: $2.50 to $2640), with similar trends exhibited in European studies. The key driver of cost savings was from reduction in LOS. Savings were higher among hospitals with comprehensive ASPs which included therapy review and antibiotic restrictions.ConclusionsOur data indicates that hospital ASPs have significant value with beneficial clinical and economic impacts. More robust published data is required in terms of implementation, LOS, and overall costs so that decision-makers can make a stronger case for investing in ASPs, considering competing priorities. Such data on ASPs in lower- and middle-income countries is limited and requires urgent attention.

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Section: Resultsmentioning

confidence: 99%

Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review

Nathwani

Varghese

Stephens

et al. 2019

Antimicrob Resist Infect Control

303

209

View full text Add to dashboard Cite

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“…9–12 Also, prior studies that did focus on testing aimed to increase testing, specifically with regard to cultures, rather than decrease testing, which was the aim of the project. 13 To our knowledge, this is also the first study to successfully reduce CXRs for outpatients as recommended by the IDSA. Prior studies have found no reduction in CXRs after guideline release.…”

Section: Discussionmentioning

confidence: 85%

Using Quality Improvement to Change Testing Practices for Community-acquired Pneumonia

Rogers

Lye

Ciener

et al. 2018

Pediatric Quality &Amp; Safety

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“…These studies were published between 2013 [ 24 ] and 2021 [ 25 , 26 ]. Four of the thirteen studies were randomized-control studies [ 25 , 27 , 28 , 29 ], three were cohort studies [ 24 , 30 , 31 ], one was a controlled interrupted time series analysis [ 13 ] and five were noncontrolled before-and-after studies [ 26 , 32 , 33 , 34 , 35 ]. The studies were located in a variety of countries and settings, with eight of thirteen studies being conducted in the United States [ 24 , 27 , 29 , 30 , 31 , 33 , 34 , 35 ], and the other studies being conducted in Taiwan, France, Canada, Japan and the Netherlands [ 13 , 25 , 26 , 28 , 32 ].…”

Section: Resultsmentioning

confidence: 99%

Paediatric Antimicrobial Stewardship for Respiratory Infections in the Emergency Setting: A Systematic Review

2021

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Antimicrobial resistance occurs due to the propensity of microbial pathogens to develop resistance to antibiotics over time. Antimicrobial stewardship programs (ASPs) have been developed in response to this growing crisis, to limit unnecessary antibiotic prescription through initiatives such as education-based seminars, prescribing guidelines, and rapid respiratory pathogen (RRP) testing. Paediatric patients who present to the emergency setting with respiratory symptoms are a particularly high-risk population susceptible to inappropriate antibiotic prescribing behaviours and are therefore an ideal cohort for focused ASPs. The purpose of this systematic review was to assess the efficacy and safety of ASPs in this clinical context. A systematic search of PubMed, Medline, EMBASE and the Cochrane Database of Systematic Reviews was conducted to review the current evidence. Thirteen studies were included in the review and these studies assessed a range of stewardship interventions and outcome measures. Overall, ASPs reduced the rates of antibiotic prescription, increased the prescription of narrow-spectrum antibiotics, and shortened the duration of antibiotic therapy. Multimodal interventions that were education-based and those that used RRP testing were found to be the most effective. Whilst we found strong evidence that ASPs are effective in reducing antibiotic prescribing, further studies are required to assess whether they translate to equivalent clinical outcomes.

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A Comprehensive Approach to Pediatric Pneumonia: Relationship Between Standardization, Antimicrobial Stewardship, Clinical Testing, and Cost

Abstract: Standardizing care for ED and inpatient management of CAP led to immediate and sustained improvements in antimicrobial stewardship and guideline-recommended testing without significantly affecting costs.

Cited by 16 publications

References 20 publications

Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review

Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review

Using Quality Improvement to Change Testing Practices for Community-acquired Pneumonia

Paediatric Antimicrobial Stewardship for Respiratory Infections in the Emergency Setting: A Systematic Review

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