Antimicrobial Stewardship in Pediatric Care: Strategies and Future Directions

Newland, Jason G.; Banerjee, Ritu; Gerber, Jeffrey S.; Hersh, Adam L.; Steinke, Leah; Weissman, Scott J.

doi:10.1002/j.1875-9114.2012.01155.x

Cited by 25 publications

(28 citation statements)

References 61 publications

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“…1 ASPs have proven beneficial in reducing the frequency and duration of target drug prescribing, occurrence of antiinfective-related infectious complications (eg, Clostridium difficile-associated disease) and health care costs with recent attention focusing on the role of ASP in quality improvement and patient safety. 2 ASP programs in pediatric institutions have also favorably affected antimicrobial usage [3][4][5][6][7] and recommendations for ASP development specific to pediatrics have been authored, 8,9 citing the importance of participation of an infectious disease (ID) physician and a trained clinical pharmacist. 3,4 However, limited availability of pediatric ID trained pharmacists and limited institutional resources may require modification of this classic ASP model.…”

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confidence: 99%

“…3,4 However, limited availability of pediatric ID trained pharmacists and limited institutional resources may require modification of this classic ASP model. 1,[8][9][10] In 2008, the Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center (UPMC) established an innovative collaborative model of shared ASP responsibilities by ID physicians and service-based clinical pharmacists under the direction of an ID physician leader and advisory committee. The program was developed from its onset to leverage the hospital's electronic medical record (EMR) and data warehouse to facilitate ongoing evaluations of the ASP to inform potential additional interventions.…”

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confidence: 99%

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A Quality Assessment of a Collaborative Model of a Pediatric Antimicrobial Stewardship Program

et al. 2016

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BACKGROUND: Infectious Diseases Society of America guidelines recommend that key antimicrobial stewardship program (ASP) personnel include an infectious disease (ID) physician leader and dedicated ID-trained clinical pharmacist. Limited resources prompted development of an alternative model by using ID physicians and service-based clinical pharmacists at a pediatric hospital. The aim of this study was to analyze the effectiveness and impact of this alternative ASP model. METHODS: The collaborative ASP model incorporated key strategies of education, antimicrobial restriction, day 3 audits, and practice guidelines. High-use and/or high-cost antimicrobial agents were chosen with audits targeting vancomycin, caspofungin, and meropenem. The electronic medical record was used to identify patients requiring day 3 audits and to communicate ASP recommendations. Segmented regression analyses were used to analyze quarterly antimicrobial agent prescription data for the institution and selected services over time. RESULTS: Initiation of ASP and day 3 auditing was associated with blunting of a preexisting increasing trend for caspofungin drug starts and use and a significant downward trend for vancomycin drug starts (relative change –12%) and use (–25%), with the largest reduction in critical care areas. Although meropenem use was already low due to preexisting requirements for preauthorization, a decline in drug use (–31%, P = .021) and a nonsignificant decline in drug starts (–21%, P = .067) were noted. A 3-month review of acceptance of ASP recommendations found rates of 90%, 93%, and 100% for vancomycin, caspofungin, and meropenem, respectively. CONCLUSIONS: This nontraditional ASP model significantly reduced targeted drug usage demonstrating acceptance of integration of service-based clinical pharmacists and ID consultants.

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A Quality Assessment of a Collaborative Model of a Pediatric Antimicrobial Stewardship Program

et al. 2016

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“…[23] However, although ASPs can be effective in improving the quality and safety of antimicrobial prescribing for hospitalized patients, there are unique issues relevant to children and pediatric ASPs are still in their infancy. [24]…”

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confidence: 99%

A study of antimicrobial use in children admitted to pediatric medicine ward of a tertiary care hospital

et al. 2017

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“…Although the guidelines are supported by a few pediatric‐focused studies, much of the evidence backing the recommendations is based on antimicrobial stewardship interventions in adult patients. In response to increasing recognition of the unique issues faced in pediatrics, the PIDS created a committee in 2010 that is targeted to advancing antimicrobial stewardship education and research in addition to the development of ASPs to address a variety of pediatric patients: inpatients, outpatients, and special populations (e.g., patients with cystic fibrosis) . The growth of pediatric ASPs has been gaining traction with greater awareness of the unique infectious diseases issues in children .…”

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Making a Case for Pediatric Antimicrobial Stewardship Programs

et al. 2015

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Although antimicrobials are commonly used in children, it is important to remember that they can have a profound impact on this unique patient population. Inadvertent consequences of antiinfective use in children include antimicrobial resistance, infection caused by Clostridium difficile, increased risk of obesity, and adverse drug events. In addition, compared with adults, children have different dosing requirements, antimicrobial formulation needs, pharmacokinetics, and antimicrobial susceptibility profiles. Therefore, pediatric-specific antimicrobial stewardship efforts are needed to promote appropriate use of antimicrobials in children. The primary purposes of this review article are to provide a rationale behind pediatric-focused antimicrobial stewardship and to describe currently available evidence regarding the initiatives of pediatric antimicrobial stewardship programs (ASPs). A literature search of the Medline database was performed (from inception through March 2015). The studies included in this review focus on antimicrobial stewardship interventions in inpatient pediatric settings. Ten inpatient studies involving pediatric-focused antimicrobial stewardship interventions were identified from the published literature. Four studies used the core strategy of prospective audit with feedback; two used prior approval. The remaining four used supplemental antimicrobial stewardship strategies (guidelines, clinical pathways, and computerized decision support tools). In general, the interventions resulted in decreased antimicrobial use, reduced antimicrobial costs, and fewer prescribing errors. Children have unique medical needs related to antimicrobials and deserve focused ASP efforts. The literature regarding pediatric antimicrobial stewardship interventions is limited, but published interventions may serve as paradigms for developing pediatric ASPs as demonstrated by the general success of these interventions.

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Antimicrobial Stewardship in Pediatric Care: Strategies and Future Directions

Cited by 25 publications

References 61 publications

A Quality Assessment of a Collaborative Model of a Pediatric Antimicrobial Stewardship Program

A Quality Assessment of a Collaborative Model of a Pediatric Antimicrobial Stewardship Program

A study of antimicrobial use in children admitted to pediatric medicine ward of a tertiary care hospital

Making a Case for Pediatric Antimicrobial Stewardship Programs

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