Antimicrobial Stewardship Program in a Pediatric Intensive Care Unit

Aizawa, Yuta; Suwa, Junichi; Handa, Hiroshi; Fukuoka, Kahoru; Furuichi, Mihoko; Kaneko, Tetsuji; Morikawa, Yoshihiko; Okazaki, Kaoru; Shimizu, Naoki; Horikoshi, Yuho

doi:10.1093/jpids/piy031

Cited by 20 publications

(29 citation statements)

References 12 publications

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“…6 Our results corroborate previous reports in high-risk populations that have shown that ASPs do not result in higher mortality or readmissions. 6,23 Additionally in our study, patients with a single ASP review and agreed upon recommendations had a shorter LOS, which further highlights the potential benefits of the ASP.…”

Section: Discussionsupporting

confidence: 61%

“…11 Hesitation by physicians to de-escalate or stop antimicrobials because of disease severity, especially in highrisk patients, can be challenging for ASP teams. 23 Thus, demonstrating that stewardship efforts, including the recommendation to stop therapy, do not result in increased morbidity or mortality is important. A recent systematic review and meta-analysis of audit with feedback in the ICU setting, using mortality as the outcome, did not identify an increased risk of death with ASP prospective audit with feedback.…”

Section: Discussionmentioning

confidence: 99%

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Clinical impact of an antimicrobial stewardship program on high-risk pediatric patients

Goldman

Newland

Price

et al. 2019

Infect. Control Hosp. Epidemiol.

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Objective:To evaluate the clinical impact of an antimicrobial stewardship program (ASP) on high-risk pediatric patients.Design:Retrospective cohort study.Setting:Free-standing pediatric hospital.Patients:This study included patients who received an ASP review between March 3, 2008, and March 2, 2017, and were considered high-risk, including patients receiving care by the neonatal intensive care (NICU), hematology/oncology (H/O), or pediatric intensive care (PICU) medical teams.Methods:The ASP recommendations included stopping antibiotics; modifying antibiotic type, dose, or duration; or obtaining an infectious diseases consultation. The outcomes evaluated in all high-risk patients with ASP recommendations were (1) hospital-acquired Clostridium difficile infection, (2) mortality, and (3) 30-day readmission. Subanalyses were conducted to evaluate hospital length of stay (LOS) and tracheitis treatment failure. Multivariable generalized linear models were performed to examine the relationship between ASP recommendations and each outcome after adjusting for clinical service and indication for treatment.Results:The ASP made 2,088 recommendations, and 50% of these recommendations were to stop antibiotics. Recommendation agreement occurred in 70% of these cases. Agreement with an ASP recommendation was not associated with higher odds of mortality or hospital readmission. Patients with a single ASP review and agreed upon recommendation had a shorter median LOS (10.2 days vs 13.2 days; P < .05). The ASP recommendations were not associated with high rates of tracheitis treatment failure.Conclusions:ASP recommendations do not result in worse clinical outcomes among high-risk pediatric patients. Most ASP recommendations are to stop or to narrow antimicrobial therapy. Further work is needed to enhance stewardship efforts in high-risk pediatric patients.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Clinical impact of an antimicrobial stewardship program on high-risk pediatric patients

Goldman

Newland

Price

et al. 2019

Infect. Control Hosp. Epidemiol.

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“…Prospective audit and feedback has previously been proposed as an antibiotic stewardship intervention in adults and children [24][25][26] . However, the impact of this type of intervention in the PICU setting is not known, with only a limited number of published reports related to PICUs 3,[17][18][19][20][21] . In this study, complete or partial adherence (at least one out of two recommendations followed) to the given antibiotic stewardship recommendations was 79%.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic stewardship in the PICU: Impact of ward rounds led by paediatric infectious diseases specialists on antibiotic consumption

Renk

Sarmisak

Spott

et al. 2020

Sci Rep

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Antimicrobial stewardship programmes (ASp) are aimed at optimising antimicrobial utilization. However, only few studies have focused on paediatric intensive care units (picU), where inappropriate antibiotic use occurs frequently. We assessed the effect and safety of a once weekly paediatric infectious disease (piD) ward round with prospective audit and feedback on antibiotic consumption in a multidisciplinary PICU. This study was conducted within 6-months periods before and after the implementation of a weekly PID-ward round. Antimicrobial management and two main recommendations per patient were discussed and documented. the primary outcome was antimicrobial utilization, measured by days of therapy (DoT) and length of therapy (LoT) per 1000 patient days (PD) for all PICU stays. Secondary outcomes included PICU mean length of stay, total mortality, infectionrelated mortality and cost of therapy. 1964 PD were analyzed during the pre-and 1866 PD during the post-implementation phase. Adherence to the recommendations was 79%. An 18% reduction of DoT/1000 PD was observed in the post-implementation period (p = 0.005). LoT/1000 PD decreased by 11% (p = 0.09). Meropenem and vancomycin usage were reduced by 49% (p = 0.07) and 56% (p = 0.03), respectively. We conclude, that a once weekly PID-ward round with prospective audit and feedback is safe and effective and reduces antibiotic consumption in PICUs.

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“…5,7 After 5 years of handshake stewardship, MacBrayne et al 8 reported 25% reduction in antimicrobial use, demonstrating sustainable efficacy of handshake stewardship. Variations in handshake stewardship exist in numerous centers, targeting different services, [9][10][11] or entire hospitals. 12,13 Anecdotally, the success of handshake stewardship lies in the ongoing face-to-face interaction between the antimicrobial stewardship program and medical teams, fostering collaboration and promoting real-time education about optimal antimicrobial management.…”

mentioning

confidence: 99%

Physician experiences implementing antimicrobial stewardship rounds in pediatric hospital medicine: An exploratory, qualitative study

McCreary

Tse-Chang

Forbes

et al. 2021

ASHE

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Objectives: An antimicrobial stewardship intervention was implemented for pediatric medicine units using an in-person rounds-based approach to provide stewardship recommendations and education from an antimicrobial stewardship physician and antimicrobial stewardship pharmacist. Design, Setting, Participants, and Methods: In this exploratory qualitative study, purposeful sampling was used to recruit participants for individual interviews at a tertiary- and quaternary-care referral center. Pediatricians and residents who attended ≥1 stewardship round were included. A semistructured interview guide was created focusing on perceptions of antimicrobial stewardship, personal experiences at stewardship rounds, and perceived impacts on patient care. Using a constant comparative analysis approach, codes were developed and collapsed into themes. Results: Overall, 8 pediatricians and 10 residents completed interviews. Qualitative analysis yielded 3 themes: insights into clinical reasoning, opportunity for growth and learning, and establishing and exploring professional relationships. The handshake-rounds approach encouraged participants to critically evaluate antimicrobial choices and to engage in discussion with the antimicrobial stewardship team. Participants felt validated at stewardship rounds and gained confidence prescribing antimicrobials. Face-to-face interaction reduced reluctance for some participants to consult infectious disease (ID) service; however, others worried that physicians may avoid ID consultation because of stewardship rounds. Conclusions: Participants found stewardship rounds to be an effective strategy for education and development of clinical reasoning skills for optimal antimicrobial prescribing—choosing wisely or choosing rightly. The effects of stewardship rounds on timing and frequency of ID consultation are interesting. Further research into important patient outcomes and consultation practices are needed locally, but our experiences may help others to reflect on the power of conversation and relationships in antimicrobial stewardship.

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Antimicrobial Stewardship Program in a Pediatric Intensive Care Unit

Cited by 20 publications

References 12 publications

Clinical impact of an antimicrobial stewardship program on high-risk pediatric patients

Clinical impact of an antimicrobial stewardship program on high-risk pediatric patients

Antibiotic stewardship in the PICU: Impact of ward rounds led by paediatric infectious diseases specialists on antibiotic consumption

Physician experiences implementing antimicrobial stewardship rounds in pediatric hospital medicine: An exploratory, qualitative study

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