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

Abstract

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.

Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review

“…When comparing the impact of ASP in NICU versus paediatric ICU settings, NICU ASPs appear to achieve more reduction in antibiotic consumption and use of broad-spectrum/restricted agents 25. However, there are extremely few published reports of NICU ASP and recent reports from PICUs that have achieved reduced antibiotic consumption and use of broad-spectrum antibiotics 25 36 37…”

Airway multidrug‐resistant organisms in a population of tracheostomy and chronic ventilator‐dependent children at a tertiary care pediatric hospital

“…Tracheostomy and ventilator‐dependent children are frequently prescribed broad‐spectrum empiric antibiotics for illnesses 7,11,12 . Frequent and prolonged use of antibiotics is associated with emergence of antibiotic resistance in numerous patient populations, 13–15 but there is a paucity of data specific to tracheostomy and ventilator‐dependent children.…”

“…T A B L E 5 Pair-wise comparison of hospitalizations, ED visits, and antibiotic use per year between pre-MDRO and post-MDRO Tracheostomy and ventilator-dependent children are frequently prescribed broad-spectrum empiric antibiotics for illnesses. 7,11,12 Frequent and prolonged use of antibiotics is associated with emergence of antibiotic resistance in numerous patient populations, [13][14][15] but there is a paucity of data specific to tracheostomy and ventilator-dependent children. Our study found that increased antibiotic usage and episodes of hospitalization put these patients at risk of MDROs.…”

Antimicrobial stewardship program in pediatric medicine

“…Given multiple risk factors, medical providers are often hesitant to follow ASP recommendations for de‐escalation or discontinuation of antimicrobial therapy. Although there is a lack of sufficient data about the efficacy of implementation of ASP initiatives in special populations (neonates, immunocompromised), some reports show that following ASP recommendations at least did not result in poor clinical outcomes 51 …”

“…Although there is a lack of sufficient data about the efficacy of implementation of ASP initiatives in special populations (neonates, immunocompromised), some reports show that following ASP recommendations at least did not result in poor clinical outcomes. 51 …”