Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections

Abstract

The effectiveness of antimicrobial stewardship programs (ASP) in reducing antimicrobial use (AU) in children has been proved. Many interventions have been described suitable for different institution sizes, priorities, and patients, with surgical wards being one of the areas that may benefit the most. We aimed to describe the results on AU and length of stay (LOS) in a pre-post study during the three years before (2014–2016) and the three years after (2017–2019) implementation of an ASP based on postprescription review with feedback in children and adolescents admitted for appendix-related intraabdominal infections (AR-IAI) in a European Referral Paediatric University Hospital. In the postintervention period, the quality of prescriptions (QP) was also evaluated. Overall, 2021 AR-IAIs admissions were included. Global AU, measured both as days of therapy/100 patient days (DOT/100PD) and length of therapy (LOT), and global LOS remained unchanged in the postintervention period. Phlegmonous appendicitis LOS (p = 0.003) and LOT (p < 0.001) significantly decreased, but not those of other AR-IAI diagnoses. The use of piperacillin–tazobactam decreased by 96% (p = 0.044), with no rebound in the use of other Gram-negative broad-spectrum antimicrobials. A quasisignificant (p = 0.052) increase in QP was observed upon ASP implementation. Readmission and case fatality rates remained stable. ASP interventions were safe, and they reduced LOS and LOT of phlegmonous appendicitis and the use of selected broad-spectrum antimicrobials, while increasing QP in children with AR-IAI.

Assessment of the Plans to Optimize Antimicrobial Use in the Pediatric Population in Catalan Hospitals: The VINCat Pediatric PROA SHARP Survey

“…In pediatric populations, infectious diseases are among the main causes of hospitalization and consultation, and antibiotics are the main therapeutic option in primary and hospital care [2,8]. The specific features of infectious diseases in pediatric patients, and the differences in the efficacy and safety of antimicrobials in this population with respect to adults, have contributed to the significant increase in PROA designed for children in recent years [2,[9][10][11][12][13][14][15].…”

“…Several studies have evaluated the implementation and development of pediatric antimicrobial stewardship programs, above all in the US [19][20][21][22]. In Spain, information on the current state of pediatric PROA is scarce, both at national and at regional level [10,14,15,19]. The objective of this study is to assess the current status of pediatric PROA in the network of hospitals belonging to the VINCat pediatric PROA group, outlining the resources available for their implementation and development and describing the various activities carried out.…”

Antimicrobial use among paediatric inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program, 2017/2018

“…Antimicrobial stewardship programs aim to find a balance between the "potent ability of antibiotics for individual patients and their potentially hazardous effects" [28]. Paediatric stewardship programs optimize how and when antimicrobials are used and have been shown to reduce inappropriate prescriptions [29] and to reduce antibiotic consumption [30][31][32][33]. Paediatric antimicrobial stewardship programs can improve patient outcomes and reduce costs [34,35].…”