Expanding Existing Antimicrobial Stewardship Programs in Pediatrics: What Comes Next

Abstract

The prevalence of pediatric antimicrobial stewardship programs (ASPs) is increasing in acute care facilities across the United States. Over the past several years, the evidence base used to inform effective stewardship practices has expanded, and regulatory interest in stewardship programs has increased. Here, we review approaches for established, hospital-based pediatric ASPs to adapt and report standardized metrics, broaden their reach to specialized populations, expand to undertake novel stewardship initiatives, and implement rapid diagnostics to continue their evolution in improving antimicrobial use and patient outcomes.

Threatened efficiency not autonomy: Prescriber perceptions of an established pediatric antimicrobial stewardship program

“…Most hospitals use a combination of strategies, with postprescription review and feedback as the primary approach. 3,34,35 Both of these interventions communicate recommendations about antimicrobials in either a restrictive or persuasive manner. Our findings suggest that the way this communication is incorporated into the everyday workflow of frontline prescribers is critical to their perception of the value of the program and, ultimately, to their level of engagement with ASP recommendations.…”

<p>Pediatric Antimicrobial Stewardship Programs: Current Perspectives</p>

“…73 There is a recognized need for AS measures focusing on children discharged to home on OPAT. 3,5,7,[87][88][89] Children with conditions such as osteomyelitis, complicated appendicitis and pneumonia with pleural empyema have traditionally been treated with prolonged OPAT. However, there is evidence to support timelier transitioning of these patients from IV to oral antibiotics.…”

“…As per Kronman et al, 5 Much of the pediatric [ASP] research performed to date has assessed stewardship programs in the acute care setting, primarily within freestanding children’s hospitals. The need to expand antimicrobial stewardship across the healthcare spectrum … has become evident.…”

“…1,3,4 Since publication of the Infectious Diseases Society of America (IDSA) guideline for ASP development in 2007, there has been a marked increase in the prevalence of formal ASPs in hospitals providing pediatric care. 1,5,6 This has occurred in part because of enhanced recognition of factors unique to AS in children. As noted by pediatric AS experts, children are not simply little adults.…”

“…Important local variables to consider include resource availability, observed behavioral determinants of antimicrobial prescribing and system infrastructure – truly a “one size does not fit all” approach. 5 , 12 This review: 1) provides an overview of broadly applicable strategies for pediatric ASP use, 2) outlines suggested process and outcome measurements for gauging pediatric ASP success, and 3) describes how collaboration on a local level and on a global scale are critical to ensuring that broad objectives of pediatric ASPs are met.…”