Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Abstract

Background: Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods: MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results: Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions: Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.

Effectiveness and Sustainability of an Antimicrobial Stewardship Program for Perioperative Prophylaxis in Pediatric Surgery

“…A recently published systematic scoping review on antibiotic stewardship in pediatrics [ 11 ] reported that so far only eight studies focused on PAP. Six showing an improvement in antibiotic usage appropriateness after PAP guideline implementation [ 4 , 5 , 6 , 12 , 13 , 14 ], one not reporting any change in PAP adherence after a checklist and antibiotic order list implementation [ 7 ], and one [ 15 ] reporting no significant changes in hospital-associated infection rate nor in multidrug-resistant organism rate.…”

Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health

“…It was originally defined as organized interpositions with the premise of improving antimicrobial use when selecting the appropriate agents, the correct dose, route of administration, and the duration of therapy without prejudicing patient outcomes. 39 , 40 AMS refers to a set of coordinated strategies to (i) improve patient care, and outcomes by optimal therapy; (ii) reduce collateral damage by reducing antimicrobial use (less resistance), and (iii) reduce the cost for antibiotics. 41 These strategies can be used globally to help control AMR by increasing awareness of the public and educating healthcare professionals on the prudent use of antimicrobials as part of an ASP.…”

Pediatric antimicrobial stewardship in the COVID-19 outbreak

“…1 Although short of the level of acceptance these have reached in the United States, the implementation of pediatric ASPs in European hospitals has increased over the last few years. 1 It has been suggested that the ASP should be helpful in the preparation for and response to the SARS-CoV-2/COVID-19 outbreak, 2 but no formal recommendations have been published. Whether pediatric ASP remains an essential activity or not during the COVID-19 pandemic has yet to be clarified.…”