Role of antimicrobial stewardship programmes in children: a systematic review

Silva, A R Araujo da; Dias, Déborah Cardoso Albernaz de Almeida; Marques, Amanda; Biase, C Biscaia di; Murni, Indah K; Dramowski, Angela; Sharland, Mike; Hüebner, Johannes; Zingg, Walter

doi:10.1016/j.jhin.2017.08.003

Cited by 71 publications

(69 citation statements)

References 22 publications

(22 reference statements)

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“…This is the first systematic scoping review analysing the implementation of ASPs in pediatrics globally, in both inpatient and outpatients settings. Previously, two systematic reviews had been conducted which did not include ASPs intervention in outpatient settings, with Smith et al [154] limited to inpatient interventions in the USA and Da Silva et al [155] limited to general pediatric wards and PICU.…”

Section: Main Findingsmentioning

confidence: 99%

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

Donà

Barbieri

Daverio

et al. 2020

Antimicrob Resist Infect Control

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108

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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.

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Section: Main Findingsmentioning

confidence: 99%

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

Donà

Barbieri

Daverio

et al. 2020

Antimicrob Resist Infect Control

Self Cite

108

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“…Effectiveness of ASPs in paediatric inpatient populations other than neonates has been summarised by two systematic reviews 24 25. The first review identified nine studies in various US paediatric inpatient settings,24 the second review focused on paediatric intensive care, and identified nine studies from the US, Germany, Indonesia and Singapore 25. All studies reported reductions in the use of antibiotics overall and broad-spectrum/restricted antibiotics in particular 25.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review

et al. 2020

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IntroductionAntimicrobial stewardship programmes (ASPs) are recommended to improve antibiotic use in healthcare and reduce antimicrobial resistance (AMR). Our aim was to investigate the effectiveness of ASPs in reducing antibiotic consumption, use of broad-spectrum/restricted antibiotics, antibiotic resistance and healthcare-associated infections (HAIs) in neonates.MethodsWe searched PUBMED, SCIELO, EMBASE and the Cochrane Database (January 2000–April 2019) to identify studies on the effectiveness of ASPs in neonatal wards and/or neonatal intensive care units (NICUs). Outcomes were as follows: reduction of antibiotic consumption overall and of broad-spectrum/target antibiotics, inappropriate antibiotic use, antibiotic resistance and HAIs. ASPs conducted in settings other than acute care hospitals, for children older than 1 month, and ASPs addressing antifungal and antiviral agents, were excluded.ResultsThe initial search identified 53 173 titles and abstracts; following the application of filters and inclusion criteria, a total of six publications were included in the final analysis. All studies, of which one was multi-centre study, were published after 2010. Five studies were conducted exclusively in NICUs. Four articles applied multimodal interventions. Reduction of antibiotic consumption overall and/or inappropriate antibiotic use were reported by four articles; reduction of broad-spectrum/targeted antibiotics were reported by four studies; No article evaluated the impact of ASPs on AMR or the incidence of HAI in neonates.ConclusionASPs can be effectively applied in neonatal settings. Limiting the use of broad-spectrum antibiotics and shorting the duration of antibiotic treatment are the most promising approaches. The impact of ASPs on AMR and HAI needs to be evaluated in long-term studies.

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“…[17][18][19][20][21] Literature supporting ASP interventions in critically ill neonates and children are especially limited, and extrapolation of published PAF success in a specific institution's ICU may be difficult due to differences in patient populations served and institutional microorganism resistance patterns. 22 Further exploration of the factors impacting the success of stewardship in critically ill children are needed. Interestingly, we did not find that any specific marker of infection (eg, procalcitonin, CRP, fever), antimicrobial, or severity of illness (eg, LOS, ICU LOS, need for mechanical ventilation) impacted adherence to PAFR.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Antimicrobial Stewardship Program Recommendation Disagreement

Bio

Kruger

Lee

et al. 2018

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo identify predictors of disagreement with antimicrobial stewardship prospective audit and feedback recommendations (PAFR) at a free-standing children's hospital.DESIGNRetrospective cohort study of audits performed during the antimicrobial stewardship program (ASP) from March 30, 2015, to April 17, 2017.METHODSThe ASP included audits of antimicrobial use and communicated PAFR to the care team, with follow-up on adherence to recommendations. The primary outcome was disagreement with PAFR. Potential predictors for disagreement, including patient-level, antimicrobial, programmatic, and provider-level factors, were assessed using bivariate and multivariate logistic regression models.RESULTSIn total, 4,727 antimicrobial audits were performed during the study period; 1,323 PAFR (28%) and 187 recommendations (15%) were not followed due to disagreement. Providers were more likely to disagree with PAFR when the patient had a gastrointestinal infection (odds ratio [OR], 5.50; 95% confidence interval [CI], 1.99-15.21), febrile neutropenia (OR, 6.14; 95% CI, 2.08-18.12), skin or soft-tissue infections (OR, 6.16; 95% CI, 1.92-19.77), or had been admitted for 31-90 days at the time of the audit (OR, 2.08; 95% CI, 1.36-3.18). The longer the duration since the attending provider had been trained (ie, the more years of experience), the more likely they were to disagree with PAFR recommendations (OR, 1.02; 95% CI, 1.01-1.04).CONCLUSIONSEvaluation of our program confirmed patient-level predictors of PAFR disagreement and identified additional programmatic and provider-level factors, including years of attending experience. Stewardship interventions focused on specific diagnoses and antimicrobials are unlikely to result in programmatic success unless these factors are also addressed.Infect Control Hosp Epidemiol 2018;806-813.

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Role of antimicrobial stewardship programmes in children: a systematic review

Cited by 71 publications

References 22 publications

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

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

Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review

Predictors of Antimicrobial Stewardship Program Recommendation Disagreement

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