Sustained pediatric antimicrobial stewardship program with consultation to infectious diseases reduced carbapenem resistance and infection-related mortality

Horikoshi, Yuho; Suwa, Junichi; Handa, Hiroshi; Kaneko, Tetsuji; Furuichi, Mihoko; Aizawa, Yuta; Fukuoka, Kahoru; Okazaki, Kaoru; Ito, Kenta; Shoji, Takayo

doi:10.1016/j.ijid.2017.09.012

Cited by 59 publications

(66 citation statements)

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“…None of the patients was treated with carbapenem as definitive therapy. The antimicrobial stewardship program at the present hospital restricts the use of broad‐spectrum antimicrobial agents and encourages the use of narrower spectrum antimicrobial agents whenever possible . Another implication of this study, however, is that carbapenem use may be spared in non‐severe cases of pediatric pyelonephritis caused by ESBL‐producing Enterobacteriaceae.…”

Section: Discussionmentioning

confidence: 89%

Cefmetazole for extended‐spectrum β‐lactamase‐producing Enterobacteriaceae in pediatric pyelonephritis

Araki

Fukuoka

Handa

et al. 2019

Pediatrics International

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Background Pyelonephritis caused by extended‐spectrum β‐lactamase (ESBL)‐producing Enterobacteriaceae is an urgent problem in pediatrics. Although carbapenem is the standard therapy for infections caused by ESBL‐producing Enterobacteriaceae, some cephamycins, including cefmetazole, are stable against hydrolysis by ESBL. There are few reports, however, on the use of cefmetazole in children. The aim of this study was to evaluate the therapeutic effect of cefmetazole in pediatric pyelonephritis caused by ESBL‐producing Enterobacteriaceae. Methods Children with pyelonephritis caused by ESBL‐producing Enterobacteriaceae were enrolled between April 2010 and November 2016 at Tokyo Metropolitan Children's Medical Center. Presence of ESBL was tested for using the disk diffusion method. Medical records were reviewed for a past history of bacterial infection. The outcomes were clinical cure rate at 4 weeks and the duration of therapy in the cefmetazole and non‐cefmetazole groups. Results Fifty‐five patients met the criteria for pyelonephritis caused by ESBL‐producing Enterobacteriaceae. The most common causative organisms were Escherichia coli (n = 51; 92.7%), Klebsiella pneumoniae (n = 3; 5.5%), and K. oxytoca (n = 1; 1.8%). Thirty‐six and 19 patients were treated with cefmetazole and with other antibiotics as definitive therapy, respectively. There was no difference in the clinical cure rate (86.1% vs 89.5%; P = 0.72) or duration of therapy (median, 7.0 vs 7.0 days; P = 0.73) between the cefmetazole and non‐cefmetazole groups. Conclusions Cefmetazole was not inferior to the other antibiotics in the treatment of pyelonephritis caused by ESBL‐producing Enterobacteriaceae in children. Cefmetazole is a valuable therapeutic alternative to carbapenems for treating pyelonephritis caused by ESBL‐producing Enterobacteriaceae.

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Section: Discussionmentioning

confidence: 89%

Cefmetazole for extended‐spectrum β‐lactamase‐producing Enterobacteriaceae in pediatric pyelonephritis

Araki

Fukuoka

Handa

et al. 2019

Pediatrics International

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“…Implementation of a prospective audit with intervention and feedback is useful for solving these problems. Reports have shown that implementing a pre‐authorisation and prospective audit with intervention and feedback reduces the infection‐related mortality rate and treatment duration, and improves the clinical response in patients receiving carbapenem. However, it is still unclear whether or not a prospective audit with intervention and feedback without carbapenem restriction improves clinical outcomes in patients receiving carbapenem injection.…”

Section: Discussionmentioning

confidence: 99%

“…The rate of 30-d re-infection was significantly lower (13.4% vs 3.2%, P < 0.001; Table 2), and the re-infection-free survival was significantly longer in the intervention group (HR, 0.35; 95% CI, 0.18-0.68; P = 0.002; Figure 2B). No significant differences were noted in the treatment duration (7 [5][6][7][8][9][10]…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…This strategy can be used to recommend de‐escalation and discontinuation of broad‐spectrum antimicrobials. Horikoshi et al reported that implementing antimicrobial pre‐authorisation and prospective audit with intervention and feedback for carbapenem reduces the infection‐related mortality . However, to our knowledge, there has been no report showing the clinical impact of a prospective audit with intervention and feedback without carbapenem restriction.…”

Section: Introductionmentioning

confidence: 99%

“…Horikoshi et al reported that implementing antimicrobial preauthorisation and prospective audit with intervention and feedback for carbapenem reduces the infection-related mortality. 6 However, to our knowledge, there has been no report showing the clinical impact of a prospective audit with intervention and feedback without carbapenem restriction. In August 2009, we developed a hospitalwide, multidisciplinary intervention programme based on this prospective audit with an intervention and feedback strategy without carbapenem restriction to optimise antibiotic use within 24 hours after the onset of therapy.…”

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confidence: 98%

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Clinical impact of a prospective audit with intervention and feedback without carbapenem restriction in patients receiving carbapenem injection

et al. 2018

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Background Antimicrobial stewardship is required to ensure the appropriate use of antimicrobials. However, few reports have shown the impact of antimicrobial stewardship on clinical outcomes. Methods To evaluate the clinical outcomes of implementing a prospective audit with intervention and feedback without carbapenem pre‐authorisation, we conducted a single‐centre, prospective cohort study in patients who received carbapenem injection. Subjects were allocated to groups receiving antimicrobial agents before (non‐intervention group) or after (intervention group) the implementation of an antimicrobial stewardship programme in the clinical setting. Results The intervention facilitated the rate of choice of effective antimicrobials on day 2 from the onset of infection (from 63.2% to 90.2%; P < 0.001). Moreover, the rates of clinical failure‐free survival (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.47‐0.89; P = 0.008) and re‐infection‐free survival (HR, 0.35; 95% CI, 0.18‐0.68; P = 0.002) were significantly higher in the intervention group than in the non‐intervention group. A multivariate Cox proportional hazard analysis indicated that non‐implementation of antimicrobial stewardship was a significant risk factor for clinical failure in patients receiving carbapenem injection (HR, 1.56; 95% CI, 1.11‐2.19; P = 0.010). Conclusions Our prospective audit with intervention and feedback strategy without carbapenem restriction facilitated the choice of optimal antimicrobials at an early stage of infection and improved clinical outcomes in patients who received carbapenem.

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Antimicrobial stewardship program in pediatric medicine

Probst

Islamovic

Mirza

2021

Pediatric Investigation

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The rising threats from antimicrobial resistance due to inappropriate utilization of antimicrobial agents in health care including the pediatric population has been a topic of concern at the global level for the last several decades. The antimicrobial stewardship program (ASP) is a multidisciplinary institutional initiative focusing primarily on the improvement of antimicrobial prescribing practices and limiting inappropriate use. ASPs play an important role in the implementation of healthcare strategies in pediatrics worldwide to reduce antimicrobial resistance. Many published reports demonstrate how adapted ASPs in pediatrics result in improvement of unnecessary antimicrobial utilization, decreasing drug resistance and treatment failure, minimization of adverse clinical outcomes, decreasing healthcare costs and hospital length of stay, and optimization of diagnostic strategies. However, some barriers in pediatric ASP still exist. This narrative review describes core elements of ASP, the impact of implemented ASPs on pediatric healthcare, and challenges of pediatric ASP as seen by the authors.

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Sustained pediatric antimicrobial stewardship program with consultation to infectious diseases reduced carbapenem resistance and infection-related mortality

Abstract: A sustained ASP with additional consultation with the infectious disease service reduced carbapenem use and resistance in P. aeruginosa, leading to favorable outcomes in terms of length of hospitalization and infection-related mortality.

Cited by 59 publications

References 23 publications

Cefmetazole for extended‐spectrum β‐lactamase‐producing Enterobacteriaceae in pediatric pyelonephritis

Cefmetazole for extended‐spectrum β‐lactamase‐producing Enterobacteriaceae in pediatric pyelonephritis

Clinical impact of a prospective audit with intervention and feedback without carbapenem restriction in patients receiving carbapenem injection

Antimicrobial stewardship program in pediatric medicine

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