Effects of a nudge-based antimicrobial stewardship program in a pediatric primary emergency medical center

Shishido, Ayumi; Otake, Shogo; Kimura, Makoto; Tsuzuki, Shinya; Fukuda, Akiko; Ishida, Akihito; Kasai, Masashi; Kusama, Yoshiki

doi:10.1007/s00431-021-03979-3

Cited by 14 publications

(32 citation statements)

References 28 publications

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“…A summary of the included studies is provided in Table 1 . These studies were published between 2013 [ 24 ] and 2021 [ 25 , 26 ]. Four of the thirteen studies were randomized-control studies [ 25 , 27 , 28 , 29 ], three were cohort studies [ 24 , 30 , 31 ], one was a controlled interrupted time series analysis [ 13 ] and five were noncontrolled before-and-after studies [ 26 , 32 , 33 , 34 , 35 ].…”

Section: Resultsmentioning

confidence: 99%

“…These studies were published between 2013 [ 24 ] and 2021 [ 25 , 26 ]. Four of the thirteen studies were randomized-control studies [ 25 , 27 , 28 , 29 ], three were cohort studies [ 24 , 30 , 31 ], one was a controlled interrupted time series analysis [ 13 ] and five were noncontrolled before-and-after studies [ 26 , 32 , 33 , 34 , 35 ]. The studies were located in a variety of countries and settings, with eight of thirteen studies being conducted in the United States [ 24 , 27 , 29 , 30 , 31 , 33 , 34 , 35 ], and the other studies being conducted in Taiwan, France, Canada, Japan and the Netherlands [ 13 , 25 , 26 , 28 , 32 ].…”

Section: Resultsmentioning

confidence: 99%

“…Four of the thirteen studies were randomized-control studies [ 25 , 27 , 28 , 29 ], three were cohort studies [ 24 , 30 , 31 ], one was a controlled interrupted time series analysis [ 13 ] and five were noncontrolled before-and-after studies [ 26 , 32 , 33 , 34 , 35 ]. The studies were located in a variety of countries and settings, with eight of thirteen studies being conducted in the United States [ 24 , 27 , 29 , 30 , 31 , 33 , 34 , 35 ], and the other studies being conducted in Taiwan, France, Canada, Japan and the Netherlands [ 13 , 25 , 26 , 28 , 32 ]. All studies were conducted within the emergency departments and urgent care of hospitals, however the number and type of hospitals varied between studies.…”

Section: Resultsmentioning

confidence: 99%

“…All studies were conducted within the emergency departments and urgent care of hospitals, however the number and type of hospitals varied between studies. Eight of thirteen studies reported single-centre interventions [ 24 , 26 , 27 , 30 , 31 , 32 , 33 , 35 ], whilst the other five conducted reported outcomes from multiple centres [ 13 , 25 , 28 , 29 , 34 ]. Further, six studies reported outcomes from paediatric hospitals only [ 24 , 25 , 26 , 31 , 35 ], one study used both paediatric and general hospitals [ 29 ], and the remaining five studies extracted paediatric data from a general hospital with adults and children [ 13 , 27 , 28 , 30 , 32 ].…”

Section: Resultsmentioning

confidence: 99%

“…When evaluating the efficacy of ASPs, the most commonly used measures included proportion of appropriate first-line antibiotic use and broad-spectrum antibiotics. The effects of overall antibiotic use were well reported by the included studies, and the postintervention difference was statistically significant in nine of thirteen studies [13,24,26,27,29,30,[33][34][35]. As effects were seen in a variety of ASP multimodal intervention types, it can be difficult to ascertain which strategies optimised ASP delivery and therefore efficacy.…”

Section: Discussionmentioning

confidence: 99%

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Paediatric Antimicrobial Stewardship for Respiratory Infections in the Emergency Setting: A Systematic Review

2021

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Antimicrobial resistance occurs due to the propensity of microbial pathogens to develop resistance to antibiotics over time. Antimicrobial stewardship programs (ASPs) have been developed in response to this growing crisis, to limit unnecessary antibiotic prescription through initiatives such as education-based seminars, prescribing guidelines, and rapid respiratory pathogen (RRP) testing. Paediatric patients who present to the emergency setting with respiratory symptoms are a particularly high-risk population susceptible to inappropriate antibiotic prescribing behaviours and are therefore an ideal cohort for focused ASPs. The purpose of this systematic review was to assess the efficacy and safety of ASPs in this clinical context. A systematic search of PubMed, Medline, EMBASE and the Cochrane Database of Systematic Reviews was conducted to review the current evidence. Thirteen studies were included in the review and these studies assessed a range of stewardship interventions and outcome measures. Overall, ASPs reduced the rates of antibiotic prescription, increased the prescription of narrow-spectrum antibiotics, and shortened the duration of antibiotic therapy. Multimodal interventions that were education-based and those that used RRP testing were found to be the most effective. Whilst we found strong evidence that ASPs are effective in reducing antibiotic prescribing, further studies are required to assess whether they translate to equivalent clinical outcomes.

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