Impact of an antibiotic stewardship program on antibiotic choice, dosing, and duration in pediatric urgent cares

Nedved, Amanda; Lee, Brian; Hamner, Megan; Wirtz, Ann; Burns, Alaina; Feghaly, Rana E. El

doi:10.1016/j.ajic.2022.07.027

Cited by 12 publications

(8 citation statements)

References 26 publications

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“…The five-D model includes correct diagnosis, the right drug, dose, and duration, and finally de-escalation (narrow spectrum antibiotics, or stopping antibiotics based on culture results) [ 27 ]. Anti- microbial stewardship programs have proven their effectiveness in urgent care [ 28 ] as well as in hospitalized patients with potentially fatal outcomes [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Limited Therapeutic Options in Mexico for the Treatment of Urinary Tract Infections

Novales

Flores-Moreno²,

López-Vidal³

et al. 2022

Antibiotics

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The rise in antimicrobial resistance (AMR) has complicated the management of urinary tract infections (UTIs). The objective of this study was to evaluate the antimicrobial susceptibility patterns of Escherichia coli and Klebsiella pneumoniae. Design: prospective observational study. Bacteria were classified as susceptible or resistant to ampicillin-sulbactam, amikacin, gentamicin, ciprofloxacin, norfloxacin, nitrofurantoin, trimethoprim-sulfamethoxazole (TMP/SMZ), ertapenem, meropenem, and fosfomycin. The sensitivity to fosfomycin and chloramphenicol was evaluated by the disk diffusion method. Statistical analysis: the chi-square test and Fisher’s exact test were used to compare differences between categories. A p value < 0.05 was considered statistically significant. Isolates were collected from January 2019 to November 2020 from 21 hospitals and laboratories. A total of 238 isolates were received: a total of 156 E. coli isolates and 82 K. pneumoniae isolates. The majority were community-acquired infections (64.1%). Resistance was >20% for beta-lactams, aminoglycosides, fluoroquinolones, and TMP/SMZ. For E. coli isolates, resistance was <20% for amikacin, fosfomycin, and nitrofurantoin; for K. pneumoniae, amikacin, fosfomycin, chloramphenicol, and norfloxacin. All were susceptible to carbapenems. K. pneumoniae isolates registered a higher proportion of extensively drug-resistant bacteria in comparison with E. coli (p = 0.0004). In total, multidrug-resistant bacteria represented 61% of all isolates. Isolates demonstrated high resistance to beta-lactams, fluoro-quinolones, and TMP/SMZ.

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Section: Discussionmentioning

confidence: 99%

Limited Therapeutic Options in Mexico for the Treatment of Urinary Tract Infections

Novales

Flores-Moreno²,

López-Vidal³

et al. 2022

Antibiotics

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“…We used International Classification of Diseases, 10th Revision (ICD-10) codes to develop an EHR report that identified all PUC encounters of patients >60 days to 18 years of age with the following discharge diagnoses: acute otitis media (AOM), community-acquired pneumonia (CAP), group A streptococcal (GAS) pharyngitis, urinary tract infection (UTI), and certain skin and soft-tissue infections (SSTIs) (nonfacial cellulitis, abscess, and animal bites). 16 We included only patients who were prescribed systemic antibiotics. We excluded patients who were transferred or admitted, and those with a concomitant diagnosis who may have required systemic antibiotics thus possibly biasing the antibiotic prescribed for the condition of interest.…”

Section: Methodsmentioning

confidence: 99%

“…We described the timeline of our interventions and the impact of our efforts on antibiotic prescribing in a recent manuscript. 16…”

Section: Settingmentioning

confidence: 99%

“…9,14,15 When we analyzed the impact of our outpatient ASP, which we implemented in our pediatric urgent care (PUC) clinics starting in August 2018, we detected overall improvement in the rate of choosing firstline antibiotics for common pediatric infections. 16 However, we sought to understand the rates of firstline antibiotic agents prescribed for common pediatric infections in relation to race, ethnicity, preferred language, and insurance type prior to implementation of our outpatient ASP and to determine the effects the outpatient ASP had on these differences in the PUC setting. We hypothesized that following the implementation of the outpatient ASP, differences in the rates of firstline antibiotic choice within socioeconomic subgroups would be reduced.…”

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confidence: 99%

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Socioeconomic differences in antibiotic use for common infections in pediatric urgent-care centers—A quasi-experimental study

Nedved

Lee

Wirtz

et al. 2023

Infect. Control Hosp. Epidemiol.

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Objective: To investigate differences in the rate of firstline antibiotic prescribing for common pediatric infections in relation to different socioeconomic statuses and the impact of an antimicrobial stewardship program (ASP) in pediatric urgent-care clinics (PUCs). Design: Quasi-experimental. Setting: Three PUCs within a Midwestern pediatric academic center. Patients and participants: Patients aged >60 days and <18 years with acute otitis media, group A streptococcal pharyngitis, community-acquired pneumonia, urinary tract infection, or skin and soft-tissue infections who received systemic antibiotics between July 2017 and December 2020. We excluded patients who were transferred, admitted, or had a concomitant diagnosis requiring systemic antibiotics. Intervention: We used national guidelines to determine the appropriateness of antibiotic choice in 2 periods: prior to (July 2017–July 2018) and following ASP implementation (August 2018–December 2020). We used multivariable regression analysis to determine the odds ratios of appropriate firstline agent by age, sex, race and ethnicity, language, and insurance type. Results: The study included 34,603 encounters. Prior to ASP implementation in August 2018, female patients, Black non-Hispanic children, those >2 years of age, and those who self-paid had higher odds of receiving recommended firstline antibiotics for all diagnoses compared to male patients, children of other races and ethnicities, other ages, and other insurance types, respectively. Although improvements in prescribing occurred after implementation of our ASP, the difference within the socioeconomic subsets persisted. Conclusions: We observed socioeconomic differences in firstline antibiotic prescribing for common pediatric infections in the PUCs setting despite implementation of an ASP. Antimicrobial stewardship leaders should consider drivers of these differences when developing improvement initiatives.

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“…To further this effort, prioritizing strategies to reduce the duration of antibiotic usage is imperative. Decreasing overall antibiotic use is crucial because the quantity of antibiotics used substantially contributes to the development of resistance [ 48 , 49 ]. Additionally, incorporating outpatient parenteral antibiotic therapy (OPAT) into ASP activities is of great importance.…”

Section: Future Directions For Asp In Koreamentioning

confidence: 99%

Principles and practices of antimicrobial stewardship programs in Korea

Kwon,

Kim

2024

Korean J Intern Med

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This review addresses the escalating challenge posed by antibiotic resistance, highlighting its profound impact on global public health, including increased mortality rates and healthcare expenditures. The review focuses on the need to adopt the One Health approach to effectively manage antibiotic usage across human, animal, and environmental domains. Antimicrobial stewardship programs (ASPs) are considered as comprehensive strategies that encompass both core and supplementary initiatives aimed at enhancing prudent antibiotic use. The 2021 “Guidelines on Implementing ASP in Korea” introduced such strategies, with a strong emphasis on fostering multidisciplinary and collaborative efforts. Furthermore, the “Core Elements for Implementing ASPs in Korean General Hospitals,” established in 2022, provide a structured framework for ASPs, delineating leadership responsibilities, the composition of interdisciplinary ASP teams, a range of interventions, and continuous monitoring and reporting mechanisms. In addition, this review examines patient-centric campaigns such as “Speak Up, Get Smart” and emphasizes the pivotal role of a multidisciplinary approach and international cooperation in addressing the multifaceted challenges associated with antibiotic resistance.

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Impact of an antibiotic stewardship program on antibiotic choice, dosing, and duration in pediatric urgent cares

Cited by 12 publications

References 26 publications

Limited Therapeutic Options in Mexico for the Treatment of Urinary Tract Infections

Limited Therapeutic Options in Mexico for the Treatment of Urinary Tract Infections

Socioeconomic differences in antibiotic use for common infections in pediatric urgent-care centers—A quasi-experimental study

Principles and practices of antimicrobial stewardship programs in Korea

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