Impact of an Antimicrobial Stewardship Program on Antibiotic Use at a Nonfreestanding Children's Hospital

Turner, R. Brigg; Valcarlos, Elena; Loeffler, Ann M.; Gilbert, Michael J.; Chan, Douglas

doi:10.1093/jpids/piw059

Cited by 18 publications

(37 citation statements)

References 27 publications

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“…Eighteen papers (18/113, 15.9%)[40-42, 51, 54, 60, 71, 85, 87, 91, 98, 105, 106, 125, 135, 136, 138, 142] showed an increase in compliance among prescribing physicians; half of the papers analysing this outcome were from USA and Canada (10/18, 55.5%), and the main ASPs adopted were guidelines (9/34, 26.5%)[40,42,54,60,85,87,91,106,125,142], doctors education (5/34, 14.7%)[54,91,98,138,142] and other not common ASPs such as antibiotic order set[42,51], and checklists[87,91]. Sixteen of the included studies[16/113, 14.2% in total; 7/16 (43.7%) from USA, 6/16 (37.5%) from Asia and the rest (18.7%) from Europe] quantified cost savings related to the intervention[39,49,52,64,66,69,73,86,89,92,97,101,102,[122][123][124]. Decreases in costs were most often due to lower rates of drug administration.…”

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confidence: 99%

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

Donà

Barbieri

Daverio

et al. 2020

Antimicrob Resist Infect Control

113

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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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confidence: 99%

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

Donà

Barbieri

Daverio

et al. 2020

Antimicrob Resist Infect Control

113

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“…As a quaternary care freestanding children's hospital, our patient population and their infectious conditions may not mirror that of other institutions, especially nonfreestanding children's hospitals. 23 Our study adds to the literature by identifying important patient-level, programmatic, and provider-level factors that were associated with provider disagreement of PAFR. Given the time-intensive nature of PAFR, future research should explore ways to improve the acceptance of PAFR.…”

Section: Discussionmentioning

confidence: 87%

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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“…When consensus opinion determined that a recommendation was warranted, team members would jointly present the advice to providers immediately following conclusion of the standing meeting, while also concurrently discussing with providers the team's rationale underlying the proposed recommendations-consistent with the successful "prospective audit-with-feedback" approach as described elsewhere. [2][3][4][5][6][7][8][9][10][12][13][14][15] In the event of a recommendation's verbal acceptance by a provider, documentation (in the form of a progress note indicating the mutually agreed upon recommendation) would be placed in the patient's electronic medical record.…”

Section: Methodsmentioning

confidence: 99%

“…The framework for successful ASP implementation requires understanding institutional expectations, limitations likely to be encountered, and awareness of available resources that can facilitate successful program establishment and maintenance. 2,3 In contrast to multiple studies in the medical literature describing successful outcomes associated with formal ASP implementation at large freestanding US children's hospitals, 1,[4][5][6][7][8][9] to the best of our knowledge only one prior study describes outcomes associated with ASP establishment at a non-freestanding pediatric institution, 10 and implementation of a non-freestanding pediatric hospital ASP has yet to be described in detail. Patient populations and antibiotic prescribing practices at such institutions often differ from those at freestanding children's hospitals, and resources for successful program implementation and monitoring may be more limited.…”

Section: Introductionmentioning

confidence: 99%

“…Patient populations and antibiotic prescribing practices at such institutions often differ from those at freestanding children's hospitals, and resources for successful program implementation and monitoring may be more limited. 10,11 Our aims were twofold. First, we planned to describe the implementation of an ASP utilizing a prospective audit-with-feedback methodology at a nonfreestanding children's hospital.…”

Section: Introductionmentioning

confidence: 99%

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Implementation and Impact of an Antimicrobial Stewardship Program at a Non-freestanding Children's Hospital

Klatte¹,

Kopcza²,

Knee³

et al. 2018

The Journal of Pediatric Pharmacology and Therapeutics

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(ASP) have been associated with improvements in antibiotic utilization and patient outcomes; however, ASP studies originating from nonfreestanding children's hospitals are lacking. In this study, we present the implementation and impact of a multidisciplinary ASP that employs a collaborative physician and pharmacist driven thrice-weekly prospective audit-with-feedback approach at a non-freestanding children's hospital. METHODS Implementation was assessed via descriptive design. Pediatric inpatients maintained on predefined targeted antibiotics of interest for 48 to 72 hours preceding ASP review were eligible for inclusion. Outcomes evaluated included ASP recommendation and provider acceptance rates (overall and by antibiotic and provider specialty). Impact was examined using an interrupted time series design (with a preimplementation period of August 1, 2013, to July 31, 2014 and postimplementation period of December 1, 2014 to May 31, 2016). Eligibility included all targeted antibiotic usage among pediatric inpatients, with a control group comprising those who received antibiotics requiring preauthorization. Outcomes analyzed included days of antibiotic therapy per 1000 patient days (DOT/1000 PD) and 30-day hospital readmission rates over time. RESULTS Postimplementation, 882 antibiotic reviews were performed on 637 patients, with 327 recommendations generated. Reviews of patients maintained on vancomycin and clindamycin, and of those under care of intensivist and hospitalist physicians, were most likely to prompt recommendations. A mean targeted antibiotic usage decrease of 24.8 DOT/1000 PD (95% confidence interval, −62 to 14) was observed postimplementation, with no change in 30-day readmissions (0.64% during both periods). CONCLUSIONS ASP implementation at a non-freestanding children's hospital was feasible and allowed for identification of areas for targeted quality improvement, while demonstrating modest antibiotic use reduction without adversely impacting patient care. ABBREVIATIONS ASPs, antimicrobial stewardship programs; DOT/1000 PD, days of antibiotic therapy per 1000 patient days KEYWORDS antimicrobial stewardship; non-freestanding hospital

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Impact of an Antimicrobial Stewardship Program on Antibiotic Use at a Nonfreestanding Children's Hospital

Cited by 18 publications

References 27 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

Predictors of Antimicrobial Stewardship Program Recommendation Disagreement

Implementation and Impact of an Antimicrobial Stewardship Program at a Non-freestanding Children's Hospital

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