Outpatient antimicrobial stewardship programs in pediatric institutions in 2020: Status, needs, barriers

Abstract

Objective: To assess current resources, interventions, and obstacles of pediatric outpatient antimicrobial stewardship programs (ASP). Design: Cross-sectional study. Setting: Institutions from the Sharing Antimicrobial Reports for Pediatric Stewardship OutPatient collaborative (SHARPS-OP). Participants: Antimicrobial stewardship leaders from the above institutions. Methods: An investigator-developed survey was deployed online in September 2020 to antimicrobial stewardship leaders in SHARPS-OP institutions. The survey was divided into 4 sections: (1) basic information, (2) status of pediatric outpatient ASP in the institutions including financial support, (3) outpatient ASP interventions undertaken by the institutions, and (4) needs and SHARPS-OP collaborative goals. Results: Of 56 invited institutions, 45 participated, achieving an 80% response rate. Only 5 sites (11%) had allocated financial support for an outpatient ASP, compared to 42 (95.6%) for their inpatient ASP. The most widely used outpatient ASP interventions included antimicrobial guidance (57.8%), education (46.7%), and quality improvement projects (37.8%). Time was identified as the biggest barrier to expanding outpatient ASPs (91.1%), followed by financial support (53.3%), development of meaningful reports (51.1%), and administrative support (44.4%). Important goals of the collaborative included seeking learning opportunities and developing clear metrics for pediatric outpatient ASP benchmarking. Program needs included securing operational support (35.8%) and strengthening data analysis (31.6%). Conclusions: Very few pediatric institutions with robust inpatient ASPs have devoted time and financial support to advance outpatient efforts. To promote appropriate antibiotic prescribing in the outpatient arena, time and resource funding by administrative leaders are necessary to develop a robust, sustainable stewardship infrastructure.

Novel expansion of a well-established antimicrobial stewardship program: Enhancing program efficiency and reach

“…Despite limited resources, many programs are also expanding ASPs to the outpatient setting. 16 Physician and pharmacist support for ASP overall has increased, but the majority of ASPs still report lack of time as a barrier to implementation of a successful ASP. 7 Our ASP consists of a large multidisciplinary team with organized efforts for project sharing and time management, yet team members still report challenges due to time constraints and competing priorities.…”

One size does not fit all: advanced practice provider considerations for the antimicrobial steward

“…An ASP APP could fill critical roles in expanding an ASPs’ reach, particularly in outpatient and emergency department settings that remain areas of need. 46 , 47 These practice settings employ APPs at a higher rate than inpatient settings, and APPs could provide a critical perspective on intervention development and implementation. 2 While there have not been published studies on the financial benefits of ASP utilization of APPs, APPs may help expand the pool of available stewards at a lower FTE rate than physicians or pharmacists, which may benefit smaller ASPs where the financial resources can be limited.…”

Appropriateness of Antibiotic Prescribing in the Emergency Department of Mofid Children's Hospital: A Retrospective Cross-Sectional Study

“…We also found that the incorrect prescription of antibiotics in one of the largest children's referral hospitals in Iran had a high prevalence, which shows the urgent need to review the therapeutic and educational methods. El Feghaly et al emphasized that very few specialized children's treatment centers have dedicated standard antibiotic prescription patterns for hospitalized patients to promote treatment efforts, and this issue requires the implementation of appropriate plans by managers (24).…”