Pediatric Antimicrobial Stewardship: State of the Art

Godbout, Emily; Pakyz, Amy; Markley, John Daniel; Noda, Andrew; Stevens, Michael P.

doi:10.1007/s11908-018-0644-7

Cited by 35 publications

(26 citation statements)

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“…Rationale: The misuse and overuse of broad-spectrum antimicrobials in healthcare, the community, veterinary medicine, and the environment have contributed to a global public health emergency [123]. De-escalation of antimicrobials, where appropriate, is warranted to minimize adverse effects of unnecessarily prolonged administration.…”

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confidence: 99%

“…Although a relationship between antimicrobial stewardship programs (ASPs) and a decrease in antimicrobial resistance has not yet been shown, studies suggest that inpatient pediatric ASPs may reduce antimicrobial usage without contributing to adverse patient outcomes [123]. The "Start Smart -Then Focus" work from Public Health England suggests a pragmatic approach of the five "antimicrobial prescribing decision" options to include (1) stop antimicrobials if there is no evidence of infection, (2) switch antimicrobials from IV to oral, (3) change antimicrobials-ideally to a narrower spectrum-or broader if required, (4) continue and document next review date or stop date, and (5) outpatient parenteral antimicrobial therapy [133].…”

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Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

et al. 2020

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Objectives: To develop evidence-based recommendations for clinicians caring for children (including infants, school-aged children, and adolescents) with septic shock and other sepsis-associated organ dysfunction.Design: A panel of 49 international experts, representing 12 international organizations, as well as three methodologists and three public members was convened. Panel members assembled at key international meetings (for those The Society of Critical Care Medicine guidelines are intended for general information only, are not medical advice, and do not replace professional advice, which should be sought for any medical condition. The full disclaimer for guidelines can be accessed at https ://www.sccm.org/Resea rch/Guide lines /Guide lines . panel members attending the conference), and a stand-alone meeting was held for all panel members in November 2018. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. Teleconferences and electronic-based discussion among the chairs, co-chairs, methodologists, and group heads, as well as within subgroups, served as an integral part of the guideline development process. Methods:The panel consisted of six subgroups: recognition and management of infection, hemodynamics and resuscitation, ventilation, endocrine and metabolic therapies, adjunctive therapies, and research priorities. We conducted a systematic review for each Population, Intervention, Control, and Outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak, or as a best practice statement. In addition, "in our practice" statements were included when evidence was inconclusive to issue a recommendation, but the panel felt that some guidance based on practice patterns may be appropriate. Results:The panel provided 77 statements on the management and resuscitation of children with septic shock and other sepsis-associated organ dysfunction. Overall, six were strong recommendations, 49 were weak recommendations, and nine were best-practice statements. For 13 questions, no recommendations could be made; but, for 10 of these, "in our practice" statements were provided. In addition, 52 research priorities were identified. Conclusions:A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations. Despite this challenge, these recommendations regarding the management of children with septic shock and other sepsis-associated organ dysfunction provide a foundation for consistent care to improve outcomes and inform future research. S14 the group heads, panel members, and methodologists. Searches utilized ...

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Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

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“…Para o foco deste artigo, foram selecionadas 27 revisões sistemáticas sobre programas ou intervenções denominados antimicrobial stewardship e implementados em ambiente hospitalar ( 10 - 15 , 19 , 24 - 42 ). O fluxograma do processo de seleção é apresentado na figura 1 .…”

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“…Programas de stewardship pediátricos (auditoria prospectiva de 72 h com feedback , auditoria prospectiva com feedback , diretrizes de restrição e prática clínica), administração de handshake (cumprimento das ações por meio de incentivo do gestor) e estratégias de gerenciamento do uso racional de antimicrobianos (equipes multidisciplinares, orientações práticas para sepse tardia e enterocolite necrosante e auditoria prospectiva com feedback) ( 19 )…”

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“…No Brasil, com a finalidade de estabelecer ações de prevenção e controle da resistência microbiana nos serviços de saúde, a Agência Nacional de Vigilância Sanitária (ANVISA) elaborou em 2018 o Plano de Ação da Vigilância Sanitária em Resistência aos Antimicrobianos ( 17 ), o Plano Nacional para a Prevenção e o Controle da Resistência Microbiana nos Serviços de Saúde e a Rede de Resistência Microbiana ( 18 ). Entretanto, são escassos os estudos sobre programas de stewardship em serviços pediátricos, em departamentos de emergência e em países de baixa e média renda ( 19 ).…”

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Gestão das intervenções de prevenção e controle da resistência a antimicrobianos em hospitais: revisão de evidências

Melo

Araújo

Bortoli

et al. 2020

Revista Panamericana De Salud Pública

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Objetivo. Identificar intervenções efetivas para enfrentar a resistência a antimicrobianos em hospitais e possíveis barreiras para sua implementação. Métodos. Realizou-se uma síntese de evidências para a elaboração de políticas com base na metodologia proposta nas ferramentas SUPPORT. As buscas na literatura foram realizadas em novembro e dezembro de 2018, em 14 bases de dados. Um diálogo deliberativo, para identificar barreiras na implementação das intervenções, foi realizado presencialmente com 23 participantes (gestores, pesquisadores e profissionais de saúde) e 14 ouvintes, divididos em três grupos. A moderação foi feita por pesquisadores com experiência na condução de diálogos deliberativos. Resultados. Foram identificadas 27 revisões sistemáticas sobre intervenções para gestão de antimicrobianos (programas de stewardship) combinadas e individuais. Essas intervenções abordaram estratégias de educação, sistemas eletrônicos, biomarcadores e diversas formas de manejo de antimicrobianos. As principais barreiras para a implementação das intervenções, identificadas por meio da literatura e do diálogo deliberativo, foram: falta de infraestrutura e recursos humanos, insatisfação do paciente em relação à conduta terapêutica; diferenças culturais da equipe multidisciplinar; sobrecarga de trabalho da equipe; falta de financiamento/planejamento. Conclusão. A maioria das estratégias identificadas mostrou-se efetiva para gestão da resistência aos antimicrobianos em âmbito hospitalar. Deve-se enfatizar que a confiança nos resultados pode ser melhorada com novas pesquisas de maior qualidade metodológica.

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Association of Diagnostic Stewardship for Blood Cultures in Critically Ill Children With Culture Rates, Antibiotic Use, and Patient Outcomes

et al. 2022

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and the Bright STAR Authorship Group IMPORTANCE Blood culture overuse in the pediatric intensive care unit (PICU) can lead to unnecessary antibiotic use and contribute to antibiotic resistance. Optimizing blood culture practices through diagnostic stewardship may reduce unnecessary blood cultures and antibiotics.OBJECTIVE To evaluate the association of a 14-site multidisciplinary PICU blood culture collaborative with culture rates, antibiotic use, and patient outcomes. DESIGN, SETTING, AND PARTICIPANTS This prospective quality improvement (QI) collaborative involved 14 PICUs across the United States from 2017 to 2020 for the Bright STAR (Testing Stewardship for Antibiotic Reduction) collaborative. Data were collected from each participating PICU and from the Children's Hospital Association Pediatric Health Information System for prespecified primary and secondary outcomes. EXPOSURES A local QI program focusing on blood culture practices in the PICU (facilitated by a larger QI collaborative). MAIN OUTCOMES AND MEASURESThe primary outcome was blood culture rates (per 1000 patient-days/mo). Secondary outcomes included broad-spectrum antibiotic use (total days of therapy and new initiations of broad-spectrum antibiotics Ն3 days after PICU admission) and PICU rates of central line-associated bloodstream infection (CLABSI), Clostridioides difficile infection, mortality, readmission, length of stay, sepsis, and severe sepsis/septic shock.RESULTS Across the 14 PICUs, the blood culture rate was 149.4 per 1000 patient-days/mo preimplementation and 100.5 per 1000 patient-days/mo postimplementation, for a 33% relative reduction (95% CI, 26%-39%). Comparing the periods before and after implementation, the rate of broad-spectrum antibiotic use decreased from 506 days to 440 days per 1000 patient-days/mo, respectively, a 13% relative reduction (95% CI, 7%-19%). The broad-spectrum antibiotic initiation rate decreased from 58.1 to 53.6 initiations/1000 patient-days/mo, an 8% relative reduction (95% CI, 4%-11%). Rates of CLABSI decreased from 1.8 to 1.1 per 1000 central venous line days/mo, a 36% relative reduction (95% CI, 20%-49%). Mortality, length of stay, readmission, sepsis, and severe sepsis/septic shock were similar before and after implementation. CONCLUSIONS AND RELEVANCE Multidisciplinary diagnostic stewardship interventions canreduce blood culture and antibiotic use in the PICU. Future work will determine optimal strategies for wider-scale dissemination of diagnostic stewardship in this setting while monitoring patient safety and balancing measures.

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Pediatric Antimicrobial Stewardship: State of the Art

Cited by 35 publications

References 66 publications

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children

Gestão das intervenções de prevenção e controle da resistência a antimicrobianos em hospitais: revisão de evidências

Association of Diagnostic Stewardship for Blood Cultures in Critically Ill Children With Culture Rates, Antibiotic Use, and Patient Outcomes

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