August 22, 2012

Program Significantly Reduces Antibiotic Usage
in Pediatric Hospitals

Arlington, VAA prospective-audit-with-feedback antibiotic stewardship program (ASP) significantly decreased antibiotic usage at 25 pediatric hospitals, according to a recent article published in the Journal of the Pediatric Infectious Diseases Society.

The program, which involved 8,765 patients at 25 Child Health Corporation of America hospitals, resulted in a substantial decrease in antibiotic usage, ranging from 37% at the beginning of the effort to 13% at the end of the observation period, which lasted nearly 3 years.

The ASP reviewed 10,460 broad-spectrum or select antibiotics suggested for the patients in the 30 months following the intervention. The most common antibiotics reviewed were ceftriaxone/cefotaxime (43%), vancomycin (18%), ceftazidime (12%), and meropenem (7%).

A total of 2,378 recommendations were made in 19% of the patients (1,703), usually to stop antibiotics all together (41%). Clinicians were compliant with agreed-upon ASP recommendations in 92% of patients, study authors note.

The research began after the Infectious Diseases Society of America (IDSA) issued a guideline in 2007 on the implementation of hospital ASPs. IDSA described two core stewardship strategies to curb the rise of drug-resistant microbes—prospective-audit-with-feedback and preauthorization—and suggested research would be required to determine if the strategies would be effective in a pediatric setting.

In an accompanying article, the authors describe the process of creating an ASP at a 317-bed Kansas City, Missouri, children's hospital and how clinicians responded to it.

The five steps they discuss include:

* forming a multidisciplinary team;
* determining the type of program and which antimicrobials to monitor;
* deciding which mechanism to use in identifying patients;
* developing and implementing an evaluation process; and
* communicating the goals and logistics of the ASP to the hospital's affected clinicians.

In a subsequent survey of 365 clinicians, the 56% who responded had a positive view of the ASP. The overwhelming majority agreed that the ASP had improved the use of antibiotics, 83%; decreased their inappropriate use, 84%; and improved the quality of patient care, 82%. Only 6% of respondents said the ASP interfered with clinical decision-making with 5% saying they found the ASP's recommendations "threatening."

U.S. Pharmacist Social Connect