Benefits of a Pediatric Antimicrobial Stewardship Program in Antimicrobial Use and Quality of Prescriptions in a Referral Children's Hospital.

Author: 

Velasco Arnaiz E, Simó Nebot S, Ríos Barnés M, López Ramos MG, Monsonís M, Urrea Ayala M, Jordan I, Mas Comas A, Casadevall Llandrich R, Ormazábal Kirchner D, Cuadras Pallejà D, Pérez Pérez C, Millet Elizalde M, Sánchez Ruiz E, Fortuny C, Noguera-Julian A.
J Pediatr. 2020 Jun 6. pii: S0022-3476(20)30709-5

Abstract: 

Objectives: To evaluate the results of the first 24 months of a postprescription review with feedback (PPRF)-based antimicrobial stewardship program (ASP) in a European referral children´s hospital.

Study design: We performed a pre-post study comparing antimicrobial use between the control (2015-16) and the intervention periods (2017-18) expressed in days-of-therapy/100 days-present (DOT/100 DP). Quality of prescriptions was evaluated by quarterly cross-sectional point-prevalence surveys (PPS). Length-of-stay (LOS), re-admission rates, in-hospital mortality rates, cost of systemic antimicrobial agents and antimicrobial resistance (AMR) rates were included as complementary outcomes.

Results: Total AU and antibacterial use significantly decreased during the intervention period (p=0.002 and p=0.001 respectively), and total antifungal use remained stable. A significant decline in parenteral antimicrobial use was also observed (P < .001). In 8 quarterly PPS (938 prescriptions evaluated), the mean prevalence of use of any antimicrobial among inpatients was 39%. An increasing trend in the rate of 'optimal' prescriptions was observed after the first PPS (p=0.0898). 'Non-optimal' prescriptions were more common in surgical than in medical departments, in antibacterial prescriptions with prophylactic intention, and in empirical more than in targeted treatments. No significant differences were observed in terms of mortality or readmission rates. Only minor changes in AMR rates were noted.

Conclusions: Our ASP safely decreased AU and expenditure, and a trend towards improvement in QP was also observed.

Keywords: antibiotic; antifungal; antimicrobial resistance; pediatrics; quality indicators.