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Clinical impact of an antimicrobial stewardship program on high-risk pediatric patients

Published online by Cambridge University Press:  17 July 2019

Jennifer L. Goldman Open the ORCID record for Jennifer L. Goldman [Opens in a new window] ,
Jason G. Newland ,
Michael Price ,
Diana Yu  and
Brian R. Lee
Jennifer L. Goldman*
Affiliation:
Children’s Mercy Hospitals & Clinic, University of Missouri–Kansas City, Kansas City, Missouri
Jason G. Newland
Affiliation:
St Louis Children’s Hospital, Washington University, St Louis, Missouri
Michael Price
Affiliation:
University of Texas Southwestern Medical Center, Dallas, Texas
Diana Yu
Affiliation:
Doernbecher Children’s Hospital, Portland, Oregon
Brian R. Lee
Affiliation:
Children’s Mercy Hospitals & Clinic, University of Missouri–Kansas City, Kansas City, Missouri
*
Author for correspondence: Jennifer Goldman, E-mail: jlgoldman@cmh.edu
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Abstract

Objective:

To evaluate the clinical impact of an antimicrobial stewardship program (ASP) on high-risk pediatric patients.

Design:

Retrospective cohort study.

Setting:

Free-standing pediatric hospital.

Patients:

This study included patients who received an ASP review between March 3, 2008, and March 2, 2017, and were considered high-risk, including patients receiving care by the neonatal intensive care (NICU), hematology/oncology (H/O), or pediatric intensive care (PICU) medical teams.

Methods:

The ASP recommendations included stopping antibiotics; modifying antibiotic type, dose, or duration; or obtaining an infectious diseases consultation. The outcomes evaluated in all high-risk patients with ASP recommendations were (1) hospital-acquired Clostridium difficile infection, (2) mortality, and (3) 30-day readmission. Subanalyses were conducted to evaluate hospital length of stay (LOS) and tracheitis treatment failure. Multivariable generalized linear models were performed to examine the relationship between ASP recommendations and each outcome after adjusting for clinical service and indication for treatment.

Results:

The ASP made 2,088 recommendations, and 50% of these recommendations were to stop antibiotics. Recommendation agreement occurred in 70% of these cases. Agreement with an ASP recommendation was not associated with higher odds of mortality or hospital readmission. Patients with a single ASP review and agreed upon recommendation had a shorter median LOS (10.2 days vs 13.2 days; P < .05). The ASP recommendations were not associated with high rates of tracheitis treatment failure.

Conclusions:

ASP recommendations do not result in worse clinical outcomes among high-risk pediatric patients. Most ASP recommendations are to stop or to narrow antimicrobial therapy. Further work is needed to enhance stewardship efforts in high-risk pediatric patients.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 9 , September 2019 , pp. 968 - 973
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: The preliminary results of this study were presented in poster format at IDWeek 2018, October 4, 2018, in San Francisco, California.

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