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Antimicrobial Stewardship Programs in Pediatrics

  • Adam L. Hersh (a1), Susan E. Beekmann (a2), Philip M. Polgreen (a2), Theoklis E. Zaoutis (a3) and Jason G. Newland (a4)...

Abstract

Objective.

To describe the prevalence, characteristics, and barriers to implementation of antimicrobial stewardship programs (ASPs) in pediatrics.

Design and Participants.

In December 2008, we surveyed the pediatric members of the Emerging Infections Network, a network of infectious diseases consultants located throughout North America. Participants responded regarding whether their hospital had or planned to develop an ASP, its characteristics, barriers to improvement or implementation, and perceptions about antimicrobial resistance.

Results.

Of 246 pediatric infectious disease consultants surveyed, 147 (60%) responded. Forty-five respondents (33%) reported having an ASP, and 25 (18%) were planning a program. The percentage of respondents from freestanding children's hospitals who were planning ASPs was higher than the percentage of respondents from other settings who were planning ASPs (P = .04). Most existing programs were developed before 2000 and had a limited number of full-time equivalent staff, and few programs used a prospective audit-and-feedback structure. Many programs were not monitoring important end points associated with ASPs, including cost and number of antibiotic-days. The major barriers to implementation of an ASP were lack of resources, including funding, time, and personnel, noted by more than 50% of respondents. Regardless of the presence of an ASP, respondents perceived antibiotic resistance as a more significant problem nationally than at their local hospital (P < .001).

Conclusions.

The prevalence of ASPs in pediatrics is limited, and opportunities exist to improve current programs.

Copyright

Corresponding author

3333 California St, Ste 265, Box 0936, San Francisco, CA 94118 (hershad@peds.ucsf.edu)

References

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1.Bouza, E, Sousa, D, Munoz, P, Rodriguez-Creixems, M, Fron, C, Lechuz, JG. Bloodstream infections: a trial of the impact of different methods of reporting positive blood culture results. Clin Infect Dis 2004;39:11611169.
2.Hecker, MT, Aron, DC, Patel, NP, Lehmann, MK, Donskey, CI. Unnecessary use ot antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003;163:972978.
3.Bolon, MK, Arnold, AD, Feldman, HA, et al.Evaluating vancomycin use at a pediatric hospital: new approaches and insights. Infect Control Hosp Epidemiol 2005;26:4755.
4.Castle, M, Wilfert, CM, Cate, TR, Osterhout, S. Antibiotic use at Duke University Medical Center. JAMA 1977;237:28192822.
5.Scheckler, WE, Bennett, JV. Antibiotic usage in seven community hospitals. JAMA 1970;213:264267.
6.Byl, B, Clevenbergh, P, Jacobs, F, et al.Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect Dis 1999;29:6066.
7.Potocki, M, Goette, J, Szucs, TD, Nadal, D. Prospective survey of antibiotic utilization in pediatric hospitalized patients to identify targets for improvement of prescription. Infection 2003;31:398403.
8.Sunenshine, RH, Liedtke, LA, Jernigan, DB, Strausbaugh, LJ. Role of infectious diseases consultants in management of antimicrobial use in hospitals. Clin Infect Dis 2004;38:934938.
9.Dellit, TH, Owens, RC, McGowan, JE Jr, et al.Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159177.
10.Evans, HL, Lefrak, SN, Lyman, J, et al.Cost of gram-negative resistance. Crit Care Med 2007;35:8995.
11.McGowan, JE Jr. Economic impact of antimicrobial resistance. Emerg Infect Dis 2001;7:286292.
12.Cosgrove, SE, Carmeli, Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis 2003;36:14331437.
13.Maragakis, LL, Perencevich, EN, Cosgrove, SE. Clinical and economic burden of antimicrobial resistance. Expert Rev Anti Infect Ther 2008;6:751763.
14.Cosgrove, SE, Patel, A, Song, X, et al.Impact of different methods of feedback to clinicians after postprescription antimicrobial review based on the Centers for Disease Control and Prevention's 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults. Infect Control Hosp Epidemiol 2007;28:641646.
15.Ruttimann, S, Keck, B, Hartmeier, C, Maetzel, A, Bucher, HC. Long-term antibiotic cost savings from a comprehensive intervention program in a medical department of a university-affiliated teaching hospital. Clin Infect Dis 2004;38:348356.
16.Carling, P, Fung, T, Killion, A, Terrin, N, Barza, M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol 2003;24:699706.
17.Evans, RS, Pestotnik, SL, Classen, DC, et al.A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med 1998;338:232238.
18.Ansari, F, Gray, K, Nathwani, D, et al.Outcomes of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis. J Antimicrob Chemother 2003;52:842848.
19.LaRocco, A Jr.Concurrent antibiotic review programs—a role for infectious diseases specialists at small community hospitals. Clin Infect Dis 2003;37:742743.
20.Apisarnthanarak, A, Danchaivijitr, S, Khawcharoenporn, T, et al.Effectiveness of education and an antibiotic-control program in a tertiary care hospital in Thailand. Clin Infect Dis 2006;42:768775.
21.Metjian, TA, Prasad, PA, Kogon, A, Coffin, SE, Zaoutis, TE. Evaluation of an antimicrobial stewardship program at a pediatric teaching hospital. Pediatr Infect Dis J 2008;27:106111.
22.Di Pentima, MC, Chan, S, Eppes, SC, Klein, JD. Antimicrobial prescription errors in hospitalized children: role of antimicrobial stewardship program in detection and intervention. Clin Pediatr (Phila) 2009;48:505512.
23.Agwu, AL, Lee, CK, Jain, SK, et al.A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center. Clin Infect Dis 2008;47:747753.
24.Ghaleb, MA, Barber, N, Franklin, BD, Yeung, VW, Khaki, ZF, Wong, IC. Systematic review of medication errors in pediatric patients. Ann Phar-macother 2006;40:17661776.
25.Newland, JG, Stach, LM, Jackson, MA, Myers, AL, Herigon, JC, Zaoutis, TE. Successful Implementation of an Antimicrobial Stewardship Program at a Children's Hospital. San Diego: Society for Healthcare Epidemiology of America, 2009.
26.Giblin, TB, Sinkowitz-Cochran, RL, Harris, PL, et al.Clinicians' perceptions of the problem of antimicrobial resistance in healthcare facilities. Arch Intern Med 2004;164:16621668.
27.Wester, CW, Durairaj, L, Evans, AT, Schwartz, DN, Husain, S, Martinez, E. Antibiotic resistance: a survey of physician perceptions. Arch Intern Med 2002;162:22102216.
28.Barlam, TF, DiVall, M. Antibiotic-stewardship practices at top academic centers throughout the United States and at hospitals throughout Massachusetts. Infect Control Hosp Epidemiol 2006;27:695703.

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