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Clinical Diagnoses and Antimicrobials Predictive of Pediatric Antimicrobial Stewardship Recommendations: A Program Evaluation

  • Jennifer L. Goldman (a1), Brian R. Lee (a2), Adam L. Hersh (a3), Diana Yu (a4), Leslie M. Stach (a5), Angela L. Myers (a1), Mary Anne Jackson (a1), James C. Day (a1), Russell J. McCulloh (a1) and Jason G. Newland (a1)...

Abstract

BACKGROUND

The number of pediatric antimicrobial stewardship programs (ASPs) is increasing and program evaluation is a key component to improve efficiency and enhance stewardship strategies.

OBJECTIVE

To determine the antimicrobials and diagnoses most strongly associated with a recommendation provided by a well-established pediatric ASP.

DESIGN AND SETTING

Retrospective cohort study from March 3, 2008, to March 2, 2013, of all ASP reviews performed at a free-standing pediatric hospital.

METHODS

ASP recommendations were classified as follows: stop therapy, modify therapy, optimize therapy, or consult infectious diseases. A multinomial distribution model to determine the probability of each ASP recommendation category was performed on the basis of the specific antimicrobial agent or disease category. A logistic model was used to determine the odds of recommendation disagreement by the prescribing clinician.

RESULTS

The ASP made 2,317 recommendations: stop therapy (45%), modify therapy (26%), optimize therapy (19%), or consult infectious diseases (10%). Third-generation cephalosporins (0.20) were the antimicrobials with the highest predictive probability of an ASP recommendation whereas linezolid (0.05) had the lowest probability. Community-acquired pneumonia (0.26) was the diagnosis with the highest predictive probability of an ASP recommendation whereas fever/neutropenia (0.04) had the lowest probability. Disagreement with ASP recommendations by the prescribing clinician occurred 22% of the time, most commonly involving community-acquired pneumonia and ear/nose/throat infections.

CONCLUSIONS

Evaluation of our pediatric ASP identified specific clinical diagnoses and antimicrobials associated with an increased likelihood of an ASP recommendation. Focused interventions targeting these high-yield areas may result in increased program efficiency and efficacy.

Infect Control Hosp Epidemiol 2015;00(0): 1–8

Copyright

Corresponding author

Address correspondence to Jennifer Goldman, MD, Department of Pediatrics, Divisions of Pediatric Infectious Diseases & Clinical Pharmacology, Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108 (jlgoldman@cmh.edu).

Footnotes

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Presented in part: IDWeek; Philadelphia, Pennsylvania; October 9, 2014; abstract 46704.

Footnotes

References

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1. 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.
2. Di Pentima, MC, Chan, S, Hossain, J. Benefits of a pediatric antimicrobial stewardship program at a children’s hospital. Pediatrics 2011;128:10621070.
3. 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.
4. DiazGranados, CA. Prospective audit for antimicrobial stewardship in intensive care: impact on resistance and clinical outcomes. Am J Infect Control 2012;40:526529.
5. Newland, JG, Stach, LM, De Lurgio, SA, et al. Impact of a prospective-audit-with-feedback antimicrobial stewardship program at a children’s hospital. J Ped Infect Dis 2012;1:179186.
6. 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.
7. LaRosa, LA, Fishman, NO, Lautenbach, E, Koppel, RJ, Morales, KH, Linkin, DR. Evaluation of antimicrobial therapy orders circumventing an antimicrobial stewardship program: investigating the strategy of “stealth dosing.”. Infect Control Hosp Epidemiol 2007;28:551556.
8. Lautenbach, E, LaRosa, LA, Marr, AM, Nachamkin, I, Bilker, WB, Fishman, NO. Changes in the prevalence of vancomycin-resistant enterococci in response to antimicrobial formulary interventions: impact of progressive restrictions on use of vancomycin and third-generation cephalosporins. Clin Infect Dis 2003;36:440446.
9. Morgan, AS, Brennan, PJ, Fishman, NO. Impact of a vancomycin restriction policy on use and cost of vancomycin and incidence of vancomycin-resistant Enterococcus . Ann Pharmacother 1997;31:970973.
10. 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.
11. Hersh, AL, Beekmann, SE, Polgreen, PM, Zaoutis, TE, Newland, JG. Antimicrobial stewardship programs in pediatrics. Infect Control Hosp Epidemiol 2009;30:12111217.
12. Newland, JG, Gerber, JS, Weissman, SJ, et al. Prevalence and characteristics of antimicrobial stewardship programs at freestanding children’s hospitals in the United States. Infect Control Hosp Epidemiol 2014;35:265271.
13. Stach, LM, Hedican, EB, Herigon, JC, Jackson, MA, Newland, JG. Clinicians’ attitudes towards an antimicrobial stewardship program at a children’s hospital. J Ped Infect Dis 2012;1:190197.
14. Feudtner, C, Hays, RM, Haynes, G, Geyer, JR, Neff, JM, Koepsell, TD. Deaths attributed to pediatric complex chronic conditions: national trends and implications for supportive care services. Pediatrics 2001;107:e99.
15. Bradley, JS, Byington, CL, Shah, SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011;53:e25e76.
16. Newman, RE, Hedican, EB, Herigon, JC, Williams, DD, Williams, AR, Newland, JG. Impact of a guideline on management of children hospitalized with community-acquired pneumonia. Pediatrics 2012;129:e597e604.
17. Toikka, P, Irjala, K, Juven, T, et al. Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect Dis J 2000;19:598602.
18. Hersh, AL, Shapiro, DJ, Newland, JG, Polgreen, PM, Beekmann, SE, Shah, SS. Variability in pediatric infectious disease consultants’ recommendations for management of community-acquired pneumonia. PLOS ONE 2011;6:e20325.
19. Sick, AC, Lehmann, CU, Tamma, PD, Lee, CK, Agwu, AL. Sustained savings from a longitudinal cost analysis of an Internet-based preapproval antimicrobial stewardship program. Infect Control Hosp Epidemiol 2013;34:573580.
20. Venugopal, V, Lehmann, CU, Diener-West, M, Agwu, AL. Longitudinal evaluation of a World Wide Web-based antimicrobial stewardship program: assessing factors associated with approval patterns and trends over time. Am J Infect Control 2014;42:100105.
21. Mehta, JM, Haynes, K, Wileyto, EP, et al. Comparison of prior authorization and prospective audit with feedback for antimicrobial stewardship. Infect Control Hosp Epidemiol 2014;35:10921099.
22. Davey, P, Brown, E, Charani, E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2013;4:(CD003543).
23. Nowak, MA, Nelson, RE, Breidenbach, JL, Thompson, PA, Carson, PJ. Clinical and economic outcomes of a prospective antimicrobial stewardship program. Am J Health Syst Pharm 2012;69:15001508.
24. MacDougall, C, Polk, RE. Antimicrobial stewardship programs in health care systems. Clin Microbiol Rev 2005;18:638656.

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