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Outpatient antimicrobial stewardship programs in pediatric institutions in 2020: Status, needs, barriers

Published online by Cambridge University Press:  22 October 2021

Rana E. El Feghaly Open the ORCID record for Rana E. El Feghaly [Opens in a new window] ,
Elizabeth A. Monsees ,
Alaina Burns ,
Ann Wirtz ,
Brian R. Lee ,
Adam L. Hersh  and
Jason G. Newland
Rana E. El Feghaly*
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri University of Missouri Kansas City School of Medicine, Kansas City, Missouri
Elizabeth A. Monsees
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri University of Missouri Kansas City School of Medicine, Kansas City, Missouri
Alaina Burns
Affiliation:
University of Missouri Kansas City School of Medicine, Kansas City, Missouri Department of Pharmacy, Children’s Mercy Kansas City, Kansas City, Missouri
Ann Wirtz
Affiliation:
University of Missouri Kansas City School of Medicine, Kansas City, Missouri Department of Pharmacy, Children’s Mercy Kansas City, Kansas City, Missouri
Brian R. Lee
Affiliation:
University of Missouri Kansas City School of Medicine, Kansas City, Missouri Division of Health Services and Outcomes Research, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
Adam L. Hersh
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, Utah
Jason G. Newland
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
*
Author for correspondence: Rana E. El Feghaly, E-mail: relfeghaly@cmh.edu
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Abstract

Objective:

To assess current resources, interventions, and obstacles of pediatric outpatient antimicrobial stewardship programs (ASP).

Design:

Cross-sectional study.

Setting:

Institutions from the Sharing Antimicrobial Reports for Pediatric Stewardship OutPatient collaborative (SHARPS-OP).

Participants:

Antimicrobial stewardship leaders from the above institutions.

Methods:

An investigator-developed survey was deployed online in September 2020 to antimicrobial stewardship leaders in SHARPS-OP institutions. The survey was divided into 4 sections: (1) basic information, (2) status of pediatric outpatient ASP in the institutions including financial support, (3) outpatient ASP interventions undertaken by the institutions, and (4) needs and SHARPS-OP collaborative goals.

Results:

Of 56 invited institutions, 45 participated, achieving an 80% response rate. Only 5 sites (11%) had allocated financial support for an outpatient ASP, compared to 42 (95.6%) for their inpatient ASP. The most widely used outpatient ASP interventions included antimicrobial guidance (57.8%), education (46.7%), and quality improvement projects (37.8%). Time was identified as the biggest barrier to expanding outpatient ASPs (91.1%), followed by financial support (53.3%), development of meaningful reports (51.1%), and administrative support (44.4%). Important goals of the collaborative included seeking learning opportunities and developing clear metrics for pediatric outpatient ASP benchmarking. Program needs included securing operational support (35.8%) and strengthening data analysis (31.6%).

Conclusions:

Very few pediatric institutions with robust inpatient ASPs have devoted time and financial support to advance outpatient efforts. To promote appropriate antibiotic prescribing in the outpatient arena, time and resource funding by administrative leaders are necessary to develop a robust, sustainable stewardship infrastructure.

Keywords

outpatient antimicrobial stewardshippediatricsurveycollaborativeantibiotic stewardship
Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 10 , October 2022 , pp. 1396 - 1402
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: This work was presented as a highlighted E-poster during IDWeek 2021, which was held virtually September 29, 2021, through Sunday, October 3, 2021.

References

Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51–e77.CrossRefGoogle Scholar
US national action plan for combating antibiotic-resistant bacteria (national action plan). Centers for Disease Control and Prevention website. https://www.cdc.gov/drugresistance/usactivities/national-action-plan.html. Accessed September 22, 2021.Google Scholar
APPROVED: New antimicrobial stewardship standard. Jt Comm Perspect 2016;36(7):1, 3–4, 8.Google Scholar
Nathwani, D, Varghese, D, Stephens, J, Ansari, W, Martin, S, Charbonneau, C. Value of hospital antimicrobial stewardship programs (ASPs): a systematic review. Antimicrob Resist Infect Control 2019;8:35.CrossRefGoogle ScholarPubMed
Huebner, C, Flessa, S, Huebner, NO. The economic impact of antimicrobial stewardship programmes in hospitals: a systematic literature review. J Hosp Infect 2019;102:369–376.Google ScholarPubMed
Garcia Reeves, AB, Lewis, JW, Trogdon, JG, Stearns, SC, Weber, DJ, Weinberger, M. Association between statewide adoption of the CDC’s Core Elements of Hospital Antimicrobial Stewardship Programs and rates of methicillin-resistant Staphylococcus aureus bacteremia and Clostridioides difficile infection in the United States. Infect Control Hosp Epidemiol 2020;41:430–437.Google ScholarPubMed
Lee, CF, Cowling, BJ, Feng, S, et al. Impact of antibiotic stewardship programmes in Asia: a systematic review and meta-analysis. J Antimicrob Chemother 2018;73:844–851.CrossRefGoogle ScholarPubMed
Kapadia, SN, Abramson, EL, Carter, EJ, et al. The expanding role of antimicrobial stewardship programs in hospitals in the United States: lessons learned from a multisite qualitative study. Jt Comm J Qual Patient Saf 2018;44:68–74.Google ScholarPubMed
Duffy, E, Ritchie, S, Metcalfe, S, Van Bakel, B, Thomas, MG. Antibacterials dispensed in the community comprise 85%–95% of total human antibacterial consumption. J Clin Pharm Ther 2018;43:59–64.CrossRefGoogle ScholarPubMed
Suda, KJ, Hicks, LA, Roberts, RM, Hunkler, RJ, Matusiak, LM, Schumock, GT. Antibiotic expenditures by medication, class, and healthcare setting in the United States, 2010–2015. Clin Infect Dis 2018;66:185–190.Google ScholarPubMed
Fleming-Dutra, KE, Hersh, AL, Shapiro, DJ, et al. Prevalence of Inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA 2016;315:1864–1873.CrossRefGoogle ScholarPubMed
Hersh, AL, King, LM, Shapiro, DJ, Hicks, LA, Fleming-Dutra, KE. Unnecessary antibiotic prescribing in US ambulatory care settings, 2010–2015. Clin Infect Dis 2021;72:133–137.Google ScholarPubMed
Ray, MJ, Tallman, GB, Bearden, DT, Elman, MR, McGregor, JC. Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study. BMJ 2019;367:16461.Google ScholarPubMed
Zetts, RM, Garcia, AM, Doctor, JN, Gerber, JS, Linder, JA, Hyun, DY. Primary care physicians’ attitudes and perceptions towards antibiotic resistance and antibiotic stewardship: a national survey. Open Forum Infect Dis 2020;7:ofaa244.CrossRefGoogle ScholarPubMed
Gerber, JS, Jackson, MA, Tamma, PD, et al. Policy statement: antibiotic stewardship in pediatrics. J Pediatric Infect Dis Soc 2021;10:641–649.Google Scholar
Sanchez, GV, Fleming-Dutra, KE, Roberts, RM, Hicks, LA. Core elements of outpatient antibiotic stewardship. MMWR Recommend Repts 2016;65(6). doi: 10.15585/mmwr.rr6506a1external icon.Google ScholarPubMed
NewsCAP: Joint Commission issues antimicrobial stewardship requirements for ambulatory health care. Am J Nurs 2019;119:13.Google Scholar
Drekonja, DM, Filice, GA, Greer, N, et al. Antimicrobial stewardship in outpatient settings: a systematic review. Infect Control Hosp Epidemiol 2015;36:142–152.CrossRefGoogle ScholarPubMed
Mistry, RD, Newland, JG, Gerber, JS, et al. Current state of antimicrobial stewardship in children’s hospital emergency departments. Infect Control Hosp Epidemiol 2017;38:469–475.Google ScholarPubMed
Zachariah, P, Newland, JG, Gerber, JS, et al. Costs of antimicrobial stewardship programs at US children’s hospitals. Infect Control Hosp Epidemiol 2016;37:852–854.CrossRefGoogle ScholarPubMed
Newland, JG, Gerber, JS, Kronman, MP, et al. Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS): a quality improvement collaborative. J Pediatric Infect Dis Soc 2018;7:124–128.CrossRefGoogle ScholarPubMed
Tribble, AC, Lee, BR, Flett, KB, et al. Appropriateness of antibiotic prescribing in United States children’s hospitals: a national point prevalence survey. Clin Infect Dis 2020;71:e226–e234.CrossRefGoogle ScholarPubMed
McPherson, CC, Vesoulis, ZA, Metjian, TA, et al. Utilization of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative electronic mailing list (listserv) by healthcare professionals. Infect Control Hosp Epidemiol 2021;42:1118–1120.Google ScholarPubMed
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;35:265–271.CrossRefGoogle ScholarPubMed
Eudy, JL, Pallotta, AM, Neuner, EA, et al. Antimicrobial stewardship practice in the ambulatory setting from a national cohort. Open Forum Infect Dis 2020;7:ofaa513.CrossRefGoogle ScholarPubMed
Yadav, K, Stahmer, A, Mistry, RD, May, L. An implementation science approach to antibiotic stewardship in emergency departments and urgent care centers. Acad Emerg Med 2020;27:31–42.Google ScholarPubMed
Marcelin, JR, Chung, P, Van Schooneveld, TC. Antimicrobial stewardship in the outpatient setting: a review and proposed framework. Infect Control Hosp Epidemiol 2020;41:833–840.CrossRefGoogle ScholarPubMed
Dona, D, Barbieri, E, Daverio, M, et al. Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review. Antimicrob Resist Infect Control 2020;9:3.CrossRefGoogle ScholarPubMed
Walters, EM, D’Auria, J, Jackson, C, Walsh-Kelly, C, Park, D, Willis, ZI. An ambulatory antimicrobial stewardship initiative to improve diagnosis and treatment of urinary tract infections in children. Jt Comm J Qual Patient Saf 2019;45:829–837.Google ScholarPubMed
Brennan-Krohn, T, Ozonoff, A, Sandora, TJ. Adherence to guidelines for testing and treatment of children with pharyngitis: a retrospective study. BMC Pediatr 2018;18:43.CrossRefGoogle ScholarPubMed
Bozzella, MJ, Harik, N, Newland, JG, Hamdy, RF. From paper to practice: strategies for improving antibiotic stewardship in the pediatric ambulatory setting. Curr Probl Pediatr Adolesc Health Care 2018;48:289–305.CrossRefGoogle ScholarPubMed
Newland, JG. Improving antibiotic use through quality improvement methods: quality improvement for antibiotic use. Jt Comm J Qual Patient Saf 2019;45:787–788.Google ScholarPubMed
El Feghaly, RE, Burns, A, Goldman, JL, Myers, A, Purandare, AV, Lee, BR. Novel outpatient antibiotic prescribing report of respiratory infections in a pediatric health system’s emergency departments and urgent care clinics. Am J Infect Control 2021;49:398–400.CrossRefGoogle Scholar
Larsen, GY, Brilli, R, Macias, CG, et al. Development of a quality improvement learning collaborative to improve pediatric sepsis outcomes. Pediatrics 2021;147.Google ScholarPubMed
Cantey, JB, Wozniak, PS, Pruszynski, JE, Sanchez, PJ. Reducing unnecessary antibiotic use in the neonatal intensive care unit (SCOUT): a prospective interrupted time-series study. Lancet Infect Dis 2016;16:1178–1184.CrossRefGoogle ScholarPubMed
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