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Inpatient Antimicrobial Stewardship in Pediatrics: A Systematic Review
Michael J Smith1, Jeffrey S Gerber2, Adam L Hersh3
1Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky.
Insights
Pediatric antimicrobial stewardship programs (ASPs) and interventions reduce antimicrobial use, costs, and errors without harming patient safety. More research is needed to fully understand their impact.
Area of Science:
- Pediatric infectious diseases
- Health services research
- Antimicrobial stewardship
Background:
- Clinical and economic outcomes of pediatric antimicrobial stewardship programs (ASPs) and interventions are not well-documented.
- Limited review exists on the effectiveness of supplemental antimicrobial stewardship (AS) strategies in children.
Purpose of the Study:
- To systematically review and summarize the clinical and economic outcomes of pediatric antimicrobial stewardship programs (ASPs) and other AS interventions.
- To assess the impact of these programs on antimicrobial utilization, prescribing errors, costs, and patient safety.
Main Methods:
- Systematic review of PubMed-identified studies using keywords related to antimicrobial stewardship and pediatric populations.
- Inclusion criteria focused on inpatient studies in the United States involving children, infants, or newborns.
- Summarized clinical and economic outcomes reported in the selected studies.
Main Results:
- Nine studies reported on formal pediatric ASPs, and eight focused on specific AS interventions.
- Key outcomes included decreased antimicrobial utilization (11 studies), prescribing errors (3 studies), and drug costs (3 studies).
- No adverse patient safety effects were identified; however, data on antimicrobial resistance impact are limited.
Conclusions:
- Published pediatric studies indicate that ASPs and AS interventions reduce antimicrobial use, costs, and prescribing errors.
- These interventions appear to have no negative impact on patient safety.
- The current evidence base is limited, necessitating further research on prescribing appropriateness, outcomes, and economic evaluations.
Background:
The clinical and economic outcomes associated with pediatric antimicrobial stewardship programs (ASPs) and other supplemental antimicrobial stewardship (AS) interventions have not been well described or reviewed.
Methods:
We performed a systematic review using PubMed to identify studies with any of the following terms in the title or abstract: "antimicrobial stewardship," "antimicrobial control," "antibiotic control," or "antibiotic stewardship." Studies were further limited to inpatient studies in the United States that contained the terms: "child," "children," "pediatric*" ("*" includes all terms with the same stem), "paediatric,*" "newborn," "infant," or "neonat,*" in the title or abstract. Clinical and economic outcomes from each relevant study were summarized.
Results:
Nine original studies reported outcomes related to formal pediatric ASPs. An additional 8 studies focused on specific AS interventions; 3 on management of community-acquired pneumonia, 2 on vancomycin-specific initiatives, and 1 each on clinical support, antibiotic restriction, and antibiotic rotation. Reported outcomes include decreases in antimicrobial utilization (11 studies), prescribing errors (3 studies), and drug costs (3 studies). Five studies assessed the potential adverse effects of AS interventions on patient safety and found none. Data to support an association between pediatric AS interventions and antimicrobial resistance are limited.
Conclusions:
A small number of pediatric studies evaluating ASPs or other AS strategies have been published. These studies demonstrate reductions in antimicrobial utilization, cost, and prescribing errors with no apparent negative impact on patient safety. Although the studies are promising, the current evidence base is limited. Additional studies focusing on the appropriateness and outcomes of antimicrobial prescribing practices as well as more formalized economic evaluations are needed.
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