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Published on: August 30, 2018
Pediatric antibiotic stewardship: successful interventions to reduce broad-spectrum antibiotic use on general
Katharina Kreitmeyr1,2,3, Ulrich von Both1,3, Alenka Pecar2
1Division of Pediatric Infectious Diseases, Dr. von Hauner Children's Hospital, LMU Munich, Munich, Germany.
Insights
Implementing antibiotic stewardship programs (ASP) improved rational antibiotic use in pediatric wards. This led to decreased antibiotic therapy duration and better adherence to guidelines without adverse effects.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Resistance
- Public Health
Background:
- Antibiotic stewardship programs (ASP) are crucial for optimizing antibiotic use and combating bacterial resistance.
- Effective ASP implementation is vital for improving patient safety and healthcare outcomes.
Purpose of the Study:
- To evaluate the impact of specific antibiotic stewardship program interventions on antibiotic consumption in general pediatric wards.
- To assess changes in antibiotic prescribing patterns, dosage accuracy, and guideline adherence post-ASP implementation.
Main Methods:
- A prospective study comparing pre-intervention (2014) and post-intervention (2015) periods in pediatric wards.
- Implementation of an ASP bundle including infectious diseases ward rounds, consultation services, and internal guidelines.
- Analysis of antibiotic consumption, dosage accuracy, and adherence to community-acquired pneumonia (CAP) guidelines.
Main Results:
- Antibiotic prescription rates remained stable, but overall days-of-therapy and length-of-therapy decreased.
- Significant reductions in cephalosporin and fluoroquinolone use, with an increase in penicillin use.
- Improved dosage accuracy (78.8% to 97.6%) and CAP guideline adherence (39.5% to 93.5%) were observed.
Conclusions:
- ASP implementation significantly improved rational antibiotic use and patient safety in pediatric wards.
- The study highlights the effectiveness of a multi-faceted ASP approach.
- Further investigation is needed to determine the long-term effects of the implemented ASP bundle.
Purpose:
Antibiotic stewardship programs (ASP) optimize antibiotic usage and combat antibiotic resistance of bacteria. The objective of this study was to assess the impact of specific ASP interventions on antibiotic consumption in general pediatric wards.
Methods:
We conducted a prospective study to compare a pre-intervention (Sept.-Dec. 2014) and post-intervention (Sept.-Dec. 2015) period. An ASP bundle was established including (1) infectious diseases (ID) ward rounds (prospective-audit-with-feedback), (2) ID consultation service, (3) internal guidelines on empiric antibiotic therapy. Medical records on four general pediatric wards were reviewed daily to analyze: (1) antibiotic consumption, (2) antibiotic dosage ranges according to local guidelines, and (3) guideline adherence for community-acquired pneumonia (CAP).
Results:
Antibiotic prescribing for 273 patients (pre-intervention) was compared to 263 patients (post-intervention). Antibiotic prescription rate did not change (30.6 vs. 30.5%). However, overall days-of-therapy and length-of-therapy decreased by 10.5 and 7.7%, respectively. Use of cephalosporins and fluoroquinolones decreased by 35.5 and 59.9%, whereas the use of penicillins increased by 15.0%. An increase in dosage accuracy was noted (78.8 vs. 97.6%) and guideline adherence for CAP improved from 39.5 to 93.5%. Between the two study periods, no adverse effects regarding length of hospital stay and in-hospital mortality were observed.
Conclusions:
Our data demonstrate that implementation of an ASP was associated with a profound improvement of rational antibiotic use and, therefore, patient safety. Considering the relatively short observation period, the long-term effects of our ASP bundle need to be further investigated.
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