Clinical impact of an antimicrobial stewardship program on high-risk pediatric patients

Area of Science:

• Infectious Diseases
• Pediatric Hospital Medicine
• Antimicrobial Stewardship

Background:

• Antimicrobial resistance necessitates effective antimicrobial stewardship programs (ASP).
• High-risk pediatric populations, including those in neonatal intensive care (NICU), hematology/oncology (H/O), and pediatric intensive care units (PICU), require careful antibiotic management.
• The clinical impact of ASPs in these vulnerable groups is crucial to understand.

Purpose of the Study:

• To evaluate the clinical impact of an antimicrobial stewardship program (ASP) on high-risk pediatric patients.
• To assess the association between ASP recommendations and key clinical outcomes including hospital-acquired infections, mortality, and readmissions.
• To determine if ASP interventions affect hospital length of stay and treatment failure in specific conditions.

Main Methods:

• Retrospective cohort study of high-risk pediatric patients (NICU, H/O, PICU) who received ASP review between 2008 and 2017.
• Evaluated ASP recommendations (e.g., stopping antibiotics, modifying therapy, infectious diseases consultation).
• Analyzed outcomes: Clostridium difficile infection, mortality, 30-day readmission, length of stay (LOS), and tracheitis treatment failure using multivariable models.

Main Results:

• The ASP made 2,088 recommendations, with 50% advising to stop antibiotics; 70% agreement was observed.
• Agreement with ASP recommendations was not associated with increased mortality or hospital readmission.
• Patients with agreed ASP recommendations had a shorter median LOS (10.2 vs 13.2 days; P < .05).

Conclusions:

• Antimicrobial stewardship program recommendations are safe for high-risk pediatric patients.
• Most ASP recommendations focus on de-escalation of antimicrobial therapy.
• Further efforts are needed to optimize ASP impact in high-risk pediatric populations.