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Published on: August 30, 2018
Use of Prospective Audit and Feedback to Reduce Antibiotic Exposure in a Pediatric Cardiac ICU
Hayden T Schwenk1,2, Jenna F Kruger1, Loren D Sacks3
1Lucile Packard Children's Hospital Stanford, Palo Alto, CA.
Insights
A prospective audit and feedback program significantly reduced antibiotic use in a pediatric cardiac intensive care unit (ICU). This intervention targeted antibiotic stewardship, with over a third of audited antibiotics leading to recommendations.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Antimicrobial stewardship
Background:
- Antibiotic utilization in pediatric cardiac intensive care units (ICUs) can be high.
- Optimizing antibiotic use is crucial for patient outcomes and combating resistance.
- Prospective audit and feedback is a strategy to improve antimicrobial prescribing.
Purpose of the Study:
- To evaluate the impact of a prospective audit and feedback intervention on antibiotic utilization in a pediatric cardiac ICU.
- To characterize the audits, recommendations, and adherence rates of the intervention.
Main Methods:
- A before-and-after study design was employed in a pediatric cardiac ICU.
- A prospective audit and feedback program for IV antibiotics was implemented.
- Antibiotic utilization was compared before (18 months) and after (24 months) intervention implementation.
Main Results:
- Mean IV antibiotic use decreased by 20% (701 vs. 880 days of therapy per 1,000 patient-days; p=0.001).
- No significant differences were observed in length of stay or mortality.
- 988 audits and 370 recommendations (37% rate) were generated; broad-spectrum agents for sepsis were commonly audited.
Conclusions:
- Prospective audit and feedback significantly reduced antibiotic use in a pediatric cardiac ICU.
- The intervention identified key areas for antimicrobial stewardship, with over one-third of audited antibiotics prompting recommendations.
Objectives:
We sought to determine whether a prospective audit and feedback intervention decreased antibiotic utilization in a pediatric cardiac ICU and to describe the characteristics of prospective audit and feedback audits and recommendations.
Design:
Before-after study.
Setting:
Pediatric cardiac ICU of a freestanding children's hospital.
Patients:
All patients admitted to the cardiac ICU.
Interventions:
A prospective audit and feedback program was established in our hospital's pediatric cardiac ICU on December 7, 2015. The antimicrobial stewardship program audited IV antibiotics, communicated prospective audit and feedback recommendations to the cardiac ICU, and regularly reviewed recommendation adherence. Mean monthly antibiotic utilization 18 months before ("preprospective audit and feedback"; from June 1, 2014 to November 30, 2015) and 24 months after ("prospective audit and feedback"; from January 1, 2016 to December 31, 2017) prospective audit and feedback implementation was compared. Antibiotic audit data during the prospective audit and feedback period were reviewed to capture the characteristics of prospective audit and feedback audits, recommendations, and adherence.
Measurements And Main Results:
Mean cardiac ICU IV antibiotic use decreased 20% (701 vs 880 days of therapy per 1,000 patient days, p = 0.001) during the prospective audit and feedback period compared with the preprospective audit and feedback period. There was no difference in mean cardiac ICU length of stay (p = 0.573), mean hospital length of stay (p = 0.722), or the rate of discharge due to death (p = 0.541). There were 988 antibiotic audits and 370 prospective audit and feedback recommendations (37% recommendation rate) during the study period. The most commonly audited antibiotic category was broad-spectrum gram-negative agents and the most common indication for use was sepsis. Broad-spectrum gram-positive agents were more likely to be associated with a recommendation.
Conclusions:
There was a significant reduction in antibiotic use following implementation of a prospective audit and feedback program in our pediatric cardiac ICU. Over one-third of antibiotics audited in our cardiac ICU were associated with a prospective audit and feedback recommendation, revealing important targets for future antimicrobial stewardship efforts in this population.
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