[Antibiotic escalation with the inclusion of a checklist in the pediatric intensive care unit]

Area of Science:

• Pediatric critical care medicine
• Infectious diseases
• Antimicrobial stewardship

Background:

• Antibiotic surveillance is crucial for optimizing antibiotic therapy.
• Inappropriate antibiotic use contributes to resistance and adverse outcomes.
• Pediatric intensive care units (PICUs) require targeted strategies for antibiotic stewardship.

Purpose of the Study:

• To evaluate the impact of a prospective checklist on antibiotic scaling at 48 hours post-prescription in a PICU.
• To assess changes in infectious diseases (ID) specialist consultation rates and vancomycin prescription following checklist implementation.

Main Methods:

• An ambispective cohort study compared patients managed with a new checklist to a historical cohort.
• The primary outcome was antibiotic scaling at 48 hours; secondary outcomes included ID consultation and vancomycin use.
• Statistical analyses included chi-squared, Fischer's, and Mann-Whitney U tests, with results expressed as RR and ARR.

Main Results:

• Checklist implementation reduced antibiotic scaling from 56.4% to 21.4% (p < 0.0001), with an Absolute Risk Reduction (ARR) of 35%.
• Vancomycin prescription decreased from 64.5% to 40% (p < 0.001), with an ARR of 24.5%.
• Infectious diseases specialist consultations increased significantly from 9.6% to 32.8% (p < 0.0001).

Conclusions:

• Checklist implementation is effective in decreasing antibiotic scaling and vancomycin use in the PICU.
• The intervention successfully increased the rate of infectious diseases specialist consultations.
• These findings support the use of checklists as a tool for enhancing antimicrobial stewardship in pediatric critical care.