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Improving paediatric antimicrobial stewardship in hospital-based settings: why, where and how?
E Tanner1, A P S Munro2,3, J Gray2
1University of Southampton Medical School, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Insights
A new nurse-led outpatient parenteral antimicrobial therapy (OPAT) service improved antimicrobial prescribing and increased the number of children treated at home. This initiative enhances antimicrobial stewardship and potentially reduces healthcare costs.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Healthcare Management
Background:
- Antimicrobial resistance (AMR) is a global health priority.
- Pediatric inpatient care often lacks sufficient antimicrobial stewardship.
- Intravenous (IV) antimicrobials are frequently used in hospitalized children.
Purpose of the Study:
- To evaluate a nurse-led ambulatory outpatient parenteral antimicrobial therapy (OPAT) service for children.
- To assess the impact on antimicrobial prescribing quality and patient ambulation timing.
- To analyze outcomes for common pediatric infections treated with short-course IV antimicrobials.
Main Methods:
- Retrospective review of cases managed in two 2-month periods: pre-service (Sept-Oct 2016) and post-service (Sept-Oct 2018).
- Prospective evaluation of the nurse-led ambulatory OPAT service.
- Comparison of antimicrobial prescribing appropriateness and ambulation rates.
Main Results:
- Appropriate IV antibiotic management decisions at 48 hours increased from 75% (2016) to 96% (2018).
- Patient ambulation on IV antibiotics rose from 19% (2016) to 64% (2018).
- Suboptimal antimicrobial prescribing decisions at initial hospital presentation persisted in 2018.
Conclusions:
- A nurse-led ambulatory OPAT service significantly improved antimicrobial use in pediatric patients.
- The service facilitated earlier patient discharge, optimizing inpatient bed utilization.
- Ambulatory OPAT services offer potential cost savings and improved antimicrobial stewardship in pediatrics.
Background:
Antimicrobial resistance (AMR) is being recognized as a priority by healthcare organizations across the world. However, many children are managed on IV antimicrobials in hospital with very little consideration of antimicrobial stewardship issues.
Objectives:
A nurse-led paediatric ambulatory outpatient parenteral antimicrobial therapy (OPAT) service, managing children with common infections being ambulated on short courses of IV antimicrobials, was introduced within Southampton Children's Hospital in January 2018. We evaluated the impact of this service in terms of the quality of antimicrobial prescribing and timing of ambulation in children presenting with common infections.
Methods:
All cases managed within the service were reviewed in two separate 2 month time periods: prior to introduction of the service (September-October 2016) and then prospectively after its introduction (September-October 2018).
Results:
A total of 96% of IV antibiotic management decisions at 48 h were deemed appropriate in 2018, compared with 75% in 2016. A total of 64% of patients were ambulated on IV antibiotics at some point during their treatment course in 2018, compared with 19% in 2016. However, a significant proportion of antimicrobial decisions made at the point of presentation to hospital remained suboptimal in 2018.
Conclusions:
Children are commonly managed with IV antibiotics in hospital. We demonstrate marked improvements in appropriate antimicrobial use through the introduction of a nurse-led ambulatory OPAT service. In addition, such a service can promote a greater proportion of children being ambulated from hospital, freeing up valuable inpatient beds and potentially delivering cost savings that can be used to fund such services.
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