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Antimicrobial Stewardship in Bronchiolitis: A Retrospective Cohort Study of Three PICUs in Canada
Nada A Aljassim1, Kim C Noël2, Christina Maratta3
1Department of Pediatric Critical Care, Critical Care Center, King Fahad Medical City, Riyadh, Saudi Arabia.
Insights
Antimicrobial stewardship programs in pediatric intensive care units (PICUs) increased the likelihood of discontinuing antimicrobial treatments for children with bronchiolitis. Further research is needed to confirm their role in reducing unnecessary antimicrobial use.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Health services research
Background:
- Bronchiolitis is a common respiratory infection in infants and young children, often leading to hospitalization in pediatric intensive care units (PICUs).
- Antimicrobial use in PICUs for bronchiolitis is a concern due to potential resistance and side effects.
- Antimicrobial stewardship programs (ASPs) aim to optimize antimicrobial use.
Purpose of the Study:
- To evaluate the association between implementing an ASP and antimicrobial use in critically ill children with bronchiolitis.
- To assess the impact of ASP presence on antimicrobial prescribing patterns across multiple Canadian PICUs.
Main Methods:
- A multicenter retrospective cohort study was conducted across three Canadian PICUs over two winter seasons.
- Regression models were used to analyze the association between ASP implementation/presence and antimicrobial discontinuation, duration, and prescriptions.
- The study included 372 pediatric patients (≤2 years old) admitted with bronchiolitis.
Main Results:
- Implementation of an ASP at one PICU was associated with a significantly increased likelihood of discontinuing antimicrobials within 72 hours (OR, 25.63).
- The presence of an ASP across three PICUs also showed a strong association with increased antimicrobial discontinuation (OR, 20.79).
- No significant association was found between ASPs and antimicrobial treatment duration or initial prescriptions.
Conclusions:
- Antimicrobial stewardship programs are associated with a higher likelihood of discontinuing antimicrobial therapy in pediatric patients with viral bronchiolitis.
- While ASPs appear effective in promoting antimicrobial discontinuation, further large-scale studies are required to fully elucidate their role in reducing overall antimicrobial consumption in this population.
Objectives:
To determine the association between the implementation of an antimicrobial stewardship program at a local PICU and to determine the association between the presence of an antimicrobial stewardship programs and antimicrobial use across three Canadian PICUs, among critically ill children with bronchiolitis.
Design:
A multicenter retrospective cohort study.
Setting:
Three Canadian PICUs over two winter seasons.
Interventions:
An antimicrobial stewardship program was implemented at PICU 1 at the end of season 1.
Patients:
Patients less than or equal to 2 years old admitted with bronchiolitis.
Measurements And Main Results:
We used regression models with an interaction term between site (PICU 1 and PICU 2) and season (1 and 2) as the primary analysis to determine the association between implementation of an antimicrobial stewardship program at PICU 1 and 1) the proportion of antimicrobials discontinued 72 hours after hospital admission (logistic regression), 2) antimicrobial treatment duration (negative binomial regression), and 3) antimicrobial prescriptions within 48 hours of hospital admission (logistic regression). As a secondary analysis, we determined the association between having an antimicrobial stewardship program present and the aforementioned outcomes across the three PICUs. A total of 372 patients were included. During seasons 1 and 2, median age was 2.2 months (interquartile range, 1.2-6.2 mo) and 2.1 months (interquartile range, 1.3-6.8 mo), respectively. Among patients with viral bronchiolitis, implementation of an antimicrobial stewardship program at PICU 1 was associated with increased odds of discontinuing antimicrobials (odds ratio, 25.63; 95% CI, 2.86-326.29), but not with antimicrobial duration (odds ratio, 0.56; 95% CI, 0.31-1.02) or antimicrobial prescriptions (odds ratio, 0.33; 95% CI, 0.10-1.04). The presence of an antimicrobial stewardship program was similarly associated with antimicrobial discontinuation among patients with viral bronchiolitis (odds ratio, 20.79; 95% CI, 2.46-244.92), but not with antimicrobial duration (odds ratio, 0.57; 95% CI, 0.32-1.03) or antimicrobial prescriptions (odds ratio, 0.37; 95% CI, 0.12-1.11).
Conclusions:
Antimicrobial stewardship programs were associated with increased likelihood of discontinuing antimicrobial treatments in the PICU patients with viral bronchiolitis. However, larger studies are needed to further determine the role of an antimicrobial stewardship programs in reducing unnecessary antimicrobial use in this patient population.
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