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The effect of Telehealth Antimicrobial Stewardship Program (Tele-ASP) on antimicrobial use in a pediatric intensive
Abdulla Alfraij1, Ahmed Abdelmoniem2, Mohamed Elseadawy2
1Pediatric Intensive Care Unit, Department of Pediatrics, Farwaniya Hospital, Sabah Al-Nasser, Al Farwaniya, Kuwait; Pediatric Intensive Care Unit, Department of Pediatrics, General Ahmadi Hospital, Kuwait Oil Company (KOC), Al-Ahmadi, Kuwait.
Background:
Overuse or misuse of antimicrobials is common in pediatric intensive care units (PICU) and may be associated with poor clinical outcomes. Although an antimicrobial stewardship program (ASP) has been found to improve this practice, the required expertise in infectious diseases may be limited in some centers. We aimed to evaluate the effect of telehealth ASP on the rate of PICU antimicrobial use in a center without a local Infectious Diseases consultation service.
Methods:
A retrospective cohort study was performed between October 1st, 2018, and October 31st, 2020, in Farwaniya Hospital PICU, a 20-bed unit. All pediatric patients who were admitted to PICU and received systemic antimicrobials during the study period were included and followed until hospital discharge. The ASP team provided weekly prospective audit and feedback on antimicrobial use starting October 8th, 2019. A pediatric infectious diseases specialist joined the ASP rounds remotely. Descriptive analyses and a pre-post intervention comparison of days of therapy (DOT) were used to assess the effectiveness of the ASP intervention.
Results:
There were 272 and 156 PICU admissions received systemic antimicrobial before and after the initiation of ASP, respectively. Bronchiolitis and pneumonia were the most common admission diagnoses, together compromising 60.7% and 61.2% of cases pre- and post-ASP. The requirement for respiratory support was higher post-ASP (76.5% vs. 91.5%, p < 0.001). Average monthly antimicrobial use decreased from 922 (95%CI 745-1000) to 485 DOT/1000 patient-days (95%CI 246-722, P < 0.05). A decline in DOT was observed across most antibiotic classes, except for ceftriaxone. No effect on the length of PICU stay, length of hospitalization, or mortality was observed. Most (89.7%) ASP recommendations were followed either fully or partially.
Conclusion:
In settings where Infectious Diseases consultation services are unavailable, PICU telehealth ASP can be effectively implemented and associated with significantly reducing antimicrobial use.
Insights
Telehealth antimicrobial stewardship programs (ASP) significantly reduced antimicrobial use in pediatric intensive care units (PICU) lacking infectious disease specialists. This remote approach offers a viable solution for improving antimicrobial prescribing practices in underserved settings.
Area of Science:
- Infectious Diseases
- Pediatric Critical Care
- Healthcare Management
Background:
- Antimicrobial overuse is prevalent in pediatric intensive care units (PICU), potentially leading to adverse outcomes.
- Antimicrobial stewardship programs (ASP) can improve antimicrobial use, but require infectious diseases (ID) expertise, which may be limited in some centers.
- This study evaluated the impact of a telehealth ASP in a PICU without local ID consultation.
Purpose of the Study:
- To assess the effectiveness of a telehealth ASP in reducing antimicrobial utilization within a PICU.
- To determine if remote ID specialist involvement can optimize antimicrobial prescribing in resource-limited settings.
Main Methods:
- A retrospective cohort study was conducted in a 20-bed PICU from October 2018 to October 2020.
- A telehealth ASP, including remote ID specialist consultation, was implemented in October 2019.
- Antimicrobial use, measured in days of therapy (DOT) per 1000 patient-days, was compared pre- and post-intervention.
Main Results:
- Average monthly antimicrobial use decreased significantly from 922 to 485 DOT/1000 patient-days post-ASP implementation (P < 0.05).
- A reduction in DOT was observed across most antibiotic classes, with high adherence to ASP recommendations (89.7%).
- No significant changes were noted in PICU length of stay, hospitalization duration, or mortality.
Conclusions:
- Telehealth ASP is an effective strategy for reducing antimicrobial use in PICUs lacking on-site infectious diseases consultation.
- This model demonstrates the feasibility of remote expert support for antimicrobial stewardship in underserved healthcare environments.
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