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Long-term outcomes of an educational paediatric antimicrobial stewardship programme: a quality improvement study
Marta Aboza Garcia1, Walter Goycochea-Valdivia1, Germán Peñalva2,3
1Paediatric Infectious Diseases, Rheumatology and Immunology Unit, UniversityHospital Virgen del Rocío, Institute of Biomedicine of Seville (IBIS)/ Universidad deSevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica, Seville, Spain.
Insights
Antimicrobial stewardship programmes (ASPs) in paediatrics improved prescription quality and partially reduced antimicrobial consumption. While mortality trends remained unchanged, the study highlights the benefits of intensified educational interventions in pediatric settings.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Quality Improvement Science
Background:
- Antimicrobial stewardship programmes (ASPs) are crucial for reducing antimicrobial consumption (AMC) and improving prescription quality (QOP).
- Evidence regarding the long-term impact of ASPs specifically within pediatric populations remains limited.
- This study evaluates the sustained effects of an intensified pediatric ASP.
Purpose of the Study:
- To assess the long-term outcomes of an intensified antimicrobial stewardship programme (ASP) in a pediatric tertiary hospital.
- To evaluate the impact of enhanced educational interventions on antimicrobial prescribing practices and consumption in children.
- To analyze trends in bloodstream infections (BSIs) and associated mortality rates following ASP intensification.
Main Methods:
- A quality improvement study employing an interrupted time series analysis was conducted.
- Data were collected from January 2013 to December 2019, comparing pre- and post-intervention periods.
- Key metrics included QOP, AMC (defined daily doses per 1000 occupied bed days), BSI incidence density, and all-cause crude death rate (CDR).
Main Results:
- Inappropriate prescribing decreased significantly by 51.4% post-intervention.
- Overall AMC showed no significant trend change, but neonatology AMC reduced by 28.8%.
- Significant reductions were observed in anti-pseudomonal cephalosporin use (-51.2%) and carbapenem use (-2.4% quarterly per cent change); BSI-related CDR also decreased (-3.6% quarterly per cent change).
Conclusions:
- Intensified counseling and educational activities within a pediatric ASP can improve QOP and partially reduce AMC.
- The study indicates that sustained educational efforts are effective in optimizing antimicrobial use in pediatric patients.
- Long-term decreasing trends in mortality were not significantly altered by the ASP intensification.
Background And Objectives:
Antimicrobial stewardship programmes (ASPs) have resulted in antimicrobial consumption (AMC) reduction and quality of prescription (QOP) improvement. However, evidence of ASP impact in paediatrics is still limited. This study aims to assess a paediatric ASP long-term outcomes.
Methods:
A quality improvement study assessed by a interrupted time series analysis was conducted in a paediatric tertiary hospital. QOP expressed as proportion of adequate prescriptions, AMC measured by defined daily dose incidence per 1000 occupied bed days, incidence density of bloodstream infections (BSIs) and its related all-cause crude death rate (CDR) were compared between pre (from January 2013 to December 2015) and post (from January 2016 to December 2019) ASP activities intensification, which included a dedicated paediatric infectious diseases physician to actively perform educational interviews with prescribers.
Results:
Inappropriate prescribing showed a significant downward shift associated to the intervention with a -51.4% (-61.2% to -41.8%) reduction with respect to the expected values. Overall AMC showed no trend change after the intervention. For neonatology a28.8% (-36.8% to -20.9%) reduction was observed. Overall anti-pseudomonal cephalosporin use showed a -51.2% (-57.0% to -45.4%) reduction. Decreasing trends were observed for carbapenem use, with a quarterly per cent change (QPC) of -2.4% (-4.3% to -0.4%) and BSI-related CDR (QPC=-3.6%; -5.4% to -1.7%) through the study period. Healthcare-associated multi-drug-resistant BSI remained stable (QPC=2.1; -0.6 to 4.9).
Conclusions:
Intensification of counselling educational activities within an ASP suggests to improve QOP and to partially reduce AMC in paediatric patients. The decreasing trends in mortality remained unchanged.
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