The Impact of an Antimicrobial Stewardship Program on Days of Therapy in the Pediatric Center: An Interrupted...

Area of Science:

• Pediatric Infectious Diseases
• Antimicrobial Resistance
• Public Health

Background:

• Antimicrobial resistance (AMR) poses a significant threat to public health.
• Pediatric populations are particularly vulnerable to infections caused by resistant pathogens.
• Effective antimicrobial stewardship programs (ASPs) are crucial for combating AMR.

Purpose of the Study:

• To evaluate the impact of an antimicrobial stewardship program (ASP) on antimicrobial resistance, usage, and mortality in pediatric bacteremia.
• To analyze trends in antimicrobial-resistant pathogens before and after ASP implementation.
• To assess the 30-day overall mortality rate in pediatric patients with bacteremia.

Main Methods:

• Retrospective single-center study of pediatric inpatients (2001-2019).
• Interrupted time-series analysis to compare antimicrobial use (days of therapy per 1,000 patient-days) pre- and post-ASP implementation (2008).
• Chi-squared test to analyze proportions of resistant pathogens and 30-day mortality.

Main Results:

• The incidence of extended-spectrum beta-lactamase (ESBL)-producing *Escherichia coli* and *Klebsiella pneumoniae* bacteremia significantly increased post-ASP (17% to 35%).
• Total antimicrobial use significantly decreased after ASP implementation (delta slope = -16.5, P=0.049).
• The 30-day overall mortality rate remained stable at 10% in both pre- and post-intervention periods.

Conclusions:

• Implementation of an ASP in pediatric patients effectively reduced overall antimicrobial use.
• ASP introduction did not lead to an increase in 30-day mortality, even with rising ESBL-producing gram-negative bacteremia.
• ASPs are valuable tools for optimizing antimicrobial use in pediatric settings while managing resistance challenges.