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Improving Antibiotic Stewardship in a Pediatric Long-term Care Facility
Gevick Safarians1, Rong Guo2, Irwin K Weiss3
1Department of Bioengineering.
Insights
Antimicrobial stewardship interventions in pediatric long-term care facilities can safely reduce ciprofloxacin use for respiratory illnesses. This study demonstrates significant decreases in antibiotic prescriptions without adverse patient outcomes.
Area of Science:
- Pediatric Healthcare
- Infectious Disease Management
- Antimicrobial Stewardship
Background:
- Limited research exists on antimicrobial stewardship in pediatric long-term care facilities.
- Febrile respiratory illnesses are common indications for antibiotic use in this population.
Purpose of the Study:
- To evaluate the feasibility and safety of reducing empirical ciprofloxacin use for febrile respiratory illnesses.
- To assess the impact of an antimicrobial stewardship educational intervention in a pediatric long-term care facility.
Main Methods:
- A 1-year educational intervention was implemented in a 45-bed pediatric long-term care facility.
- Data on antibiotic use, infections, hospitalizations, and outcomes were collected retrospectively and prospectively.
- Statistical process control charts were used for data analysis.
Main Results:
- Ciprofloxacin use decreased by 76% (17 to 4 days/1000 facility patient days).
- Antibiotic prescriptions for bacterial tracheitis dropped by 89%.
- No increase in positive cultures, hospitalizations, or hospital antibiotic use was observed.
Conclusions:
- Antimicrobial stewardship interventions are effective in reducing antibiotic use in pediatric long-term care settings.
- Reductions in ciprofloxacin and overall antibiotic prescriptions can be achieved without compromising patient safety.
- This approach can help combat antibiotic resistance in vulnerable pediatric populations.
Objectives:
Antimicrobial stewardship is little studied in pediatric long-term care facilities. We sought to determine whether empirical ciprofloxacin for febrile respiratory illnesses could be safely reduced in our pediatric long-term care facility.
Methods:
All patients living in the 45-bed facility were included. A 1-year educational intervention for antimicrobial stewardship was implemented. Days of ciprofloxacin therapy, infections, microbiology, hospitalizations, other antibiotic use, methicillin-resistant Staphylococcus aureus and Clostridioides difficile infections, and mortality were recorded at regular intervals retrospectively from 5 years before intervention and prospectively for 8 years after intervention. Data were analyzed using statistical process control charts.
Results:
A majority of patients had tracheostomy tubes (96%) and ventilator dependence (58%). Ciprofloxacin use declined by 76% (17 to 4 days/1000 facility patient days). Antibiotic prescriptions for bacterial tracheitis decreased by 89% (38 to 4 courses per 6-month period). No increases in positive blood or urine cultures, hospitalizations, or need for hospital antibiotics were observed.
Conclusions:
An antimicrobial stewardship intervention in a pediatric long-term care facility led to decreases in ciprofloxacin use, bacterial tracheitis diagnoses, and overall antibiotic use without increasing negative outcomes.
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