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Pharmacist-led antimicrobial stewardship program in the treatment of Staphylococcus aureus bacteraemia in paediatric
Stella Caroline Schenidt Bispo da Silva1, Mariana Millan Fachi2, Marinei Campos Ricieri1
1Antimicrobial Stewardship Program, Pequeno Príncipe Hospital, Curitiba, PR, Brazil.
Insights
A pharmacist-led Antimicrobial Stewardship Program (ASP) using care bundles improved outcomes for pediatric Staphylococcus aureus bacteremia. This approach reduced mortality and reinfection rates, identifying key factors for better patient management.
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Public Health
Background:
- Care bundles are established strategies for enhancing treatment efficacy.
- Pharmacist-led Antimicrobial Stewardship Programs (ASP) can effectively guide clinical decisions and improve patient outcomes.
- This study focuses on a pharmacist-led ASP utilizing a care bundle for Staphylococcus aureus bacteremia (SAB) in a pediatric setting.
Purpose of the Study:
- To evaluate the impact of a pharmacist-led ASP with a care bundle on clinical outcomes in pediatric patients with Staphylococcus aureus bacteremia.
- To assess the effect on infection-related mortality and 90-day reinfection rates.
- To identify risk factors influencing outcomes in pediatric SAB.
Main Methods:
- Retrospective cohort study in a Brazilian pediatric hospital (2014-2021).
- Included 120 pediatric patients with S. aureus bacteremia.
- Compared pre-intervention (n=44) and intervention (n=76) periods, with the intervention featuring a pharmacist-led ASP and care bundle (2017-2021).
Main Results:
- Multivariate analysis identified significant factors impacting outcomes: infant patients (OR 12.998), use of >3 antimicrobial regimens (OR 0.006), intervention period (OR 0.060), follow-up blood culture (OR 18.953), early source control (OR 0.002), and de-escalation to oxacillin (OR 0.041).
- The pharmacist-led ASP model demonstrated increased adherence to the care bundle.
- A reduced probability of negative outcomes was observed during the intervention period.
Conclusions:
- The pharmacist-led ASP model, incorporating a care bundle, improved adherence and reduced negative outcomes in pediatric S. aureus bacteremia.
- Key risk factors were identified, providing insights for enhanced clinical management.
- This strategy contributes to better patient outcomes in the pediatric population.
Background:
Care bundles are a recognised strategy to improve treatment. When managed through an Antimicrobial Stewardship Program (ASP) based on the pharmacist-led program model, care bundles can be an effective tool to guide decision making in clinical practice and to improve patient outcomes. This study aimed to evaluate the results of a pharmacist-led ASP which included a care bundle based on clinical outcomes of Staphylococcus aureus bacteraemia (SAB) in a paediatric hospital.
Methods:
A retrospective cohort study with multivariate analysis was conducted in a paediatric hospital in Brazil. The study comprised 120 paediatric patients with a positive blood culture for S. aureus with occurred between 2014 and 2021 and clinical and laboratory results consistent with infection. The study was classified into two periods: pre-intervention (n=44) and intervention (n=76). A pharmacist-led ASP program with a care bundle was established during the intervention period 2017-2021. The primary outcome assessed was the impact on clinical outcomes, including infection-related mortality and 90-day reinfection rate, both being considered therapeutic failure.
Results:
The multivariate analysis demonstrated that the following variables had an impact on primary outcome: infant patients [Odds ratio (OR) 12.998, P=0.044]; use of more than three antimicrobial treatment regimens [OR 0.006, P=0.017]; intervention period [OR 0.060, P=0.034]; bundle item 1 - follow-up blood culture [OR 18.953, P=0.049]; bundle item 2 - early source control [OR 0.002, P=0.018]; bundle item 4 - de-escalation to oxacillin for methicillin-sensitive S. aureus [OR 0.041, P=0.046].
Conclusions:
The pharmacist-led ASP model showed an increase in adherence to the care bundle between the two study periods, with reduced probability of a negative outcome. Furthermore, risk factors for S. aureus bacteraemia were identified that may inform management and contribute to better patient outcomes in the paediatric population.
