Antimicrobial Stewardship Programs in Pediatric Intensive Care Units: A Systematic Scoping Review

Area of Science:

• Pediatric Critical Care Medicine
• Infectious Diseases
• Healthcare Management

Background:

• Antimicrobial stewardship programs (ASPs) and diagnostic stewardship programs (DSPs) are critical for combating antimicrobial resistance.
• Implementation of these programs in pediatric intensive care units (PICUs) is essential but may face unique challenges.

Purpose of the Study:

• To review and summarize the current implementation status of ASPs and DSPs specifically within PICUs.
• To identify common strategies, outcomes, and challenges associated with these stewardship programs in pediatric critical care settings.

Main Methods:

• A systematic literature search was conducted across major databases (Embase, MEDLINE, Scopus, Cochrane Library) from 2007 to 2024.
• Studies evaluating ASP or DSP implementation in PICUs were included, with data extracted using standardized forms.
• Included references were managed and screened using Rayyan software.

Main Results:

• 18 studies were included: 13 focused on ASPs and 5 on DSPs.
• Most ASP studies reported positive effects on antimicrobial consumption, often using persuasive strategies.
• Significant heterogeneity in intervention types, outcome metrics, and study designs was observed, limiting direct comparisons.
• DSP studies primarily examined biomarkers and pathogen testing, with limited impact on antibiotic prescribing.

Conclusions:

• ASP implementation in PICUs is ongoing but remains limited, with considerable variability in outcome measurement.
• Harmonizing reporting metrics is essential for comparing program effectiveness and optimizing antimicrobial stewardship strategies in PICUs.
• Further research is needed to establish best practices for diagnostic stewardship in pediatric critical care.