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Improving Antibiotic Use in Pediatric Hospitals in Argentina: A Quality Improvement Study
Facundo Jorro-Baron1,2, Cecilia Echave2, Viviana Rodriguez1
1Instituto de Efectividad Clínica y Sanitaria, Ciudad Autónoma de Buenos Aires, Argentina.
Insights
Implementing an antibiotic stewardship program (ASP) in pediatric hospitals promoted the use of narrower-spectrum antibiotics. This quality improvement initiative focused on improving antibiotic selection in pediatric care settings.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Quality Improvement in Healthcare
Background:
- Antibiotic resistance is a growing global health threat, necessitating effective antimicrobial stewardship programs (ASPs).
- Pediatric hospitals require tailored strategies to optimize antibiotic use and combat resistance.
- Previous efforts to reduce antibiotic days of therapy (DOT) and increase narrow-spectrum antibiotic use have shown variable success.
Purpose of the Study:
- To evaluate the impact of an antibiotic stewardship program (ASP) implementation on antibiotic prescribing patterns in two pediatric hospitals.
- To assess the achievement of a 15% reduction in days of antibiotic therapy (DOT) and a 20% increase in access antibiotic group (narrower spectrum) utilization.
- To identify barriers and facilitators for successful ASP implementation using a quality improvement (QI) framework.
Main Methods:
- A quality improvement (QI) initiative was implemented, including a formative phase to identify barriers and facilitators.
- Key strategies involved developing an antibiotic management program, establishing a data system, and fostering teamwork.
- Intervention included learning sessions, coaching, and QI training. Primary outcomes measured DOT and access antibiotic group use percentage.
Main Results:
- Data from 249 patients (baseline) and 588 patients (implementation period) were analyzed.
- Access antibiotic group consumption increased from 30.7% to 37.9%.
- Antibiotic DOT showed variable results, with an average of 854 in the baseline period and 1068 in the implementation period.
Conclusions:
- The quality improvement initiative demonstrated that antibiotic stewardship program (ASP) implementation in pediatric hospitals is associated with increased use of narrow-spectrum antibiotics.
- While DOT did not meet the initial reduction target, the shift towards narrower-spectrum antibiotic selection indicates a positive impact on antimicrobial stewardship.
Objective:
We aimed to achieve a 15% reduction in days of antibiotic therapy (DOT) and a 20% increase in access antibiotic group (narrower spectrum of the World Health Organization classification) units after 24 weeks of implementing an antibiotic stewardship program (ASP) in 2 pediatric hospitals.
Methods:
We implemented a quality improvement (QI) initiative preceded by a formative phase to identify barriers and facilitators. The strategy included developing an antibiotic management program, establishing a data management and learning system, and fostering teamwork and effective communication. The intervention spanned 2 learning sessions, each with an action period, and was supported by coaching and QI training. Primary outcomes included DOT per 1000 hospital days and the access antibiotic group use percentage. We examined the implementation of change ideas and adherence to clinical pathways for process measures using mortality rates as a balancing measure. Run charts tracked follow-up outcomes, with control charts employed once sufficient data points were collected.
Results:
We gathered data from 249 patients during the baseline period (BP) (Jan 2022 to June 2022) and from 588 patients during the implementation period (IP) (July 2022 to January 2023). The IP group included younger patients with higher rates of acute lower respiratory tract infections and more severe clinical conditions. Access antibiotic group consumption was 30.7% in BP and 37.9% in IP. Concerning antibiotic DOT, throughout time, we observed variable results with many points outside the control limits, with an average of 854 in BP and 1068 in IP.
Conclusion:
The QI initiative demonstrated that ASP implementation in pediatric hospitals was associated with antibiotic narrow-spectrum selection.
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