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Establishing Priority Pediatric Antimicrobial Stewardship Interventions in the US: Findings from a Delphi Consensus
Harry Obeng1, Emmanuel Tetteh2, Sara Malone2
1Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA.
Insights
Experts identified key priorities for pediatric antimicrobial stewardship programs (ASPs) to combat antimicrobial resistance (AMR). Focus areas include care settings, prescription practices, and outcome-based strategies for better pediatric antibiotic use.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Global Health Security
Background:
- Antimicrobial resistance (AMR) poses a significant global health threat, with children facing heightened risks.
- Pediatric antimicrobial stewardship programs (ASPs) struggle with implementation due to reliance on adult guidelines and limited pediatric data.
- Children's unique drug metabolism and limited treatment options exacerbate AMR risks.
Purpose of the Study:
- To identify and prioritize critical intervention areas for pediatric ASPs.
- To develop evidence-based strategies for improving pediatric antimicrobial use.
- To address the challenges in implementing effective pediatric antimicrobial stewardship.
Main Methods:
- A four-round modified Delphi consensus process involving pediatric infectious disease and stewardship experts.
- Iterative surveys and in-person discussions to gather and refine expert input on priority areas.
- Thematic grouping and structured feedback for consensus-building on key interventions.
Main Results:
- Twenty experts identified 25 priority items, narrowed to seven key priorities.
- Priorities clustered into three themes: Care Settings (outpatient, ICU), Prescriptions (shorter duration, narrow-spectrum), and Strategies (outcome metrics, diagnostics, patient tracking).
- High-impact areas for intervention include outpatient clinics and intensive care units.
Conclusions:
- Expert consensus provides a foundation for developing targeted pediatric ASP interventions.
- Findings can inform policy and practice to optimize antimicrobial use in children.
- The study offers a strategic roadmap for combating AMR in pediatric populations.
Background/Objectives:
Antimicrobial resistance (AMR) is a major global health threat, with children at higher risk due to developmental differences in drug metabolism, limited treatment options and inappropriate antibiotic use. Pediatric antimicrobial stewardship programs (ASPs) face implementation challenges, often relying on adult-based guidelines and limited pediatric-specific evidence. This study aimed to identify and prioritize the most critical areas for pediatric ASP intervention development through a structured, multi-round Delphi consensus process with experts in antimicrobial stewardship and infectious diseases.
Method:
A four-round modified Delphi process was conducted to identify and prioritize key pediatric ASP interventions. Experts in antimicrobial stewardship and infectious diseases were recruited through an existing clinical trial. Using an iterative survey and in-person discussions, experts provided input on priority areas, which were thematically grouped and refined across rounds. Structured feedback supported real-time refinement and consensus-building.
Results:
Twenty experts participated in the process, generating 25 priority items in Round 1 through open-ended responses. These were narrowed to seven key priorities through structured voting and discussion. The final items were clustered into three intersecting themes: Care Settings, Prescriptions, and Strategies. Care Settings focused on high-impact areas such as outpatient clinics and intensive care units, where misuse is common and/or care is complex. The prescriptions theme prioritized shorter durations and narrow-spectrum agents. The strategy theme highlighted the need for outcome-based metrics, improved diagnostic stewardship, and routine tracking of patient outcomes to guide and assess stewardship efforts.
Conclusions:
This expert consensus identified key priorities for pediatric ASPs, providing a foundation for future interventions. Findings can be used to inform policy and practice, improving the appropriate use of antimicrobials in pediatrics and combating AMR.
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