Impact of antimicrobial stewardship maturity on resistance and pediatric clinical outcomes: A multicenter cohort...

Area of Science:

• Pediatric Infectious Diseases
• Hospital Epidemiology
• Antimicrobial Stewardship

Background:

• Antimicrobial resistance (AMR) presents a significant global health challenge, especially impacting pediatric populations in resource-limited settings.
• The maturity of antimicrobial stewardship programs (ASPs) is crucial for combating AMR, but its impact on clinical outcomes in pediatric care requires further investigation.
• Peruvian pediatric hospitals face high rates of infections caused by multidrug-resistant organisms, necessitating effective intervention strategies.

Purpose of the Study:

• To assess the relationship between antimicrobial stewardship program (ASP) maturity and clinical outcomes in Peruvian pediatric hospitals.
• To identify patient-level risk factors associated with infections caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae.
• To evaluate the impact of ASP interventions on infection rates, patient outcomes, and hospital efficiency.

Main Methods:

• A multicenter, retrospective cohort study involving 1,250 pediatric patients hospitalized for bloodstream or urinary tract infections across three Peruvian hospitals (2020-2023).
• Multilevel logistic regression and propensity score matching (PSM) analyses were employed to identify risk factors and assess ASP impact.
• Data collection focused on infection prevalence, patient characteristics, antibiotic use, and ASP maturity levels.

Main Results:

• The prevalence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae infections was 32.9%.
• Key patient-level risk factors for ESBL infections included prior antibiotic use (aOR 5.82) and central venous catheter presence (aOR 2.10).
• Higher ASP maturity correlated with a reduced likelihood of ESBL infection (aOR 0.85), and direct ASP intervention significantly decreased hospital length of stay, 30-day mortality, and time to appropriate therapy.

Conclusions:

• Pediatric antimicrobial resistance (AMR) is a critical issue in Peru, demanding urgent attention and targeted interventions.
• Investing in and strengthening antimicrobial stewardship programs (ASPs) is an evidence-based strategy to effectively combat pediatric AMR.
• Enhanced ASPs demonstrate a measurable positive impact on clinical outcomes, patient safety, and hospital resource management in pediatric settings.