The Journal of the Pediatric Infectious Diseases Society (JPIDS) has released the largest and most rigorous evaluation to date of the impact on reducing the days of antibiotic therapy in a childrens hospital using a prospective-audit-with-feedback antibiotic stewardship program (ASP). The study utilized a control group of the 25-member childrens hospitals of the Child Health Corporation of America. A companion article describes how the ASP was created within this 317-bed tertiary care childrens hospital and clinicians attitudes toward itthe first published account of such a pediatric program.
Up to 35 percent of inpatient antibiotic prescriptions are either unnecessary or inappropriate. The Infectious Diseases Society of America (IDSA)'s 2007 guideline on the implementation of hospital ASPs described two core stewardship strategies to curb the rise of drug-resistant microbes: prospective-audit-with-feedback, and preauthorization. IDSA said that research would be needed to determine whether these strategies would be effective in pediatrics.
In this more-than-33-month study of 8,765 patients, Newland, et al., observed a significant decrease in antibiotic usageranging from a 37 percent decrease in the early months, to 13 percent at the end of the observation. In particular, the study showed up to a 19 percent monthly reduction in broad-spectrum antibiotics, which the Centers for Disease Control and Prevention (CDC) has recommended avoiding in order to prevent resistance in hospitalized children.
In the companion article, Stach, et al., describe the five-part process they used to create their ASP, including: forming a multi-disciplinary team; determining the type of program (prospective-audit-with-feedback) and which antimicrobials to monitor; deciding which mechanism to use in identifying patients (a report was created in the hospitals EMR system); developing and implementing an evaluation process; and, communicating the goals and logistics of the ASP to the hospitals affected clinicians.
The authors surveyed 365 clinicians; the 56 percent who responded had a positive view of the ASP. The overwhelming majority agreed that the ASP had improved the use (83 percent) of antibiotics, decreased their inappropriate use (84 percent), and improved the quality of patient care (82 percent). An ASP goal was to provide education to those affected by the program; 90 percent said it did and 66 percent agreed it led to practice changes. Of negative feelings, only 6 percent felt the ASP interfered with clinical decision-making and 5 percent thought the ASPs recommendations were threatening.
The quarterly Journal of the Pediatric Infectious Diseases Society (JPIDS) represents the spectrum of peer-reviewed, scientific and clinical information on perinatal, childhood and adolescent infectious diseases.