Antimicrobial stewardship programs in freestanding children's hospitals.

TitleAntimicrobial stewardship programs in freestanding children's hospitals.
Publication TypeJournal Article
Year of Publication2015
AuthorsHersh AL, De Lurgio SA, Thurm C, Lee BR, Weissman SJ, Courter JD, Brogan TV, Shah SS, Kronman MP, Gerber JS, Newland JG
JournalPediatrics
Volume135
Issue1
Pagination33-9
Date Published01/2015
ISSN1098-4275
KeywordsAmbulatory Care Facilities, Anti-Infective Agents, Child, Cohort Studies, Drug Prescriptions, Hospitals, Pediatric, Humans, Practice Guidelines as Topic, Retrospective Studies, Time Factors
Abstract

BACKGROUND AND OBJECTIVE: Single-center evaluations of pediatric antimicrobial stewardship programs (ASPs) suggest that ASPs are effective in reducing and improving antibiotic prescribing, but studies are limited. Our objective was to compare antibiotic prescribing rates in a group of pediatric hospitals with formalized ASPs (ASP+) to a group of concurrent control hospitals without formalized stewardship programs (ASP-).

METHODS: We evaluated the impact of ASPs on antibiotic prescribing over time measured by days of therapy/1000 patient-days in a group of 31 freestanding children's hospitals (9 ASP+, 22 ASP-). We compared differences in average antibiotic use for all ASP+ and ASP- hospitals from 2004 to 2012 before and after release of 2007 Infectious Diseases Society of America guidelines for developing ASPs. Antibiotic use was compared for both all antibacterials and for a select subset (vancomycin, carbapenems, linezolid). For each ASP+ hospital, we determined differences in the average monthly changes in antibiotic use before and after the program was started by using interrupted time series via dynamic regression.

RESULTS: In aggregate, as compared with those years preceding the guidelines, there was a larger decline in average antibiotic use in ASP+ hospitals than in ASP- hospitals from 2007 to 2012, the years after the release of Infectious Diseases Society of America guidelines (11% vs 8%, P = .04). When examined individually, relative to preimplementation trends, 8 of 9 ASP+ hospitals revealed declines in antibiotic use, with an average monthly decline in days of therapy/1000 patient-days of 5.7%. For the select subset of antibiotics, the average monthly decline was 8.2%.

CONCLUSIONS: Formalized ASPs in children's hospitals are effective in reducing antibiotic prescribing.

DOI10.1542/peds.2014-2579
Alternate JournalPediatrics
PubMed ID25489018
Grant ListK08 HS023320 / HS / AHRQ HHS / United States
K08HS023320 / HS / AHRQ HHS / United States