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Benefits of a Pediatric Antimicrobial Stewardship Program in Antimicrobial Use and Quality of Prescriptions in a Referral Children's Hospital

2020; Elsevier BV; Volume: 225; Linguagem: Inglês

10.1016/j.jpeds.2020.06.008

1097-6833

Eneritz Velasco‐Arnaiz, Silvia Simó Nebot, María Ríos-Barnés, María Goretti López Ramos, Manuel Monsonís, Mireia Urrea‐Ayala, Iolanda Jordán, Anna Mas-Comas, Ricard Casadevall-Llandrich, Daniel Ormazábal-Kirchner, Daniel Cuadras, Cristina Pérez-Pérez, Marta Millet-Elizalde, Emília Sánchez, Clàudia Fortuny, Antoni Noguera‐Julián,

Urinary Tract Infections Management

ObjectivesTo evaluate the results of the first 24 months of a postprescription review with feedback-based antimicrobial stewardship program in a European referral children's hospital.Study designWe performed a pre-post study comparing antimicrobial use between the control (2015-2016) and the intervention periods (2017-2018) expressed in days of therapy/100 days present. Quality of prescriptions was evaluated by quarterly cross-sectional point-prevalence surveys. Length of stay, readmission rates, in-hospital mortality rates, cost of systemic antimicrobial agents, and antimicrobial resistance rates were included as complementary outcomes.ResultsTotal antimicrobial use and antibacterial use significantly decreased during the intervention period (P = .002 and P = .001 respectively), and total antifungal use remained stable. A significant decline in parenteral antimicrobial use was also observed (P < .001). In 8 quarterly point-prevalence surveys (938 prescriptions evaluated), the mean prevalence of use of any antimicrobial among inpatients was 39%. An increasing trend in the rate of optimal prescriptions was observed after the first point-prevalence survey (P = .0898). Nonoptimal prescriptions were more common in surgical than in medical departments, in antibacterial prescriptions with prophylactic intention, and in empirical more than in targeted treatments. No significant differences were observed in terms of mortality or readmission rates. Only minor changes in antimicrobial resistance rates were noted.ConclusionsOur antimicrobial stewardship program safely decreased antimicrobial use and expenditure, and a trend toward improvement in quality of prescription was also observed.