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Antimicrobial stewardship strategies reduce targeted and nontargeted antimicrobial use

Di Pentima MC. Pediatrics. 2011;doi:10.1542/peds.2010-3589.

Successful implementation of antimicrobial stewardship programs can have a significant effect on reducing targeted and nontargeted antimicrobial use, according to study results published online by the American Academy of Pediatrics. However, despite available evidence supporting antimicrobial management practices in adult health care centers, few children’s hospitals have implemented comprehensive programs, and data about the effect of antimicrobial stewardship programs in pediatric settings have been limited.

After the introduction of an antimicrobial stewardship program at Alfred I. duPont Hospital for Children in Wilmington, Del., in 2004, M. Cecilia Di Pentima, MD, MPH, and colleagues began evaluating its effect on antimicrobial use, as well as physician interventions, patient outcomes and rates of antimicrobial resistance. Active surveillance of antimicrobial use with intervention and real-time feedback to providers and reinforcement of prior authorization for selected antimicrobials were introduced at a pediatric teaching hospital.

Antimicrobial use indications were also incorporated as a mandatory field in the computerized information system. An automated report of antimicrobials prescribed, doses, patient demographics and microbiology data was generated and reviewed by both an infectious disease pharmacist and a pediatric infectious disease physician. Antimicrobial use, expressed as the number of doses administered per 1,000 patient-days, was measured 3 years before and after the implementation of the program.

According to the study results, total antimicrobial use peaked at 3,089 doses administered per 1,000 patient-days/year in 2003-2004 before implementation of the program and steadily decreased to 1,904 doses administered per 1,000 patient-days/year during the post-intervention period. Targeted antimicrobial use declined from 1,250 to 988 doses administered per 1,000 patient-days/year. Nontargeted antimicrobial use declined from 1,839 to 916 doses administered per 1,000 patient-days/year. Rates of antimicrobial resistance to broad-spectrum antimicrobials among the most common gram-negative bacilli remained low and stable over time.

“A limitation of our study is that interventions were performed at a single children’s hospital,” Di Pentima and colleagues wrote. “These implementations and outcomes might not be extrapolated to other academic and nonacademic children’s hospitals or to adult hospitals with pediatric wards that use different clinical information systems or electronic medical records.”

Disclosure: The researchers report no relevant financial disclosures.

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