910. Impact of Antimicrobial Stewardship Program (ASP) on Vancomycin Utilization in Pediatric Intensive Care and Cardiac Intensive Care Units
Session: Poster Abstract Session: Antimicrobial Utilization and Resistance in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background: The effectiveness of ASP in controlling antibiotic use has been demonstrated mostly in adult patients. This study was conducted to describe and assess the impact of ASP in a pediatric population. 

Methods: In October 2010, a multidisciplinary ASP led by infectious disease specialists and clinical pharmacists was initiated in the pediatric intensive care unit (PICU) and cardiac intensive care unit (CICU) at Children’s National Medical Center, Washington, DC. Target antibiotics for ASP, including vancomycin, were selected following a retrospective clinical and pharmacological audit of antibiotic utilization that identified most frequently overused broad spectrum antibiotics in these units. In collaboration with unit physicians, ASP procedures and guidelines were developed specific to each unit and its patient population. Electronic order sets derived from the guidelines were implemented and education to physician staff was provided. Targeted antibiotics were prospectively reviewed at 72 hours of usage and de-escalation recommendations were made based on clinical and microbiological data of each patient. The effectiveness of this program was assessed by comparing vancomycin utilization between pre-(10/2009-3/2010) and post-ASP (10/2010-3/2011) periods.

Results: Implementation of ASP decreased the total number of vancomycin antibiotic days per 1000 patient days from 258.6 to 207.2 in PICU, and from 191.1 to 150.6 in CICU. Proportion of vancomycin therapies that were properly de-escalated within 72 hours significantly increased from 58.1% to 70.6% in PICU (p=0.009), and from 49.4% to 79.1% in CICU (p=0.0001). Among the subset of vancomycin therapies provided to patients with negative microbiological cultures, proportion of therapies properly discontinued within 72 hours increased from 59.8% to 73.2% (p=0.02) in PICU and from 47.4% to 82.7% (p=0.0002) in CICU. Rates for acceptance of ASP recommendations were 92.4% in PICU and 95.7% in CICU. Mortality rates for each unit were comparable between the two periods.

Conclusion: ASP specific to pediatric patient population is effective in improving proper antibiotic use. Increasing awareness among clinicians can lead to positive changes in prescribing patterns. 

Subject Category: P. Pediatric and perinatal infections

David Hyun, MD1,2, Xiaoyan Song, PhD, MBBS3,4, Victoria Basalyga, PharmD3 and Nalini Singh, MD MPH3,4, (1)Division of Infectious Diseases, Children's National Medical Center, Washington, DC, (2)Pediatrics, George Washington University School of Medicine, Washington, DC, (3)Children's National Medical Center, Washington, DC, (4)George Washington University School of Medicine, Washington, DC


D. Hyun, None

X. Song, None

V. Basalyga, None

N. Singh, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.