880. A Prospective Audit for Initiating a Pediatric Antimicrobial Stewardship Program utilizing the Antibiotic Management Score (AMS) in an Urban Medical Center
Session: Poster Abstract Session: Pediatric Antimicrobial Stewardship
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • ID Week poster 2013.pdf (570.6 kB)
  • Background:

    Antimicrobial stewardship programs (ASPs) promote the appropriate use of antimicrobials by selecting the optimal dose, duration, and route of administration. The ASP has the potential to improve efficacy, reduce treatment related-costs, minimize drug-related adverse events, and limit the potential for emergence of antimicrobial resistance. Our objective was to audit the quality of antibiotic prescribing in children with positive blood cultures by utilizing the antibiotic management score (AMS) prior to initiating an ASP at our children’s hospital.

    Methods:

    A 2-year retrospective chart review (2010-2011) was performed for all episodes of positive blood cultures in pediatric inpatients prior to implementation of ASP at the Children's Hospital at Downstate, Brooklyn, NY. 7 antibiotic management variables were evaluated for each episode and appropriate management was determined using national and local guidelines. A score of 0 was considered as optimal management. For each inappropriate management variable 1 point was added to the Antibiotic Management Score (AMS), up to a maximum of 6 (or 7 if antibiotic drug levels were relevant) per treatment course.

      Results:

    101 episodes of positive blood cultures (age range 0-20 years) were identified. 40% of cases were treated in the NICU, 60% in pediatric inpatient units. The following major groups of bacteria were identified: 41 Coagulase-negative staphylococci, 17 S. aureus, 24 Gram-negative bacteria, and 2 Group B streptococci. A total of 621 antibiotic management variables for all cases were evaluated. The average AMS for the institution was 1.08. 48.5% of patients received suboptimal antibiotic therapy (AMS > 0) with a mean AMS of 2.2 per episode. The AMS was significantly increased in pediatric compared to neonatal units (1.4 vs. 0.84; p = 0.04). Patients with poor outcome (death or microbiological failure) had significantly higher AMS than those with good clinical outcome (mean AMS = 2.3 vs. 0.88; p = 0.01).

    Conclusion:

    The composite cumulative AMS allows quantification of deviation from management guidelines. The AMS is thus useful for monitoring the impact of an ASP on quality of antibiotic prescribing and patient outcome for individual units or clinical syndromes such as bacteremia.

    Aparna Arun, MD1, Sudhindra Pydimarri, MD, MPH2, Roopali Sharma, PharmD2 and Stephan Kohlhoff, MD2, (1)Pediatric Infectious Disease, SUNY Downstate Medical Center, Brooklyn, NY, (2)SUNY Downstate Medical Center, Brooklyn, NY

    Disclosures:

    A. Arun, None

    S. Pydimarri, None

    R. Sharma, None

    S. Kohlhoff, None

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