Impact of a Pediatric Antimicrobial Stewardship Program (ASP) on Length of Stay (LOS) and Readmission
Pediatric ASPs have demonstrated the ability to decrease antibiotic (ab) use. No data exists on the clinical impact of pediatric ASPs. We evaluated the impact of an ASP on LOS and readmission rates at a children's hospital.
Outcome data from patients enrolled between 3/3/08 – 3/3/13 in a prospective-antibiotic audit ASP were analyzed. ASP recommendations included to discontinue, modify or optimize the ab or to consult the infectious diseases service. Patients in whom a recommendation was made were propensity score matched to non-intervention patients based on the patient's age, ASP year of implementation, ab and indication for ab use, and further analyzed based on if the recommendation was implemented. Patients were stratified into 3 groups: surgical, medical and medical with complex chronic care (CCC). Patients with >1 ASP review or admitted to the pediatric or neonatal intensive care unit, or the hematology/oncology unit were excluded.
The ASP intervened on 17% (1191) of the 7051 reviewed patients. Interventions were most likely in patients receiving ceftriaxone/cefotaxime (62%), vancomycin (11%), and meropenem (5%); pneumonia (22%), urinary tract infections (19%), and rule out sepsis (9%) were the most common diagnoses. The most common intervention was stop followed by modify the ab. When ASP recommendations were followed, length of stay was shorter and there were no 30-day readmissions for surgery or patients with non CCC medical conditions.(Fig 1&2)
An ASP at a freestanding childrens hospital decreased LOS and readmission rates among patients not requiring critical care. Future work is needed to better demonstrate the clinical impact of ASPs.
Pfizer: Grant Investigator, Grant recipient
J. Goldman, None
L. Stach, None
D. Yu, None
A. Myers, None
M. A. Jackson, None
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