Pediatric Antimicrobial Stewardship Programs: A Systematic Review
Methods: We performed a systematic review using a PubMed search to identify studies with any of the following terms in the title or abstract: “antimicrobial stewardship”, “antimicrobial control”, “antibiotic control” or “antibiotic stewardship.” Studies were further limited to inpatient studies in the United States that contained the terms: “child”, “children”, “pediatric*”, “paediatric*”, “newborn”, “infant”, “neonat*” in the title or abstract. Clinical and economic outcomes from each relevant study were summarized.
Results: Of 71 studies identified, 39 were eliminated based on title. 32 remaining abstracts were reviewed, 23 of which were selected for in-depth review (14 original studies and 9 review articles). Of these, 8 original studies from 4 institutions reported outcomes related to pediatric ASPs. For studies reporting clinical outcomes, 4 studies reported decreased antimicrobial utilization, though the specific metric varied across studies; and 2 studies documented decreases in prescribing errors. Only 2 studies assessed the potential negative impact of ASPs on clinical outcomes; 1 found no difference in mortality or readmission rates after ASP implementation and another found no adverse outcomes among children for whom the ASP recommended no therapy. In terms of economic outcomes, 2 studies reported decreases in antimicrobial drug costs.
Conclusion: Although ASPs have been recommended by IDSA since 2007, only 8 pediatric studies evaluating ASPs from 4 centers have been published. These studies demonstrate reduced antimicrobial utilization, cost and prescribing errors with no apparent negative impact on patient safety. While these findings are promising, the limited evidence-base warrants further investigation. Additionally, there is need for studies focusing on the appropriateness and quality of antimicrobial prescribing practices as well as more formalized economic evaluations.
A. L. Hersh, None