Program Schedule

385
Pediatric Antimicrobial Stewardship Programs: A Systematic Review

Session: Poster Abstract Session: Pediatric Antimicrobial Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • SMITH IDSA 2014.pdf (265.1 kB)
  • Background: Judicious use of antimicrobials is critical to prevent development of resistance and may be enhanced by the activities of antimicrobial stewardship programs (ASPs).  While there are many studies of adult ASPs, the clinical and economic outcomes associated with pediatric ASPs have not been well described or reviewed.  

    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.

    Michael Smith, MD, MSCE, University of Louisville, Louisville, KY, Jeffrey S. Gerber, MD, PhD, Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA and Adam L. Hersh, MD, PhD, University of Utah School of Medicine, Salt Lake City, UT

    Disclosures:

    M. Smith, None

    J. S. Gerber, None

    A. L. Hersh, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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