Antimicrobial stewardship programs (ASPs) are essential to preventing misuse of antibiotics in inpatient settings and have been shown to result in significant cost savings and decreased rates of Clostridium difficile infection (CDI) in the adult literature. There is more limited data regarding the impact of pediatric ASPs.
In 2011, the UC Davis Children’s Hospital (a 110-bed pediatric facility) instituted an ASP using the “prospective review and audit” model. All patients receiving antimicrobials were reviewed 3 times weekly by a pediatric infectious disease (ID) physician and pediatric ID pharmacist. Inpatient prescribing providers were paged and antibiotic recommendations were provided over the phone. Interventions were prospectively recorded, and the 16 most commonly targeted antibiotics by the ASP were identified.
Whole hospital data regarding all antimicrobial drugs administered from 2008-2014 were retrospectively obtained from the electronic medical record, including antibiotic drug name, route of administration, and dosage. Antimicrobial drug costs were calculated based on representative average wholesale prices obtained from the RED BOOK Online®. Monthly pediatric CDI rates (per 10,000 patient days) were compared between the pre and post ASP periods using linear regression.
Annual costs for the 16 most commonly targeted antibiotics decreased from $164,112 in the pre-ASP period (2008-2010) to $120,540 after institution of the ASP (2011-2014), for an annual savings of $43,572. Annual costs for all antibiotics decreased from $277,620 to $221,580 ($56,040 annual savings). Pediatric CDI rates decreased from 9.2 (per 10,000 patient days) in the pre-ASP period to 2.8 after ASP (p=0.003).
There was a substantial cost reduction following implementation of the pediatric ASP, which extended beyond the antimicrobials targeted by the ASP. Rates of pediatric CDI were also significantly decreased following implementation of the ASP. Ongoing education and interactions between a stewardship team and prescribing physicians may result in more judicious use of all antimicrobials and improved patient outcomes.