1469. Pediatric antimicrobial stewardship: Itís as easy as 1-2-3 (1 hour, 2 people, 3 times a week)
Session: Poster Abstract Session: Antimicrobial Stewardship: Pediatric and OPAT
Saturday, October 10, 2015
Room: Poster Hall
Background: Optimizing antimicrobial use through antimicrobial stewardship programs (ASP) in pediatric hospitals has been less urgent because of lower C. difficilerates and less overall resistance in pathogens typically seen in children.  We sought to compare antimicrobial days of therapy (DOT) for patients preceding and following implementation of a prospective audit and feedback program.

Methods: The ASP takes place at the Children’s Hospital of Eastern Ontario, a 120 bed, tertiary care pediatric hospital in Ottawa, Canada.  Our institutional ASP consisted of a prospective audit and feedback with an ID physician and pharmacist 3 times per week on two general pediatric medicine wards.  Drug utilization reports (DUR) generated from the pharmacy database for all patients prescribed an antimicrobial and admitted under general pediatrics were used to obtain DOT which was calculated as “stop date” minus “start date”. The first 6 months after ASP implementation (Aug 4, 2014-Jan 31, 2015) was compared to the same 6 month period in the year preceding ASP implementation (Aug 1, 2013-Jan 31, 2014).  A Poisson test was used to compare DOT/1000 patient days.  Acceptance rates of common ASP recommendations were recorded. 

Results: DOT/1000 patient days was 512 in the pre-ASP period versus 420 in the post intervention period (-18% change; p=<0.001). Use of aminopenicillins increased by 18.7/1000 patient days (p=0.004) post ASP whereas use of third generation cephalosporins decreased by 52.3/1000 patient days (p=<0.001) and clindamycin decreased by 12.4/1000 patient days (p=<0.001). The recommendation acceptance rate for targeted antimicrobials, clindamycin and second/third generation cephalosporins, was 63.6% and 77.5% respectively.

Conclusion: In the 6 months following ASP implementation, an 18% reduction in DOT/1000 patient days was observed.  Most importantly, we decreased the use of targeted antimicrobials which have a broader spectrum and potentially are associated with more adverse events. Continued measurement of antimicrobial use after ASP implementation provides a means to assess the success of our ASP and evaluate its impact on prescribing practices.

Nicole Le Saux, MD1, Jennifer Bowes, M Sc2, Lubnah El Sarji, Pharm D3, Rťgis Vaillancourt, Pharm D4, Marc Zucker, MD5, Salwa Akiki, M Sc6 and Jaime Mcdonald, Pharm D4, (1)Infection Prevention and Control, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada, (2)Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada, (3)Pharmacy, University of Toronto, Ottawa, ON, Canada, (4)Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada, (5)Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada, (6)Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada

Disclosures:

N. Le Saux, None

J. Bowes, None

L. El Sarji, None

R. Vaillancourt, None

M. Zucker, None

S. Akiki, None

J. Mcdonald, None

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