Antimicrobial stewardship programs (ASPs) promote the appropriate use of antimicrobials by selecting the optimal dose, duration, and route of administration. There is limited evidence of the effect of appropriateness of antibiotic prescribing on patient outcome.
A 3-year retrospective chart review (2010-2013) was performed for all episodes of positive blood cultures in pediatric inpatients. 7 antibiotic management variables (empiric therapy, dose, duration, frequency, de-escalation, targeted therapy and drug levels) were evaluated for each episode and appropriate management was determined. A score of 0 was considered as optimal management. For each inappropriate management variable 1 point was added to the Antibiotic Management Score (AMS), up to a maximum of 6 (or 7 if antibiotic drug levels where relevant) per treatment course. Severity of a sepsis episode was evaluated using a standardized severity score. Poor outcome was defined as either persistent bacteremia or mortality.
101 episodes of positive blood cultures (age range 0-20 years) were identified. 40% of cases were treated in the NICU, 60% in pediatric inpatient units. The following groups of bacteria were identified: 41 Coagulase-negative staphylococci, 17 S. aureus, 24 Gram-negative bacteria, and 2 Group B streptococci. The average AMS for the institution was 1.08. 48.5% of patients received suboptimal antibiotic therapy (AMS > 0) with a mean AMS of 2.2 per episode. The AMS was significantly increased in pediatric compared to neonatal units (1.4 vs. 0.84; p = 0.04). Patients with poor outcome (death or microbiological failure) had significantly higher AMS than those with good clinical outcomes (mean AMS = 2.3 vs. 0.88; p = 0.01). Severity scores were significantly higher in patients with poor outcome (p < 0.001), however, the effect of inappropriate antibiotic management on outcome remained significant after correcting for severity of illness (p = 0.004).
The composite cumulative AMS allows quantification of deviation from management guidelines. The AMS is thus useful for monitoring the impact of an ASP on quality of antibiotic prescribing and patient safety.
G. Abd El Gadir,
R. Sharma, None
S. Pydimarri, None
S. Kohlhoff, None