Guidelines for creating institutional Antimicrobial Stewardship Programs (ASPs) has led to a growing number of freestanding childrens hospitals establishing programs with dedicated members directing antimicrobial use. Therefore, we implemented an ASP program with novel interventions in a quaternary care childrens hospital to optimize antibiotic use and clinical outcomes.
A multidisciplinary team initiated an ASP in July 2013, with interventions focused at individual providers in addition to broader system-level changes. Specialty units within the hospital with the highest antibiotic use particularly use of meropenem, vancomycin, and quinolones) were a major focus of ASP educational sessions, care algorithm development, and audit with feedback. System-level interventions included standardized order sets and hospital formulary changes. Effectiveness of the ASP was measured by: 1. days of therapy per 1000 patient days pre- and post-stewardship, 2. percentage of antibiotic courses restarted within one week of discontinuation, and 3. average time on therapy per length of hospital stay by patient. Primary clinical outcomes of interest also included rates of persistent infection, and patient costs for antimicrobials.
Within a two-year period, there was a 36% reduction in antimicrobial days of therapy per 1000 patient days hospital-wide was observed. Meropenem use declined by 68% in days of therapy, vancomycin declined by 41%, and quinolones declined by 52% (Figure 1). Average length of meropenem and vancomycin courses decreased from 9.3 days to 6.3 days and 4.8 days to 3.8 days, respectively. There was no increase in rates at which antibiotics were restarted or persistently positive cultures.
After implementing a multifaceted ASP program at our institution, antimicrobial use has significantly declined and initial evidence reveals positive clinical outcomes as a result. These changes have led to lower overall antibiotic use across the institutions. Antibiotic use was optimized and correlated with improved clinical outcomes for admitted patients.
J. Courter, None
S. Goldstein, None
L. Ambroggio, None
D. Haslam, None