172. Antimicrobial Stewardship in High Risk Pediatric Patients
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions in Pediatric Populations
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • Goldman IDSA 2018 ASP HR Patient FINAL [Compatibility Mode].pdf (175.5 kB)
  • Background: The clinical impact of antimicrobial stewardship programs (ASP) on children admitted to the intensive care units (ICU) or oncology wards is unknown. The objective of this study was to determine if following ASP recommendations improved clinical outcomes in pediatric ICU and oncology patients.

    Methods: We performed a retrospective cohort study to evaluate the relationship between ASP recommendation(s) agreement and patient outcomes (hospital length of stay (LOS), 30-day mortality, hospital readmission within 30 days, and hospital-onset Clostridium difficile infection (HO-CDI)) in a high risk (HR) population. For this study, we included all children admitted to the neonatal ICU (NICU), pediatric ICU (PICU) or oncology (Onc) ward from March 2008–March 2017 who underwent an ASP review. Unadjusted differences in LOS, mortality, readmissions and HO-CDI were compared between cases of ASP agreement and disagreement. Generalized linear mixed models were used to control for potential confounders and account for patients with >1 ASP review.

    Results: ASP performed 11,545 antimicrobial reviews (PICU 3628; NICU 2824; Onc 5093) on 7,329 unique patients. ASP provided 2088 recommendations. Stop antibiotics was the most common recommendation (N=1045; 50%) followed by narrow antibiotics (N=474; 23%), and obtain an infectious disease consultation (N=334; 16%). Agreement with ASP by the prescribing clinician occurred in 70% of cases. Overall, 356 (5%) patients died, 87 (1%) had HO-CDI, and 2,608 (36%) were readmitted. Agreeing with an ASP recommendation was not associated with increased odds of mortality or readmission. Agreement with an ASP recommendation was not associated with decreased odds of acquiring HO-CDI (adjusted OR 1.58, 95% CI: 0.35, 7.26). Among HR patients with a single ASP review, the median LOS was significantly shorter for clinicians who agreed with recommendations vs. disagreed (10.3 days vs. 12.5 days, respectively, p =0.02).

    Conclusion: Agreement with an ASP recommendation was associated with a shorter LOS and no increase in readmissions or mortality. Further stewardship strategies are needed to optimize antimicrobial use in this HR pediatric population.

    Jennifer Goldman, MD, MS, Children's Mercy Kansas City, Kansas City, MO, Diana Yu, PharmD, BCPS-AQ ID, Doernbecher Children's Hospital, Portland, OR, Jason Newland, MD, MEd, FPIDS, Washington University S, Kansas City, MO, Mary Anne Jackson, MD, FIDSA, FPIDS, Pediatrics, Children's Mercy Hospital, Kansas City, MO, Gina Weddle, DNP, RN, CPNP, Infectious Disease, The Children's Mercy Hospital, Kc, MO, Russell Mcculloh, MD, Hospital Medicine, Children's Hospital & Medical Center, Omaha, NE, Angela Myers, MD, MPH, FPIDS, Children's Mercy Hospital, Kansas City and University of Missouri-Kansas City School of Medicine, Kansas City, MO, James Day, MD, Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, MO and Brian R. Lee, MPH, PhD, Health Outcomes, Children's Mercy Kansas City and University of Missouri-Kansas City SOM, Kansas City, MO

    Disclosures:

    J. Goldman, None

    D. Yu, None

    J. Newland, None

    M. A. Jackson, None

    G. Weddle, None

    R. Mcculloh, None

    A. Myers, None

    J. Day, None

    B. R. Lee, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.