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.
J. Newland, None
M. A. Jackson, None
G. Weddle, None
R. Mcculloh, None
A. Myers, None
J. Day, None
B. R. Lee, None
See more of: Poster Abstract Session