257. A Whole of Country Analysis of Antimicrobial Stewardship Resources, Activities and Barriers for Children in Hospitals in Australia
Session: Poster Abstract Session: Pediatric Antimicrobial and Diagnostic Stewardship
Thursday, October 4, 2018
Room: S Poster Hall

Background: We aimed to assess antimicrobial stewardship (AMS) resources and activities for children in hospitals throughout Australia, to identify gaps in services.

Methods: Every public hospital in Australia with paediatric beds was identified via the Australian Institute of Health and Welfare. The director of pharmacy or most senior paediatrician was asked to complete an online evaluation in 2017 regarding their AMS resources and activities. For analysis, tertiary (7) and major metropolitan hospitals (50) were combined (metropolitan) and compared to hospitals in regional (42) and rural towns (7) combined (rural).

Results: We identified 106 hospitals and received 106 (100%) responses. Paediatric bed numbers ranged from 3 to 360. In metropolitan hospitals 17 (35%) had a paediatric AMS team or representation, compared with 5 (9%) for rural (p=0.001) There was an AMS pharmacist in 42 (86%) metropolitan hospitals compared to 37 (65%) rural (p=0.1) although the majority of these were not paediatric. 51 (48%) hospitals had locally-adapted empirical antibiotic prescribing guidelines (metropolitan 28 (57%) versus rural 23 (40%)(p=0.06)), although fewer had specialty-specific guidelines (figure). 102 (96%) hospitals had restrictions on broad-spectrum antimicrobials, but formal approval systems were fewer: metropolitan 44 (90%) versus rural 35 (66%) (p=0.004)). Auditing methods differed but were mostly ad hoc, with results fed back in an untargeted way with only 22 (34%) providing direct physician feedback. There was a paucity of AMS education: only 25 (24%) provided education for senior medical staff, and 24 (23%) had no education for any staff (metropolitan 8 (17%) versus rural 16 (29%)(p=0.1)). The commonest perceived barriers to successful AMS for all hospitals were lack of dedicated infectious diseases and microbiology services (64 (60%)), lack of dedicated pharmacy resources (62 (59%)), and a lack of education for clinicians in antibiotic use (53 (50%)).

Conclusion: Australian hospitals have implemented some AMS activities for children, but most lack resources – this was much more evident in regional/rural than metropolitan hospitals. Barriers to successful AMS include a lack of infectious diseases and pharmacy resources and education, which need to be addressed in workforce planning.

AMS hospital guidelines by specialty.jpg

Penelope Bryant, BM BCh, PhD, University of Melbourne, Parkville, Australia; Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Parkville, Australia; Rch@Home, Royal Children's Hospital, Parkville, Australia; Murdoch Childrens Research Institute, Parkville, Australia, Natalie Morgan, MBBS, General Medicine, Royal Children's Hospital Melbourne, Parkville, Australia, Vanessa Clifford, MBBS, PhD, Royal Children's Hospital Melbourne, Parkville, Australia, Brendan McMullan, MBBS, Sydney Children's Hospital, Sydney, Australia, Asha Bowen, MBBS FRACP, Telethon Kids Institute, Subiaco, Australia; Princess Margaret Hospital, Subiaco, Australia and ANZPID-ASAP group

Disclosures:

P. Bryant, None

N. Morgan, None

V. Clifford, None

B. McMullan, None

A. Bowen, None

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