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Pediatric antibiotic stewardship: successful interventions to reduce broad-spectrum antibiotic use on general pediatric wards

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Abstract

Purpose

Antibiotic stewardship programs (ASP) optimize antibiotic usage and combat antibiotic resistance of bacteria. The objective of this study was to assess the impact of specific ASP interventions on antibiotic consumption in general pediatric wards.

Methods

We conducted a prospective study to compare a pre-intervention (Sept.–Dec. 2014) and post-intervention (Sept.–Dec. 2015) period. An ASP bundle was established including (1) infectious diseases (ID) ward rounds (prospective-audit-with-feedback), (2) ID consultation service, (3) internal guidelines on empiric antibiotic therapy. Medical records on four general pediatric wards were reviewed daily to analyze: (1) antibiotic consumption, (2) antibiotic dosage ranges according to local guidelines, and (3) guideline adherence for community-acquired pneumonia (CAP).

Results

Antibiotic prescribing for 273 patients (pre-intervention) was compared to 263 patients (post-intervention). Antibiotic prescription rate did not change (30.6 vs. 30.5%). However, overall days-of-therapy and length-of-therapy decreased by 10.5 and 7.7%, respectively. Use of cephalosporins and fluoroquinolones decreased by 35.5 and 59.9%, whereas the use of penicillins increased by 15.0%. An increase in dosage accuracy was noted (78.8 vs. 97.6%) and guideline adherence for CAP improved from 39.5 to 93.5%. Between the two study periods, no adverse effects regarding length of hospital stay and in-hospital mortality were observed.

Conclusions

Our data demonstrate that implementation of an ASP was associated with a profound improvement of rational antibiotic use and, therefore, patient safety. Considering the relatively short observation period, the long-term effects of our ASP bundle need to be further investigated.

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Abbreviations

ASP:

Antibiotic stewardship program

ATC:

Anatomical therapeutic chemical

CAP:

Community-acquired pneumonia

CDI:

Clostridium difficile–infection

CMI:

Case mix index

CPOE:

Computerized physician order entry

DDD:

Defined daily dose

DGI:

German Society of Infectious Diseases

DoT:

Days of antibiotic therapy

ESBL:

Extended spectrum β-lactamase producing Gram-negative bacteria

FQ:

Fluoroquinolone

ID:

Infectious diseases

IDSA:

Infectious Diseases Society of America

i.v.:

Intravenous

LMU:

Ludwig-Maximilians-University

LoT:

Length of antibiotic therapy

ME:

Medication errors

MRGN:

Multi-resistant Gram-negative bacteria

MRSA:

Methicillin-resistant Staphylococcus aureus

PD:

Patient-days

p.o.:

Oral

RDD:

Recommended daily dose

VRE:

Vancomycin-resistant Enterococcus

WHO:

World Health Organization

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Acknowledgements

This work was supported by AOK Bayern and the interprofessional PhD-program Clinical Pharmacy, LMU Munich.

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Authors and Affiliations

  1. Division of Pediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, LMU Munich, Munich, Germany

    Katharina Kreitmeyr, Ulrich von Both & Johannes Huebner

  2. Department of Pharmacy, University Hospital, LMU Munich, Munich, Germany

    Katharina Kreitmeyr & Alenka Pecar

  3. Division of Infectious Diseases, University Medical Center, Freiburg i. Br, Germany

    Johannes P. Borde & Johannes Huebner

  4. Epidemiological and Statistical Methods Research Group, Helmholtz-Center for Infection Research, Braunschweig, Germany

    Rafael Mikolajczyk

  5. Institute for Medical Epidemiology, Biostatistics and Informatics (IMEBI), Medical School of the Martin-Luther-University, Halle, Germany

    Rafael Mikolajczyk

  6. German Center for Infection Research (DZIF), Munich, Germany

    Katharina Kreitmeyr, Ulrich von Both & Johannes Huebner

  7. German Center for Infection Research (DZIF), Braunschweig, Germany

    Rafael Mikolajczyk

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  1. Katharina Kreitmeyr
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Correspondence to Johannes Huebner.

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Kreitmeyr, K., von Both, U., Pecar, A. et al. Pediatric antibiotic stewardship: successful interventions to reduce broad-spectrum antibiotic use on general pediatric wards. Infection 45, 493–504 (2017). https://doi.org/10.1007/s15010-017-1009-0

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