Thursday, July 2, 2015

Impact of a Prospective-Audit-with-Feedback Antimicrobial Stewardship Program at a Children’s Hospital

Jason Newland, MD, MEd
Children's Mercy Hospital

Objective. To describe the impact of a prospective-audit-with-feedback antimicrobial stewardship program on antibiotic use in a children’s hospital.

Design. A time-series analysis was conducted from January 1, 2004 to December 31, 2010 to determine the impact of the ASP on all and broad-spectrum (select) antibiotic use in days of therapy and length of therapy per 1000 patient days. Antibiotic use data was obtained from the Pediatric Health Information Systems, an administrative database.
Setting. 317 bed tertiary care children’s hospital
Intervention. A prospective-audit-with-feedback ASP was introduced at a children’s hospital in March of 2008.
Results. The antimicrobial stewardship program reviewed 8921 patients in the 30 months of analysis. The most common select antibiotics reviewed were ceftriaxone/cefotaxime (43%), vancomycin (20%), ceftazidime (12%) and meropenem (7%). Recommendations were made in 19% of patients;the most common recommendation was to stop antibiotics (42%). A significant decrease in the percent recommendations per month was observed over time (p<0.001). Overall, prescribing clinicians were compliant with the ASP recommendations 93% of the time; compliance rates did not change significantly over the 30 month period (p=0.34). Time-series analysis observed a 6% monthly decrease in all antibiotic use for both days of therapy and length of therapy per 1000 patient days (p<0.001). The select antibiotic monthly use decline was 12% (p<0.001) and 13% (p<0.001) for days of therapy and length of therapy per 1000 patient-days, respectively. When controlling for severity of index, a monthly decline in select antibiotics of 19% (p<0.001) was observed for both days of therapy and length of therapy per 1000 patient-days.
Conclusions. A prospective-audit-with-feedback ASP can have a significant impact on decreasing antibiotic use at a children’s hospital.