257. A Whole of Country Analysis of Antimicrobial Stewardship Resources, Activities, and Barriers for Children in Hospitals in Australia

Abstract

BackgroundWe aimed to assess antimicrobial stewardship (AMS) resources and activities for children in hospitals throughout Australia, to identify gaps in services.MethodsEvery 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 with hospitals in regional (42) and rural towns (7) combined (rural).ResultsWe 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 with 37 (65%) rural (P = 0.1) although the majority of these were not paediatric. Fifty-one (48%) hospitals had locally adapted empirical antibiotic prescribing guidelines (metropolitan 28 (57%) vs. rural 23 (40%)(P = 0.06)), although fewer had specialty-specific guidelines (figure). One hundred two (96%) hospitals had restrictions on broad-spectrum antimicrobials, but formal approval systems were fewer: metropolitan 44 (90%) vs. 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%) vs. 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%)).ConclusionAustralian 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. Disclosures All authors: No reported disclosures.