Abstract PD-014: ANTIBIOTIC STEWARDSHIP PROGRAM IN PEDIATRIC INTENSIVE CARE UNIT OF A DEVELOPING COUNTRY.

Abstract

Aims & Objectives: To determine the effects of implementation of a pharmacist led antibiotic stewardship program usage of antibiotics in pediatric intensive care unit (PICU) of low-and-middle-income country. Methods We conducted a cross sectional study in our closed-multidisciplinary PICU for three months.The four components of this program were appropriate selection of antibiotics, appropriate dosage, de-escalation / discontinuation and monitoring of interaction and drug blood levels. During rounds, our ASP team recorded all four components on each patient along with days of therapy (DOT), cost of therapy (COT) and outcome in terms of survival. Data was collected on a structured proforma. Results We studied 130 patients in both pre and post ASP categories. Age and admitting diagnoses were same in both cohorts. We found that the use of empiric antibiotics dropped from 42% in pre ASP to 30% in post ASP category. Prophylactic antibiotics were given to 43% patients in each group. During the ASP, appropriate dose adjustment by the pharmacist was done among 19% of the total cases. We demonstrated that DOT reduced from 1937 to 651 days after the ASP was introduced and prolonged (>5 days) use of antibiotics decreased from 64% in pre ASP to 47% in post ASP cohort (p <0.05). We found that the DOT was significantly reduced (p<0.05) for all the commonly used antibiotics while COT was reduced from US$ 21,000 to 8900. Mortality remained same in both groups during the study period. Conclusions ASP significantly reduced the DOT, COT, helped in early de-escalation of therapy, dose adjustment and drug monitoring.