Abstract
Introduction: The accelerating threat of multidrug-resistant bacteria (MRB) forces health care providers to use antibiotics more rationally. Antibiotic stewardship programs (ASP) are a proven and safe way to achieve that goal. They have been comprehensively studied in adults but data from secondary care pediatric hospitals are lacking.Material and Methods: In our study an ASP with standard operating procedures (SOPs), audits, a weekly ward round with experts in pediatric infectious diseases and an antibiotic pocket-card for selected infectious diseases was established in July 2017 in a Munich municipal secondary care children's hospital. All antibiotic prescriptions on general pediatric wards were reviewed each in the first quarter of 2017 and 2018. The primary outcome was adherence to treatment guidelines. Secondary outcomes were substance consumption, duration of therapy and death.Results: After the ASP was implemented guideline adherence increased significantly from 33 to 63%. The consumption of cephalosporins decreased significantly (−60%), whereas aminopenicillin use increased accordingly (+120%). Neither in the pre- nor in the post-intervention group deaths occurred.Discussion: Data on ASP in pediatric secondary care hospitals are scarce. Most previous studies have been performed at tertiary care/university children's hospitals. We demonstrate a significant improvement in guideline adherence regarding antibiotic treatments after the implementation of an ASP. Cephalosporin consumption decreased which might be relevant for the selection of MRB (e.g., vancomycin-resistant enterococci). Results are limited by the single-center design and the short observation period. The study encourages the implementation of ASPs in secondary care children's hospitals.
Highlights
The accelerating threat of multidrug-resistant bacteria (MRB) forces health care providers to use antibiotics more rationally
The implementation of antibiotic stewardship programs (ASPs) has been proven effective to reduce the burden of infections with MRB such as extendedspectrum beta-lactamase (ESBL)-producing enterobacteriaceae, vancomycin-resistant enterococcus (VRE), and methicillinresistant Staphylococcus aureus (MRSA) [3, 4]
We show here that implementing an ASP is successful in a secondary care pediatric hospital with regard to guideline adherence and reduction of cephalosporin consumption
Summary
The accelerating threat of multidrug-resistant bacteria (MRB) forces health care providers to use antibiotics more rationally. Antibiotic stewardship programs (ASP) are a proven and safe way to achieve that goal. They have been comprehensively studied in adults but data from secondary care pediatric hospitals are lacking. Infections with multidrug-resistant bacteria (MRB) are a leading global health care threat [1, 2]. The implementation of antibiotic stewardship programs (ASPs) has been proven effective to reduce the burden of infections with MRB such as extendedspectrum beta-lactamase (ESBL)-producing enterobacteriaceae, vancomycin-resistant enterococcus (VRE), and methicillinresistant Staphylococcus aureus (MRSA) [3, 4]. Further beneficial impacts of ASPs include avoiding adverse effects to unnecessary antibiotic therapies and the overall cost savings for the health systems [7, 8]
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