P0611 / #1112: ANTIMICROBIAL STEWARDSHIP AND PROCALCITONIN TESTING TO OPTIMIZE SEPSIS CARE IN CRITICALLY ILL PEDIATRIC PATIENTS

Abstract

Aims & Objectives: We aim to prospectively evaluate an antimicrobial stewardship program (ASP) and Procalcitonin (PCT) testing on septic pediatric intensive care (PICU) patients. Methods: We performed a 30-week baseline collection (Phase 1), and a 30-week evaluation (Phase 2) of ASP and PCT in PICU patients with suspected or confirmed sepsis (inclusion criteria: temperature >38.0 or <36.0 and requiring IV antibiotic). The primary endpoint was in-hospital mortality; secondary endpoints included antimicrobial adequacy, ASP interventions and acceptance, LOS, re-admissions and economic indices, etc. Segmented logistic and linear regression analyses were performed for associations. Results: Each phase had 40 children, mean age of 3.9 (1.8) years; 56.3% male; PRISM III mean was 3.3 and 7.0 (CI:±2.66,p=0.0068) in each phase, respectively. From 104 antibiotic prescriptions, 91 (88%) were guideline-concordant; 103 ASP recommendations were made in 60 assessments, with 83% full acceptance rate; in 12% of patients antimicrobials were not indicated, in 6% narrower spectrum was suggested. PCT was measured at least once in 95% of patients: in 24% initial PCT values were <0.25 ng/mL (stopping rule) while in 71% were >1 ng/mL (continuation rule). Only 1 patient died (phase 1), mortality 1.2%. In phase 2 the mean ICU LOS was shorter (-6.58 days; 95% CI, -14.51, 1.36, p=0.10) and PICU readmissions decreased (12 vs. 4; p=0.048); costs were lower (-$5,830) and QALYs were higher (0.192 vs 0.188). Conclusions: ASP and PCT testing were effectively implemented, well accepted and helpful, albeit mortality did not differ. Implementation was cost effective with fewer re-admissions and resulted in higher quality-adjusted life years.