Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-28T17:08:18.952Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence and Characteristics of Antimicrobial Stewardship Programs at Freestanding Children's Hospitals in the United States

Published online by Cambridge University Press:  10 May 2016

Jason G. Newland ,
Jeffrey S. Gerber ,
Scott J. Weissman ,
Samir S. Shah ,
Chelsea Turgeon ,
Erin B. Hedican ,
Cary Thurm ,
Matt Hall ,
Joshua Courter  and
Thomas V. Brogan
...Show all authors
Jason G. Newland*
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
Jeffrey S. Gerber
Affiliation:
Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Scott J. Weissman
Affiliation:
Division of Infectious Diseases, Seattle Children's Hospital, Seattle, Washington Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
Samir S. Shah
Affiliation:
Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio University of Cincinnati College of Medicine, Cincinnati, Ohio Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Chelsea Turgeon
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
Erin B. Hedican
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
Cary Thurm
Affiliation:
Children's Hospital Association, Overland Park, Kansas
Matt Hall
Affiliation:
Children's Hospital Association, Overland Park, Kansas
Joshua Courter
Affiliation:
Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Thomas V. Brogan
Affiliation:
Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington Division of Critical Care, Seattle Children's Hospital, Seattle, Washington
Holly Maples
Affiliation:
Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas
Brian R. Lee
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
Adam L. Hersh
Affiliation:
Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah
*
Children's Mercy Hospital and Clinics Kansas City, MO, 64108 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background and Objective.

Antimicrobial stewardship programs (ASPs) are a mechanism to ensure the appropriate use of antimicrobials. The extent to which ASPs are formally implemented in freestanding children's hospitals is unknown. The objective of this study was to determine the prevalence and characteristics of ASPs in freestanding children's hospitals.

Methods.

We conducted an electronic survey of 42 freestanding children's hospitals that are members of the Children's Hospital Association to determine the presence and characteristics of their ASPs. For hospitals without an ASP, we determined whether stewardship strategies were in place and whether there were barriers to implementing a formal ASP.

Results.

We received responses from 38 (91%) of 42. Among responding institutions, 16 (38%) had a formal ASP, and 15 (36%) were in the process of implementing a program. Most ASPs (13 [81%] of 16) were started after 2007. The median number of full-time equivalents dedicated to ASPs was 0.63 (range, 0.1–1.8). The most common antimicrobials monitored by ASPs were linezolid, vancomycin, and carbapenems. Many hospitals without a formal ASP were performing stewardship activities, including elements of prospective audit and feedback (9 [41%] of 22), formulary restriction (9 [41%] of 22), and use of clinical guidelines (17 [77%] of 22). Antimicrobial outcomes were more likely to be monitored by hospitals with ASPs (100% vs 68%; P = .01), although only 1 program provided support for a data analyst.

Conclusions.

Most freestanding children's hospitals have implemented or are developing an ASP. These programs differ in structure and function, and more data are needed to identify program characteristics that have the greatest impact.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 3 , March 2014 , pp. 265 - 271
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Dellit, TH, Owens, RC, McGowan, JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44: 159–177.CrossRefGoogle Scholar
2. Bartlett, JG. A call to arms: the imperative for antimicrobial stewardship. Clin Infect Dis 2011;53(suppl 1):S4–S7.CrossRefGoogle Scholar
3. Hersh, AL, Beekmann, SE, Polgreen, PM, Zaoutis, TE, Newland, JG. Antimicrobial stewardship programs in pediatrics. Infect Control Hosp Epidemiol 2009;30:1211–1217.CrossRefGoogle ScholarPubMed
4. Agwu, AL, Lee, CK, Jain, SK, et al. A world wide web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center. Clin Infect Dis 2008;47:747–753.CrossRefGoogle Scholar
5. Di Pentima, MC, Chan, S, Hossain, J. Benefits of a pediatric antimicrobial stewardship program at a children's hospital. Pediatrics 2011;128:1062–1070.CrossRefGoogle ScholarPubMed
6. Newland, JG, Stach, LM, De Lurgio, SA, et al. Impact of a pro-spective-audit-with-feedback antimicrobial stewardship program at a children's hospital. J Ped Infect Dis 2012;1:179–186.CrossRefGoogle ScholarPubMed
7. Fisher, BT, Lindenauer, PK, Feudtner, C. In-hospital databases. In: Strom, BL, Rimmel, SE, Hennessy, S, eds. Pharmacoepidemiology. 5th ed. Oxford, UK: Wiley-Blackwell, 2012:244–258.CrossRefGoogle Scholar
8. Carling, P, Fung, T, Killion, A, Terrin, N, Barza, M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol 2003; 24:699–706.CrossRefGoogle Scholar
9. Klevens, RM, Morrison, MA, Nadle, J, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298:1763–1771.CrossRefGoogle ScholarPubMed
10. Perez, F, Hujer, AM, Hujer, KM, Decker, BK, Rather, PN, Bonomo, RA. Global challenge of multidrug-resistant Acinetobacter bau-mannii. Antimicrob Agents Chemother 2007;51:3471–3484.CrossRefGoogle Scholar
11. Metjian, TA, Prasad, PA, Kogon, A, Coffin, SE, Zaoutis, TE. Evaluation of an antimicrobial stewardship program at a pediatric teaching hospital. Pediatr Infect Dis J 2008;27:106–111.CrossRefGoogle Scholar
12. Standiford, HC, Chan, S, Tripoli, M, Weekes, E, Forrest, GN. Antimicrobial stewardship at a large tertiary care academic medical center: cost analysis before, during, and after a 7-year program. Infect Control Hosp Epidemiol 2012;33:338–345.CrossRefGoogle Scholar
13. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 2012;33: 322–327.CrossRefGoogle Scholar
14. Gross, R, Morgan, AS, Kinky, DE, Weiner, M, Gibson, GA, Fishman, NO. Impact of a hospital-based antimicrobial management program on clinical and economic outcomes. Clin Infect Dis 2001; 33:289–295.CrossRefGoogle ScholarPubMed
15. Gerber, JS, Newland, JG, Coffin, SE, et al. Variability in antibiotic use at children's hospitals. Pediatrics 2010;126:1067–1073.CrossRefGoogle ScholarPubMed
16. Herigon, JC, Hersh, AL, Gerber, JS, Zaoutis, TE, Newland, JG. Antibiotic management of Staphylococcus aureus infections in US children's hospitals, 1999-2008. Pediatrics 2010;125:el294–el300.CrossRefGoogle ScholarPubMed