• M Cecilia Di Pentima, Shannon Chan, and Jobayer Hossain.
• Department of Pediatrics, Vanderbilt University, Nashville, TN 37232-2581, USA. cecilia.dipentima@vanderbilt.edu
• Pediatrics. 2011 Dec 1; 128 (6): 1062-70.

ObjectiveTo prospectively evaluate the effect of a comprehensive antimicrobial stewardship program on antimicrobial use, physician interventions, patient outcomes, and rates of antimicrobial resistance.MethodsActive surveillance of antimicrobial use with intervention and real-time feedback to providers and reinforcement of prior authorization for selected antimicrobials were introduced at a pediatric teaching hospital. Antimicrobial-use indications were incorporated as a mandatory field in the computerized information system. An automated report of antimicrobials prescribed, doses, patient demographics, and microbiology data was generated and reviewed by an infectious-disease pharmacist and a pediatric infectious-disease physician. Antimicrobial use, expressed as the number of doses administered per 1000 patient-days, was measured 3 years before and after the implementation of the program.ResultsTotal antimicrobial use peaked at 3089 doses administered per 1000 patient-days per year in 2003-2004 before implementation of the program and steadily decreased to 1904 doses administered per 1000 patient-days per year during the postintervention period. Targeted-antimicrobial use declined from 1250 to 988 doses administered per 1000 patient-days per year. Nontargeted-antimicrobial use declined from 1839 to 916 doses administered per 1000 patient-days per year. Rates of antimicrobial resistance to broad-spectrum antimicrobials among the most common Gram-negative bacilli remained low and stable over time.ConclusionsThe successful implementation of antimicrobial stewardship strategies had a significant impact on reducing targeted- and nontargeted-antimicrobial use, improving quality of care of hospitalized children and preventing emergence of resistance.

15 keywords...

hide…