Benefits of a Pediatric Antimicrobial Stewardship Program at a Children's Hospital

OBJECTIVE: To prospectively evaluate the effect of a comprehensive antimicrobial stewardship program on antimicrobial use, physician interventions, patient outcomes, and rates of antimicrobial resistance. METHODS: Active 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. RESULTS: Total 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. CONCLUSIONS: The 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.