Evaluation of an antimicrobial stewardship program in an Australian tertiary paediatric hospital

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Background: The rise of antimicrobial resistance has been described as a threat to human health. Judicious use of antimicrobials, through antimicrobial stewardship (AMS) is a key component of the World Health Organization’s Global action plan on antimicrobial resistance. AMS programs involve multiple strategies to ensure optimal antimicrobial selection, dosage, route of administration and duration of therapy to maximise the benefit of antimicrobials, whilst minimising the associated collateral damage. Although AMS has been a requirement for hospital accreditation in Australia since 2013 implementation and evaluation of AMS in Australian tertiary paediatric hospitals has been limited by the complexities in the patient population, and the local infrastructure and resources. Aim: Evaluate an AMS program in an Australian tertiary paediatric hospital Methods: The Centers for Disease Control and Prevention core elements of AMS for hospitals provided a framework for six studies, two studies focused on the use of the local computerised decision support and approval system (CDSS). The CDSS was assessed as an intervention to reduce inappropriate broad-spectrum antibiotic use for community-acquired pneumonia, compliance with the CDSS and its utility as a tracking tool were explored in a second study. Educational needs of nursing and non-consultant medical staff were determined using two different survey approaches. Candidate units of measure for antimicrobial surveillance were developed and used to evaluate the impact of AMS in the paediatric intensive care setting in a quasi-experimental design study. Results: Children with suspected uncomplicated community-acquired pneumonia were predominantly prescribed guideline-concordant narrow-spectrum penicillins at admission to hospital both before and after CDSS implementation. CDSS use was uncommon after standard pharmacy and AMS working hours, with ongoing implications for AMS involvement the next standard working day. Broad-spectrum antibiotics, potentially suitable for long term trend analysis were identified. Both standard adult defined daily doses and vial-based estimates did not identify an association between implementation of the CDSS and a reduction in restricted antibiotic use.
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