Formal antibiotic stewardship programs work in children’s hospitals

Children’s hospitals with formal antibiotic stewardship programs (ASPs) helped reduce antibiotic use significantly following the 2007 release of guidelines for developing these programs, according to a report published in Pediatrics.

Adam L. Hersh, MD, PhD, and his colleagues found that antibiotic prescribing improved in hospitals with and without ASPs after the 2007 release of Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship, developed by the Infectious Diseases Society of America (IDSA).

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The authors compared trends of antibiotic use in children’s hospitals with and without ASPs during two time periods (January 2004 to before January 2007) and (after January 2007 to December 2012). Thirty-one hospitals were included in the study, and nine had ASPs.

“Changes [in antibiotic use] were more pronounced among those hospitals that established formalized ASPs during this period [2007 to 2012] compared with those that did not,” Hersh and his co-authors wrote.

Prior to 2007, there was no real difference in average antibiotic use between children’s hospitals with and without ASPs (775 versus 771 days of therapy/1000 patient days). However after 2007, children’s hospitals with ASPs fared much better in reducing antibiotics (11%) compared to those hospitals without the ASPs (8%).

Before 2007, a select subset of antibiotics, which included IV vancomycin, carbapenems (meropenem, imipenem, and ertapenem), and linezolid, was used at a similar rate in children’s hospitals with and without ASPs. After the ISDA released its guidelines, children’s hospitals with ASPs did reduce their use of select antibiotics by 4% or an average of 110 days of therapy/1000 patient days. In children’s hospitals without ASPs, the average use remained steady from 114 days of therapy/1000 patient days, before 2007, to 115 days of therapy/1000 patient days, after 2007.

“Our findings suggest that the development of a formalized stewardship program, defined to include commitment of financial resources for personnel, translates into declines in antibiotic use that are above and beyond those achieved without similar investment,” Hersh and his colleagues explained.