The Impact of an Antimicrobial Stewardship Program on Days of Therapy in the Pediatric Center: An Interrupted Time-Series Analysis of a 19-Year Study.
J Korean Med Sci
; 39(21): e172, 2024 Jun 03.
Article
in En
| MEDLINE
| ID: mdl-38832477
ABSTRACT
BACKGROUND:
We aimed to analyze the effects of an antimicrobial stewardship program (ASP) on the proportion of antimicrobial-resistant pathogens in bacteremia, antimicrobial use, and mortality in pediatric patients.METHODS:
A retrospective single-center study was performed on pediatric inpatients under 19 years old who received systemic antimicrobial treatment from 2001 to 2019. A pediatric infectious disease attending physician started ASP in January 2008. The study period was divided into the pre-intervention (2001-2008) and the post-intervention (2009-2019) periods. The amount of antimicrobial use was defined as days of therapy per 1,000 patient-days, and the differences were compared using delta slope (= changes in slopes) between the two study periods by an interrupted time-series analysis. The proportion of resistant pathogens and the 30-day overall mortality rate were analyzed by the χ².RESULTS:
The proportion of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia increased from 17% (39 of 235) in the pre-intervention period to 35% (189 of 533) in the post-intervention period (P < 0.001). The total amount of antimicrobial use significantly decreased after the introduction of ASP (delta slope value = -16.5; 95% confidence interval [CI], -30.6 to -2.3; P = 0.049). The 30-day overall mortality rate in patients with bacteremia did not increase, being 10% (55 of 564) in the pre-intervention and 10% (94 of 941) in the post-intervention period (P = 0.881).CONCLUSION:
The introduction of ASP for pediatric patients reduced the delta slope of the total antimicrobial use without increasing the mortality rate despite an increased incidence of ESBL-producing gram-negative bacteremia.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Bacteremia
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Interrupted Time Series Analysis
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Antimicrobial Stewardship
/
Klebsiella pneumoniae
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Anti-Bacterial Agents
Limits:
Adolescent
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Child
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Child, preschool
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Female
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Humans
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Infant
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Male
Language:
En
Journal:
J Korean Med Sci
Journal subject:
MEDICINA
Year:
2024
Document type:
Article