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Infect Control Hosp Epidemiol. 2015 Jun;36(6):673-80. doi: 10.1017/ice.2015.45. Epub 2015 Mar 16.

Clinical diagnoses and antimicrobials predictive of pediatric antimicrobial stewardship recommendations: a program evaluation.

Author information

1
1Department of Pediatrics,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri.
2
2Center for Clinical Effectiveness,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri.
3
3Department of Pediatrics,University of Utah School of Medicine,Salt Lake City,Utah.
4
4Department of Pharmacy,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri.
5
5Department of Pharmacy,Ann & Robert H. Lurie Children's Hospital of Chicago,Chicago,Illinois.

Abstract

BACKGROUND:

The number of pediatric antimicrobial stewardship programs (ASPs) is increasing and program evaluation is a key component to improve efficiency and enhance stewardship strategies.

OBJECTIVE:

To determine the antimicrobials and diagnoses most strongly associated with a recommendation provided by a well-established pediatric ASP.

DESIGN AND SETTING:

Retrospective cohort study from March 3, 2008, to March 2, 2013, of all ASP reviews performed at a free-standing pediatric hospital.

METHODS:

ASP recommendations were classified as follows: stop therapy, modify therapy, optimize therapy, or consult infectious diseases. A multinomial distribution model to determine the probability of each ASP recommendation category was performed on the basis of the specific antimicrobial agent or disease category. A logistic model was used to determine the odds of recommendation disagreement by the prescribing clinician.

RESULTS:

The ASP made 2,317 recommendations: stop therapy (45%), modify therapy (26%), optimize therapy (19%), or consult infectious diseases (10%). Third-generation cephalosporins (0.20) were the antimicrobials with the highest predictive probability of an ASP recommendation whereas linezolid (0.05) had the lowest probability. Community-acquired pneumonia (0.26) was the diagnosis with the highest predictive probability of an ASP recommendation whereas fever/neutropenia (0.04) had the lowest probability. Disagreement with ASP recommendations by the prescribing clinician occurred 22% of the time, most commonly involving community-acquired pneumonia and ear/nose/throat infections.

CONCLUSIONS:

Evaluation of our pediatric ASP identified specific clinical diagnoses and antimicrobials associated with an increased likelihood of an ASP recommendation. Focused interventions targeting these high-yield areas may result in increased program efficiency and efficacy.

PMID:
25773192
PMCID:
PMC4583769
DOI:
10.1017/ice.2015.45
[Indexed for MEDLINE]
Free PMC Article
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