Antimicrobial stewardship programs in pediatrics.
OBJECTIVE
To describe the prevalence, characteristics, and barriers to implementation of antimicrobial stewardship programs (ASPs) in pediatrics.


METHODS
In December 2008, we surveyed the pediatric members of the Emerging Infections Network, a network of infectious diseases consultants located throughout North America. Participants responded regarding whether their hospital had or planned to develop an ASP, its characteristics, barriers to improvement or implementation, and perceptions about antimicrobial resistance.


RESULTS
Of 246 pediatric infectious disease consultants surveyed, 147 (60%) responded. Forty-five respondents (33%) reported having an ASP, and 25 (18%) were planning a program. The percentage of respondents from freestanding children's hospitals who were planning ASPs was higher than the percentage of respondents from other settings who were planning ASPs (P = .04). Most existing programs were developed before 2000 and had a limited number of full-time equivalent staff, and few programs used a prospective audit-and-feedback structure. Many programs were not monitoring important end points associated with ASPs, including cost and number of antibiotic-days. The major barriers to implementation of an ASP were lack of resources, including funding, time, and personnel, noted by more than 50% of respondents. Regardless of the presence of an ASP, respondents perceived antibiotic resistance as a more significant problem nationally than at their local hospital (P < .001).


CONCLUSIONS
The prevalence of ASPs in pediatrics is limited, and opportunities exist to improve current programs.
University of California, San Francisco, California, USA. hershad@peds.ucsf.edu
Adam L
AL
Hersh
Susan E
SE
Beekmann
Philip M
PM
Polgreen
Theoklis E
TE
Zaoutis
Jason G
JG
Newland
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D004352:Drug Resistance, Microbial; D019538:Health Care Surveys; D006776:Hospitals, Pediatric / Q000458:organization & administration* / Q000592:standards; D008485:Medical Audit / Q000458:organization & administration; D009656:North America; D010372:Pediatrics / Q000458:organization & administration* / Q000706:statistics & numerical data
D000890:Anti-Infective Agents