title: Benefits of a pediatric antimicrobial stewardship program at a children's hospital.
abstract: OBJECTIVE
  To prospectively evaluate the effect of a comprehensive antimicrobial stewardship program on antimicrobial use, physician interventions, patient outcomes, and rates of antimicrobial resistance.
  
  
  METHODS
  Active surveillance of antimicrobial use with intervention and real-time feedback to providers and reinforcement of prior authorization for selected antimicrobials were introduced at a pediatric teaching hospital. Antimicrobial-use indications were incorporated as a mandatory field in the computerized information system. An automated report of antimicrobials prescribed, doses, patient demographics, and microbiology data was generated and reviewed by an infectious-disease pharmacist and a pediatric infectious-disease physician. Antimicrobial use, expressed as the number of doses administered per 1000 patient-days, was measured 3 years before and after the implementation of the program.
  
  
  RESULTS
  Total antimicrobial use peaked at 3089 doses administered per 1000 patient-days per year in 2003-2004 before implementation of the program and steadily decreased to 1904 doses administered per 1000 patient-days per year during the postintervention period. Targeted-antimicrobial use declined from 1250 to 988 doses administered per 1000 patient-days per year. Nontargeted-antimicrobial use declined from 1839 to 916 doses administered per 1000 patient-days per year. Rates of antimicrobial resistance to broad-spectrum antimicrobials among the most common Gram-negative bacilli remained low and stable over time.
  
  
  CONCLUSIONS
  The successful implementation of antimicrobial stewardship strategies had a significant impact on reducing targeted- and nontargeted-antimicrobial use, improving quality of care of hospitalized children and preventing emergence of resistance.
authors: Department of Pediatrics, Vanderbilt University, Nashville, TN 37232-2581, USA. cecilia.dipentima@vanderbilt.edu
authors: M Cecilia
authors: MC
authors: Di Pentima
authors: Shannon
authors: S
authors: Chan
authors: Jobayer
authors: J
authors: Hossain
mesh_terms: D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017723:Drug Utilization Review / Q000592:standards*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents