title: Antimicrobial stewardship in pediatrics: focusing on the challenges clinicians face.
abstract: BACKGROUND
  Antimicrobial use is very common in hospitalized children. An assessment of clinician's prevailing knowledge and clinical approach to prescribing antimicrobials is helpful in order to develop the best strategies for successful stewardship programs. The objectives of the study were to determine fundamental knowledge of principles, approach to antimicrobial use through the clinical vignettes and to identify perceived challenges in decreasing antimicrobial use.
  
  
  METHODS
  A questionnaire was developed by subject matter experts and pretested to ensure validity. Using a cross-sectional prospective design, the questionnaire was completed anonymously by staff and trainee physicians at a single tertiary care pediatric hospital between late November 2011 and February 2012.
  
  
  RESULTS
  Of 159 eligible physicians, 86 (54.1%) responded, of which 77 (46 staff and 31 trainees) reported regularly prescribing antimicrobials. The majority of physicians had modest knowledge of factors that would increase risk of resistance however, less than 20% had correct knowledge of local resistance patterns for common bacteria. Almost half of physicians correctly answered the clinical vignettes. Over half of trainees and one third of staff relied most on online manuals for information regarding antimicrobials to assist prescription decision-making. Overall, physicians perceived that discontinuing empiric antimicrobials was the most difficult to achieve to decrease antibiotic use.
  
  
  CONCLUSIONS
  Our results highlight several challenges that pediatric practioners face with respect to knowledge and approach to antimicrobial prescribing. Pediatric stewardship programs could in this setting focus on discontinuing antimicrobials appropriately and promoting local antibiograms in the proper clinical setting to decrease overall use of antimicrobials.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bowes
authors.forename: Abdool S
authors.initials: AS
authors.lastname: Yasseen
authors.forename: Nicholas
authors.initials: N
authors.lastname: Barrowman
authors.forename: Barbara
authors.initials: B
authors.lastname: Murchison
authors.forename: Judy
authors.initials: J
authors.lastname: Dennis
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Moreau
authors.forename: Nisha
authors.initials: N
authors.lastname: Varughese
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8 L1, Canada. lesaux@cheo.on.ca.
authors.forename: Nicole
authors.initials: N
authors.lastname: Le Saux
mesh_terms: D000900:Anti-Bacterial Agents; D002648:Child; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D024881:Drug Resistance, Bacterial; D006776:Hospitals, Pediatric; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008826:Microbial Sensitivity Tests; D009864:Ontario; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D035501:Uncertainty
chemical_list: D000900:Anti-Bacterial Agents