title: Antimicrobial stewardship programs in freestanding children's hospitals.
abstract: OBJECTIVE
  Single-center evaluations of pediatric antimicrobial stewardship programs (ASPs) suggest that ASPs are effective in reducing and improving antibiotic prescribing, but studies are limited. Our objective was to compare antibiotic prescribing rates in a group of pediatric hospitals with formalized ASPs (ASP+) to a group of concurrent control hospitals without formalized stewardship programs (ASP-).
  
  
  METHODS
  We evaluated the impact of ASPs on antibiotic prescribing over time measured by days of therapy/1000 patient-days in a group of 31 freestanding children's hospitals (9 ASP+, 22 ASP-). We compared differences in average antibiotic use for all ASP+ and ASP- hospitals from 2004 to 2012 before and after release of 2007 Infectious Diseases Society of America guidelines for developing ASPs. Antibiotic use was compared for both all antibacterials and for a select subset (vancomycin, carbapenems, linezolid). For each ASP+ hospital, we determined differences in the average monthly changes in antibiotic use before and after the program was started by using interrupted time series via dynamic regression.
  
  
  RESULTS
  In aggregate, as compared with those years preceding the guidelines, there was a larger decline in average antibiotic use in ASP+ hospitals than in ASP- hospitals from 2007 to 2012, the years after the release of Infectious Diseases Society of America guidelines (11% vs 8%, P = .04). When examined individually, relative to preimplementation trends, 8 of 9 ASP+ hospitals revealed declines in antibiotic use, with an average monthly decline in days of therapy/1000 patient-days of 5.7%. For the select subset of antibiotics, the average monthly decline was 8.2%.
  
  
  CONCLUSIONS
  Formalized ASPs in children's hospitals are effective in reducing antibiotic prescribing.
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah, Salt Lake City, Utah; adam.hersh@hsc.utah.edu.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.affiliation: Children's Mercy Hospitals and Clinics, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri;
authors.forename: Stephen A
authors.initials: SA
authors.lastname: De Lurgio
authors.affiliation: Children's Hospital Association, Overland Park, Kansas City, Kansas;
authors.forename: Cary
authors.initials: C
authors.lastname: Thurm
authors.affiliation: Children's Mercy Hospitals and Clinics, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri;
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington;
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Weissman
authors.affiliation: Division of Infectious Diseases and.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Courter
authors.affiliation: Division of Critical Care, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington; and.
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Brogan
authors.affiliation: Divisions of Hospital Medicine and Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio;
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington;
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Kronman
authors.affiliation: Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
authors.affiliation: Children's Mercy Hospitals and Clinics, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri;
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
mesh_terms: D000554:Ambulatory Care Facilities; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000890:Anti-Infective Agents
keywords: antibiotics; antimicrobial stewardship; pediatrics