title: Clinical diagnoses and antimicrobials predictive of pediatric antimicrobial stewardship recommendations: a program evaluation.
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.
  
  
  METHODS
  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.
authors.affiliation: 1Department of Pediatrics,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Goldman
authors.affiliation: 2Center for Clinical Effectiveness,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lee
authors.affiliation: 3Department of Pediatrics,University of Utah School of Medicine,Salt Lake City,Utah.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.affiliation: 4Department of Pharmacy,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri.
authors.forename: Diana
authors.initials: D
authors.lastname: Yu
authors.affiliation: 5Department of Pharmacy,Ann & Robert H. Lurie Children's Hospital of Chicago,Chicago,Illinois.
authors.forename: Leslie M
authors.initials: LM
authors.lastname: Stach
authors.affiliation: 1Department of Pediatrics,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Myers
authors.affiliation: 1Department of Pediatrics,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Jackson
authors.affiliation: 1Department of Pediatrics,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri.
authors.forename: James C
authors.initials: JC
authors.lastname: Day
authors.affiliation: 1Department of Pediatrics,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri.
authors.forename: Russell J
authors.initials: RJ
authors.lastname: McCulloh
authors.affiliation: 1Department of Pediatrics,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
mesh_terms: D000890:Anti-Infective Agents / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control; D019983:Guideline Adherence; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D054539:Medication Therapy Management / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D010372:Pediatrics / Q000379:methods*; D015397:Program Evaluation; D012189:Retrospective Studies; D017751:Safety Management
chemical_list: D000890:Anti-Infective Agents