title: Impact of a Prospective-Audit-With-Feedback Antimicrobial Stewardship Program at a Children's Hospital.
abstract: BACKGROUND
  The emergence of antibiotic-resistant organisms and the lack of development of new antimicrobials have made it imperative that additional strategies be developed to maintain the effectiveness of these existing antibiotics. The objective of this study was to describe the impact of a prospective-audit-with-feedback antimicrobial stewardship program (ASP) on antibiotic use in a children's hospital.
  
  
  METHODS
  A quasi-experimental study design with a control group was performed to assess the impact of a prospective-audit-with-feedback ASP. The control group was the combined antibiotic use at 25 similar children's hospitals that are members of the Child Health Corporation of America.
  
  
  RESULTS
  The ASP reviewed 10 460 broad-spectrum or select antibiotics in 8765 patients in the 30 months following the intervention. The most common select antibiotics reviewed were ceftriaxone/cefotaxime (43%), vancomycin (18%), ceftazidime (12%), and meropenem (7%). A total of 2378 recommendations were made in 1703 (19%) patients; the most common recommendation was to stop antibiotics (41%). Clinicians were compliant with agreed-upon ASP recommendations in 92% of patients. When comparing our antibiotic use with that of the control group, a monthly decline in all antibiotics of 7% (P = .045) and 8% (P = .045) was observed for days of therapy (DoT) and length of therapy (LoT) per 1000 patient-days, respectively. An even greater effect was observed in the select antibiotics as the monthly DoT per 1000 patient-days declined 17% (P < .001) and the monthly LoT per 1000 patient-days declined 18% (P < .001).
  
  
  CONCLUSIONS
  A prospective-audit-with-feedback ASP can have a significant impact on decreasing antibiotic use at a children's hospital.
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases, University of Missouri-Kansas City School of Medicine, and Center for Clinical Effectiveness, Quality Improvement, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases, University of Missouri-Kansas City School of Medicine, and.
authors.forename: Leslie M
authors.initials: LM
authors.lastname: Stach
authors.affiliation: Center for Clinical Effectiveness, Quality Improvement, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: De Lurgio
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases, University of Missouri-Kansas City School of Medicine, and Center for Clinical Effectiveness, Quality Improvement, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
authors.forename: Erin
authors.initials: E
authors.lastname: Hedican
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases, University of Missouri-Kansas City School of Medicine, and.
authors.forename: Diana
authors.initials: D
authors.lastname: Yu
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases, University of Missouri-Kansas City School of Medicine, and Center for Clinical Effectiveness, Quality Improvement, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Herigon
authors.affiliation: Division of Infectious Diseases, Children's Hospital of Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia.
authors.forename: Priya A
authors.initials: PA
authors.lastname: Prasad
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases, University of Missouri-Kansas City School of Medicine, and.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Jackson
authors.affiliation: Department of Pediatrics, Section of Infectious Diseases, University of Missouri-Kansas City School of Medicine, and.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Myers
authors.affiliation: Division of Infectious Diseases, Children's Hospital of Philadelphia Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Pennsylvania.
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
keywords: Antimicrobial Stewardship; Children's Hospitals; Prospective Audit; Time Series