Reducing Antimicrobial Use in an Academic Pediatric Institution: Evaluation of the Effectiveness of a Prospective Audit With Real-Time Feedback.
BACKGROUND
Antimicrobial use is decreasing across freestanding children's hospitals, predominantly in institutions with antimicrobial stewardship programs (ASPs) in place. A highly effective ASP should effect a greater decrease in use than predicted by existing trends. Antimicrobial stewardship programs depend on clinician adherence to program recommendations, but little is known about factors associated with adherence.


METHODS
Parenteral antimicrobial-use data for our institution and 43 additional freestanding children's hospitals were obtained and normalized for patient census. Segmental linear regression was used to compare rates of change of parenteral antimicrobial use before and after ASP implementation. Time-series models were developed to predict use in the absence of intervention. The odds of adherence to ASP recommendations were determined based on provider characteristics and recommendation type.


RESULTS
In the 38 months before ASP implementation, parenteral antimicrobial use was decreasing at our hospital by 3.7%/year, similar to the 3.4%/year found across children's hospitals. The rate of change after implementation of the ASP at our hospital was 11.1%/year, compared to 5.6%/year for other hospitals over the same period. Of 643 interventions, teams adhered with recommendations in 495 cases (77.0%). According to adjusted analysis, primary service was not associated with adherence (P = .356). There was an association between adherence and the role of the clinician receiving a recommendation (P = .009) and the recommendation type (P = .009).


CONCLUSIONS
Understanding factors associated with adherence to ASP recommendations can help those who administer such programs to strategize interventions for maximizing efficacy. Our findings reveal the value of a formal ASP in reducing use when controlling for secular trends.
Departments of Pediatrics.
Zachary I
ZI
Willis
Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
Jessica
J
Gillon
Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
Meng
M
Xu
Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
James C
JC
Slaughter
Department of Pediatrics, Goryeb Children's Hospital, Morristown, New Jersey.
M Cecilia
MC
Di Pentima
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000073602:Antimicrobial Stewardship / Q000379:methods; D002648:Child; D005246:Feedback; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control; D008485:Medical Audit; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies
D000890:Anti-Infective Agents
antimicrobial stewardship; antimicrobial utilization; cost-effectiveness