title: Pediatric antibiotic stewardship: successful interventions to reduce broad-spectrum antibiotic use on general pediatric wards.
abstract: OBJECTIVE
  Antibiotic stewardship programs (ASP) optimize antibiotic usage and combat antibiotic resistance of bacteria. The objective of this study was to assess the impact of specific ASP interventions on antibiotic consumption in general pediatric wards.
  
  
  METHODS
  We conducted a prospective study to compare a pre-intervention (Sept.-Dec. 2014) and post-intervention (Sept.-Dec. 2015) period. An ASP bundle was established including (1) infectious diseases (ID) ward rounds (prospective-audit-with-feedback), (2) ID consultation service, (3) internal guidelines on empiric antibiotic therapy. Medical records on four general pediatric wards were reviewed daily to analyze: (1) antibiotic consumption, (2) antibiotic dosage ranges according to local guidelines, and (3) guideline adherence for community-acquired pneumonia (CAP).
  
  
  RESULTS
  Antibiotic prescribing for 273 patients (pre-intervention) was compared to 263 patients (post-intervention). Antibiotic prescription rate did not change (30.6 vs. 30.5%). However, overall days-of-therapy and length-of-therapy decreased by 10.5 and 7.7%, respectively. Use of cephalosporins and fluoroquinolones decreased by 35.5 and 59.9%, whereas the use of penicillins increased by 15.0%. An increase in dosage accuracy was noted (78.8 vs. 97.6%) and guideline adherence for CAP improved from 39.5 to 93.5%. Between the two study periods, no adverse effects regarding length of hospital stay and in-hospital mortality were observed.
  
  
  CONCLUSIONS
  Our data demonstrate that implementation of an ASP was associated with a profound improvement of rational antibiotic use and, therefore, patient safety. Considering the relatively short observation period, the long-term effects of our ASP bundle need to be further investigated.
authors.affiliation: Division of Pediatric Infectious Diseases, Dr. von Hauner Children's Hospital, LMU Munich, Munich, Germany.|Department of Pharmacy, University Hospital, LMU Munich, Munich, Germany.|German Center for Infection Research (DZIF), Munich, Germany.
authors.forename: Katharina
authors.identifier: http://orcid.org/0000-0002-5118-401X
authors.initials: K
authors.lastname: Kreitmeyr
authors.affiliation: Division of Pediatric Infectious Diseases, Dr. von Hauner Children's Hospital, LMU Munich, Munich, Germany.|German Center for Infection Research (DZIF), Munich, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: von Both
authors.affiliation: Department of Pharmacy, University Hospital, LMU Munich, Munich, Germany.
authors.forename: Alenka
authors.initials: A
authors.lastname: Pecar
authors.affiliation: Division of Infectious Diseases, University Medical Center, Freiburg i. Br, Germany.
authors.forename: Johannes P
authors.initials: JP
authors.lastname: Borde
authors.affiliation: Epidemiological and Statistical Methods Research Group, Helmholtz-Center for Infection Research, Braunschweig, Germany.|Institute for Medical Epidemiology, Biostatistics and Informatics (IMEBI), Medical School of the Martin-Luther-University, Halle, Germany.|German Center for Infection Research (DZIF), Braunschweig, Germany.
authors.forename: Rafael
authors.initials: R
authors.lastname: Mikolajczyk
authors.affiliation: Division of Pediatric Infectious Diseases, Dr. von Hauner Children's Hospital, LMU Munich, Munich, Germany. Johannes.Huebner@med.uni-muenchen.de.|Division of Infectious Diseases, University Medical Center, Freiburg i. Br, Germany. Johannes.Huebner@med.uni-muenchen.de.|German Center for Infection Research (DZIF), Munich, Germany. Johannes.Huebner@med.uni-muenchen.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Huebner
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000073602:Antimicrobial Stewardship / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy*; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D054539:Medication Therapy Management; D010372:Pediatrics / Q000379:methods*; D011014:Pneumonia / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial stewardship program (ASP); Dosing accuracy; Patient safety; Pediatric antibiotic stewardship; Quality of care, days of therapy (DoT)