Implementation and Evaluation of Antimicrobial Stewardship Program in Medical ICU in Cairo University Specialized Pediatric Hospital

Mona Abdel Aziz Wassef; Amal Mohamed Sayed; Heba Sherif Abdel Aziz; Bassant Meligy; Mona Mohiedden Abdel Halim

doi:10.3889/oamjms.2020.4553

Authors

Mona Abdel Aziz Wassef Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
Amal Mohamed Sayed Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
Heba Sherif Abdel Aziz Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
Bassant Meligy Department of Pediatric, Faculty of Medicine, Cairo University, Cairo, Egypt
Mona Mohiedden Abdel Halim Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt

DOI:

https://doi.org/10.3889/oamjms.2020.4553

Keywords:

Antimicrobial stewardship program, Antibiotic use, Pediatric antimicrobial stewardship, Antibiotic policy, Antimicrobial resistance

Abstract

BACKGROUND: High antibiotics use in pediatric intensive care units (PICUs) results in antibiotic resistance, the unfavorable clinical outcome of patients, increase the length of hospital stay, and drug expenditure.

AIM: This study aimed at setting clinical guidelines customized according to local diseases epidemiology and local cumulative antimicrobial susceptibility, implementing, and evaluating the Antimicrobial Stewardship Program (ASP) effect in; optimizing antibiotics use, decreasing antibiotics expenditure, decreasing the length of therapy and stay in hospitals, and improving patients’ clinical outcomes.

METHODS: A prospective study was conducted at a PICU of the Specialized Pediatric Hospital, Cairo University. Facility-specific guidelines were set, and the ASP was implemented and evaluated through the following indicators; adherence of physicians to the guidelines, ASP recommendations and acceptance of them, the rate of mortality, length of stay, drug costs, antibiotics days of therapy, and length of therapy.

RESULTS: The adherence to the ASP guidelines was positively correlated to the patient’s clinical outcome (p = 0.018). In post ASP period, the average length of stay and the length of therapy significantly decreased (p = 0.047, p = 0.001, respectively), the rate of adherence to the ASP guidelines was (91.9%), the days of therapy of ceftazidime, ceftriaxone, and amikacin decreased significantly (p = 0.041, p = 0.026, p = 0.004, respectively). The most common ASP recommendation was drug schedule/frequency change (26.1%) followed by drug discontinuation (17.8%) and the most common antibiotic required intervention was ampicillin-sulbactam (21.6%).

CONCLUSION: The antimicrobial stewardship is very effective in optimizing antibiotics use and leads to favorable outcomes in terms of decreased length of therapy, hospital stay, and mortality rate of the patients.

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References

Haque A, Hussain K, Ibrahim R, Abbas Q, Ahmed SA, Jurair H, et al. Impact of a pharmacist-led antibiotic stewardship program in a PICU of low/middle-income country. BMJ Open Qual. 2018;7(1):e000180. https://doi.org/10.1136/bmjoq-2017-000180 PMid:29333498

Kreitmeyr K, von Both U, Pecar A, Borde JP, Mikolajczyk R, Huebner J. Pediatric antibiotic stewardship: Successful interventions to reduce broad-spectrum antibiotic use on general pediatric wards. Infection. 2017;45(4):493-504. https:// doi.org/10.1007/s15010-017-1009-0 PMid:28397171

Llor C, Bjerrum L. Antimicrobial resistance: Risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014;5(6):229-41. https://doi. org/10.1177/2042098614554919 PMid:25436105

Meek RW, Vyas H, Piddock LJ. Nonmedical uses of antibiotics: Time to restrict their use? PLoS Biol. 2015;13(10):e1002266. https://doi.org/10.1371/journal.pbio.1002266 PMid:26444324

Centers for Disease Control and Prevention. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta: Centers for Disease Control and Prevention; 2014. https://doi.org/10.1093/ cid/ciu542

Exner M, Bhattacharya S, Christiansen B, Gebel J, Goroncy- Bermes P, Hartemann P, et al. Antibiotic resistance: What is so special about multidrug-resistant Gram-negative bacteria? GMS Hyg Infect Control. 2017;12:Doc05. PMid:28451516

Centers for Disease Control and Prevention. Antimicrobial Use and Resistance (AUR) Module. Atlanta: Centers for Disease Control and Prevention; 2017.

Morris AM, Brener S, Dresser L, Daneman N, Dellit TH, Avdic E, et al. Use of a structured panel process to define quality metrics for antimicrobial stewardship programs. Infect Control Hosp Epidemiol. 2012;33(5):500-6. https://doi.org/10.1086/665324 PMid:22476277

van Mil JW, Horvat N, Westerlund T. Classification for Drug- Related Problems V7.0 the PCNE Classification V7.0, 2003- 2016 Pharmaceutical Care Network Europe Foundation; 2016.

World Health Organization. Average Length of Stay. Geneva: World Health Organization; 2018. Available from: https://www. gateway.euro.who.int/en/indicators/hfa_540-6100-average-length-of-stay-all-hospitals. [Last accessed on 2019 Jan 05]. https://doi.org/10.1787/888933155611

Newland JG, Stach LM, De Lurgio SA, Hedican E, Yu D, Herigon JC, et al. Impact of a prospective-audit-with-feedback antimicrobial stewardship program at a children’s hospital. J Pediatric Infect Dis Soc. 2012;1(3):179-86. https://doi. org/10.1093/jpids/pis054 PMid:26619405

Stocker M, Ferrao E, Banya W, Cheong J, Macrae D, Furck A. Antibiotic surveillance on a paediatric intensive care unit: Easy attainable strategy at low costs and resources. BMC Pediatr. 2012;12:196. https://doi.org/10.1186/1471-2431-12-196 PMid:23259701

Di Pentima MC, Chan S, Hossain J. Benefits of a pediatric antimicrobial stewardship program at a children’s hospital. Pediatrics. 2011;128(6):1062-70. https://doi.org/10.1542/ peds.2010-3589 PMid:22106075

McCulloh RJ, Queen MA, Lee B, Yu D, Stach L, Goldman J, et al. Clinical impact of an antimicrobial stewardship program on pediatric hospitalist practice, a 5-year retrospective analysis. Hosp Pediatr. 2015;5(10):520-7. https://doi.org/10.1542/ hpeds.2014-0250 PMid:26427920

Horikoshi Y, Suwa J, Higuchi H, Kaneko T, Furuichi M, Aizawa Y, et al. Sustained pediatric antimicrobial stewardship program with consultation to infectious diseases reduced carbapenem resistance and infection-related mortality. Int J Infect Dis. 2017;64:69-73. https://doi.org/10.1016/j.ijid.2017.09.012 PMid:28941633

Hersh AL, De Lurgio SA, Thurm C, Lee BR, Weissman SJ, Courter JD, et al. Antimicrobial stewardship programs in freestanding children’s hospitals. Pediatrics. 2015;135(1):33-9. https://doi.org/10.1542/peds.2014-2579 PMid:25489018