Hospitalized children receiving antibiotics had a shorter length of stay and no readmissions within 30 days when their physicians adhered to an antibiotic stewardship program to stop inappropriate antibiotic prescribing.
The findings are from a 5-year study of the antibiotic stewardship program at Children’s Mercy Hospital in Kansas City, Missouri, presented this week in Philadelphia at IDWeek, a conference for infectious diseases specialists. Results showed that patients whose physicians disregarded advice to stop or change a prescribed antibiotic had a 3.5% readmission rate and an 82-hour average length of stay compared with no readmissions and a 68-hour length of stay for patients who stopped taking the antibiotic.
Of the 7051 hospitalized children whose antibiotic use was reviewed by a physician and pharmacist at Children’s Mercy Hospital, 17% of their physicians received a recommendation to change the order. “The most common recommendation by far was to stop the antimicrobial,” lead author Jason Newland, MD, said during a news conference.
Inappropriate antibiotic use most likely occurred in patients receiving ceftriaxone/cefotaxime (62%), vancomycin (11%), and meropenem (5%). The most common diagnoses that triggered a recommendation to alter antibiotic use were pneumonia (22%), urinary tract infections (19%), and rule-out sepsis (9%).
Patients in the pediatric intensive care unit, neonatal intensive care unit, and on the hematology/oncology unit were excluded from the study. Twice as many physicians agreed with advice to change the antibiotic than those who refused. “About 18% of providers will typically reject our recommendations,” said Newland, medical director of patient safety and systems reliability at Children’s Mercy Hospital.
Antibiotic stewardship programs provide substantial cost and clinical benefits, said Pranita Tamma, MD, MHS, director of the pediatric antimicrobial stewardship program at Johns Hopkins Children’s Center, who moderated the press conference. “Stewardship programs should be viewed as an extension of patient safety initiatives,” she said.
“By decreasing hospital readmissions through an antimicrobial stewardship program, Dr. Newland and colleagues are potentially also decreasing further negative sequelae for a child—healthcare-associated infections, further use of medications and other interventions, stress for the child and family, and the cost of this burden to families and our healthcare system as a whole,” Tamma added. “The dollars saved by avoiding readmissions alone is reason enough to justify a stewardship program.”