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Clinical Diagnoses and Antimicrobials Predictive of Pediatric Antimicrobial Stewardship Recommendations: A Program Evaluation

Published online by Cambridge University Press:  16 March 2015

Jennifer L. Goldman ,
Brian R. Lee ,
Adam L. Hersh ,
Diana Yu ,
Leslie M. Stach ,
Angela L. Myers ,
Mary Anne Jackson ,
James C. Day ,
Russell J. McCulloh  and
Jason G. Newland
Jennifer L. Goldman*
Affiliation:
Department of Pediatrics, Children’s Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, Missouri
Brian R. Lee
Affiliation:
Center for Clinical Effectiveness, Children’s Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, Missouri
Adam L. Hersh
Affiliation:
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
Diana Yu
Affiliation:
Department of Pharmacy, Children’s Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, Missouri
Leslie M. Stach
Affiliation:
Department of Pharmacy, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
Angela L. Myers
Affiliation:
Department of Pediatrics, Children’s Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, Missouri
Mary Anne Jackson
Affiliation:
Department of Pediatrics, Children’s Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, Missouri
James C. Day
Affiliation:
Department of Pediatrics, Children’s Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, Missouri
Russell J. McCulloh
Affiliation:
Department of Pediatrics, Children’s Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, Missouri
Jason G. Newland
Affiliation:
Department of Pediatrics, Children’s Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, Missouri
*
Address correspondence to Jennifer Goldman, MD, Department of Pediatrics, Divisions of Pediatric Infectious Diseases & Clinical Pharmacology, Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108 (jlgoldman@cmh.edu).
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Abstract

BACKGROUND

The number of pediatric antimicrobial stewardship programs (ASPs) is increasing and program evaluation is a key component to improve efficiency and enhance stewardship strategies.

OBJECTIVE

To determine the antimicrobials and diagnoses most strongly associated with a recommendation provided by a well-established pediatric ASP.

DESIGN AND SETTING

Retrospective cohort study from March 3, 2008, to March 2, 2013, of all ASP reviews performed at a free-standing pediatric hospital.

METHODS

ASP recommendations were classified as follows: stop therapy, modify therapy, optimize therapy, or consult infectious diseases. A multinomial distribution model to determine the probability of each ASP recommendation category was performed on the basis of the specific antimicrobial agent or disease category. A logistic model was used to determine the odds of recommendation disagreement by the prescribing clinician.

RESULTS

The ASP made 2,317 recommendations: stop therapy (45%), modify therapy (26%), optimize therapy (19%), or consult infectious diseases (10%). Third-generation cephalosporins (0.20) were the antimicrobials with the highest predictive probability of an ASP recommendation whereas linezolid (0.05) had the lowest probability. Community-acquired pneumonia (0.26) was the diagnosis with the highest predictive probability of an ASP recommendation whereas fever/neutropenia (0.04) had the lowest probability. Disagreement with ASP recommendations by the prescribing clinician occurred 22% of the time, most commonly involving community-acquired pneumonia and ear/nose/throat infections.

CONCLUSIONS

Evaluation of our pediatric ASP identified specific clinical diagnoses and antimicrobials associated with an increased likelihood of an ASP recommendation. Focused interventions targeting these high-yield areas may result in increased program efficiency and efficacy.

Infect Control Hosp Epidemiol 2015;00(0): 1–8

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 6 , June 2015 , pp. 673 - 680
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presented in part: IDWeek; Philadelphia, Pennsylvania; October 9, 2014; abstract 46704.

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