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Outpatient antimicrobial stewardship programs in pediatric institutions in 2020: Status, needs, barriers

Published online by Cambridge University Press:  22 October 2021

Rana E. El Feghaly Open the ORCID record for Rana E. El Feghaly [Opens in a new window] ,
Elizabeth A. Monsees ,
Alaina Burns ,
Ann Wirtz ,
Brian R. Lee ,
Adam L. Hersh  and
Jason G. Newland
Rana E. El Feghaly*
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri University of Missouri Kansas City School of Medicine, Kansas City, Missouri
Elizabeth A. Monsees
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri University of Missouri Kansas City School of Medicine, Kansas City, Missouri
Alaina Burns
Affiliation:
University of Missouri Kansas City School of Medicine, Kansas City, Missouri Department of Pharmacy, Children’s Mercy Kansas City, Kansas City, Missouri
Ann Wirtz
Affiliation:
University of Missouri Kansas City School of Medicine, Kansas City, Missouri Department of Pharmacy, Children’s Mercy Kansas City, Kansas City, Missouri
Brian R. Lee
Affiliation:
University of Missouri Kansas City School of Medicine, Kansas City, Missouri Division of Health Services and Outcomes Research, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
Adam L. Hersh
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, Utah
Jason G. Newland
Affiliation:
Division of Pediatric Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
*
Author for correspondence: Rana E. El Feghaly, E-mail: relfeghaly@cmh.edu
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Abstract

Objective:

To assess current resources, interventions, and obstacles of pediatric outpatient antimicrobial stewardship programs (ASP).

Design:

Cross-sectional study.

Setting:

Institutions from the Sharing Antimicrobial Reports for Pediatric Stewardship OutPatient collaborative (SHARPS-OP).

Participants:

Antimicrobial stewardship leaders from the above institutions.

Methods:

An investigator-developed survey was deployed online in September 2020 to antimicrobial stewardship leaders in SHARPS-OP institutions. The survey was divided into 4 sections: (1) basic information, (2) status of pediatric outpatient ASP in the institutions including financial support, (3) outpatient ASP interventions undertaken by the institutions, and (4) needs and SHARPS-OP collaborative goals.

Results:

Of 56 invited institutions, 45 participated, achieving an 80% response rate. Only 5 sites (11%) had allocated financial support for an outpatient ASP, compared to 42 (95.6%) for their inpatient ASP. The most widely used outpatient ASP interventions included antimicrobial guidance (57.8%), education (46.7%), and quality improvement projects (37.8%). Time was identified as the biggest barrier to expanding outpatient ASPs (91.1%), followed by financial support (53.3%), development of meaningful reports (51.1%), and administrative support (44.4%). Important goals of the collaborative included seeking learning opportunities and developing clear metrics for pediatric outpatient ASP benchmarking. Program needs included securing operational support (35.8%) and strengthening data analysis (31.6%).

Conclusions:

Very few pediatric institutions with robust inpatient ASPs have devoted time and financial support to advance outpatient efforts. To promote appropriate antibiotic prescribing in the outpatient arena, time and resource funding by administrative leaders are necessary to develop a robust, sustainable stewardship infrastructure.

Keywords

outpatient antimicrobial stewardshippediatricsurveycollaborativeantibiotic stewardship
Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 10 , October 2022 , pp. 1396 - 1402
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: This work was presented as a highlighted E-poster during IDWeek 2021, which was held virtually September 29, 2021, through Sunday, October 3, 2021.

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