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

Creator(s)

Jennifer L. Goldman, Children's Mercy Hospitals and Clinics
Brian R. Lee, Children's Mercy Hospitals and Clinics
Adam L. Hersh, University of Utah School of Medicine
Diana Yu, Children's Mercy Hospitals and Clinics
Leslie M. Stach, Ann & Robert H. Lurie Children's Hospital of Chicago
Angela L. Myers, Children's Mercy Hospitals and Clinics
Mary Anne Jackson, Children's Mercy Hospitals and Clinics
James C. Day, Children's Mercy Hospitals and Clinics
Russell J. McCulloh, Children's Mercy Hospitals and Clinics
Jason G. Newland, Children's Mercy Hospitals and Clinics

Document Type

Article

Publication Date

6-2015

Identifier

DOI: 10.1017/ice.2015.45; PMCID: PMC4583769

Abstract

© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved.

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.

Journal Title

Infection Control and Hospital Epidemiology

Volume

36

Issue

6

First Page

673

Last Page

680

Comments

Grant support

• KL2 TR000119/TR/NCATS NIH HHS/United States
• TL1 TR000120/TR/NCATS NIH HHS/United States
• KL2TR000119/TR/NCATS NIH HHS/United States

Recommended Citation

Goldman, J. L., Lee, B. R., Hersh, A. L., Yu, D., Stach, L. M., Myers, A. L., Jackson, M., Day, J. C., McCulloh, R. J., Newland, J. G. Clinical Diagnoses and Antimicrobials Predictive of Pediatric Antimicrobial Stewardship Recommendations: A Program Evaluation Infection Control and Hospital Epidemiology 36, 673-680 (2015).