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Background: Antimicrobial stewardship programs (ASPs) are an essential tool to combat the increasing threat of antibiotic resistance. ASPs traditionally reside in acute care settings with a focus on inpatient prescribing. However, in 2016, the Centers for Disease Control and Prevention affirmed the importance of outpatient ASP through its 4 core elements. Incorporation of these elements requires time, personnel, and funding, which may not be available in many institutions.

Objective: This study aimed to evaluate the current state of outpatient ASP in a large network of children’s hospitals and inform a programming agenda.

Design/Methods: This cross-sectional study used an investigator-developed survey to assess current resources, interventions, and obstacles of outpatient ASP. We invited institutions from the Sharing Antimicrobial Reports for Pediatric Stewardship OutPatient collaborative (SHARPS-OP), which includes 54 sites from the United States and 2 from the United Kingdom. We used descriptive statistics to examine institution characteristics, current outpatient ASP work, and elucidate collaborative goals.

Results: Forty-five sites participated achieving an 80% (45/56) response rate. Only 5 sites (11%) had allocated support for outpatient ASP, although 42 (95.6%) had allocated support for inpatient ASP (Table 1). The most widely used ASP interventions included toolkits (57.8%), education (46.7%), quality improvement projects (37.8%), research (27.8%), and electronic medical record features (27.8%) (Table 2). Time was identified as the biggest barrier to outpatient ASP (91%) followed by financial support (53%), development of meaningful reports (51.1%), and administrative support (44.4%). The most important goals of the collaborative included benchmarking and developing clear metrics for pediatric outpatient ASP (Table 3). Optional comments were provided by 93% of respondents indicating multiple areas of program needs which were condensed into 6 themes (Table 4) primarily focused on securing operational support (36%) and strengthening data analysis (31%). Likewise, data analysis was the most frequently cited request for collaborative discussion.

Conclusion(s): Most institutions had robust acute care support and appreciated the urgent need to address outpatient antibiotic use. Only a small number of participants had allocated support to secure the progression of outpatient ASP with data analysis being a universal program need.

Presented at the 2021 PAS Virtual Conference


Infectious Disease | Pediatrics

Outpatient Antimicrobial Stewardship Programs in Children’s Hospitals: Status, Needs, Barriers