Importance of Systems for Consultation about Infectious Diseases in Antimicrobial Stewardship Programs in Children's Hospitals

Abstract

The wide spread of drug resistant organisms due to inappropriate use of antibiotics is a global emergent problem, and appropriate antibiotic use is required. Although there have been many reports that the introduction of Antimicrobial Stewardship Program (ASP), a hospital based intervention designed to improve antibiotics prescription and minimize unnecessary costs, is effective against inappropriate use of antibiotics, the effect of ASP in Japanese childrens' hospitals remains unclear. In Nagano Children's Hospital, our infection control team (ICT) has challenged appropriate antibiotic use in our institute; however, we have failed to obtain expected results. Our ASP employed a prospective audit and feedback about the antibiotic prescription, but our strategy lacked a system allowing consultation on antibiotic prescription and infectious diseases. Therefore, we introduced the consultation system in 2012, although our hospital did not have a department for infectious diseases. Our consultants consisted of ICT staffs.

In this study, we retrospectively assessed the impact of our intervention. Our ASP was assessed between September 2010 and March 2016. This interval was divided into two phases: Phase 1, before intervention period and Phase 2, after intervention period. In our hospital, days of therapy (per 1000 patient-days) of meropenem significantly decreased from 13.6 to 6.5 (p=0.02). In addition, antimicrobial susceptibility of Pseudomonas aeruginosa against meropenem improved from the lowest level of 79% in 2013 to 88% in 2015. On the other hand, no change was observed in all-cause and infection-related mortalities between the phases. After the implementation of ASP in our hospital, we could safely decrease the prescription of antibiotics. In addition, the antibiotic resistance of Pseudomonas aeruginosa improved after our intervention.