The Impact of an Antimicrobial Stewardship Program on Days of Therapy in the Pediatric Center:An Interrupted Time-Series Analysis of a 19-Year Study
10.3346/jkms.2024.39.e172
- Author:
Kyung-Ran KIM
1
;
Hyo Jung PARK
;
Sun-Young BAEK
;
Soo-Han CHOI
;
Byung-Kee LEE
;
SooJin KIM
;
Jong Min KIM
;
Ji-Man KANG
;
Sun-Ja KIM
;
Sae Rom CHOI
;
Dongsub KIM
;
Joon-sik CHOI
;
Yoonsun YOON
;
Hwanhee PARK
;
Doo Ri KIM
;
Areum SHIN
;
Seonwoo KIM
;
Yae-Jean KIM
Author Information
1. Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Publication Type:Original Article
- From:Journal of Korean Medical Science
2024;39(21):e172-
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:We aimed to analyze the effects of an antimicrobial stewardship program (ASP) on the proportion of antimicrobial-resistant pathogens in bacteremia, antimicrobial use, and mortality in pediatric patients.
Methods:A retrospective single-center study was performed on pediatric inpatients under 19 years old who received systemic antimicrobial treatment from 2001 to 2019. A pediatric infectious disease attending physician started ASP in January 2008. The study period was divided into the pre-intervention (2001–2008) and the post-intervention (2009–2019) periods. The amount of antimicrobial use was defined as days of therapy per 1,000 patientdays, and the differences were compared using delta slope (= changes in slopes) between the two study periods by an interrupted time-series analysis. The proportion of resistant pathogens and the 30-day overall mortality rate were analyzed by the χ2 .
Results:The proportion of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia increased from 17% (39 of 235) in the pre-intervention period to 35% (189 of 533) in the post-intervention period (P < 0.001). The total amount of antimicrobial use significantly decreased after the introduction of ASP (delta slope value = −16.5; 95% confidence interval [CI], −30.6 to −2.3; P = 0.049). The 30-day overall mortality rate in patients with bacteremia did not increase, being 10% (55 of 564) in the pre-intervention and 10% (94 of 941) in the post-intervention period (P = 0.881).
Conclusion:The introduction of ASP for pediatric patients reduced the delta slope of the total antimicrobial use without increasing the mortality rate despite an increased incidence of ESBL-producing gram-negative bacteremia.
