Yuho Horikoshi1, Junichi Suwa2, Hiroshi Higuchi3, Tetsuji Kaneko4, Mihoko Furuichi5, Yuta Aizawa6, Kahoru Fukuoka6, Kaoru Okazaki7, Kenta Ito8, Takayo Shoji9. 1. Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu City, Tokyo, 183-8561, Japan. Electronic address: yuho_horikoshi@tmhp.jp. 2. Department of Pharmacy, Tokyo Metropolitan Children's Medical Center, Fuchu City, Tokyo, Japan. 3. Division of Microbiology, Department of Laboratory, Tokyo Metropolitan Children's Medical Center, Fuchu City, Tokyo, Japan. 4. Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Fuchu City, Tokyo, Japan. 5. Division of Infectious Diseases and Allergy, Saitama Children's Medical Center, Saitama City, Saitama, Japan. 6. Division of Infectious Diseases, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu City, Tokyo, 183-8561, Japan. 7. Division of Neonatology, Tokyo Metropolitan Children's Medical Center, Fuchu City, Tokyo, Japan. 8. Division of General Pediatrics, Aichi Children's Health and Medical Center, Ohfu City, Aichi, Japan. 9. Division of Pediatric Infectious Diseases, Shizuoka Children's Hospital, Shizuoka City, Shizuoka, Japan.
Abstract
OBJECTIVE: The impact of pediatric antimicrobial stewardship programs (ASP) on antimicrobial resistance (AMR) remains largely unknown. This study aimed to evaluate the AMR for carbapenem of Gram-negative bacilli (GNB) and carbapenem use with infectious diseases consultation after the implementation of an ASP. METHODS: This quasi-experimental study was conducted at Tokyo Metropolitan Children's Medical Center in Japan. The pre- and post-intervention periods were April 2010 to September 2011 and October 2011 to March 2017, respectively. The pre-intervention phase consisted of consultations with the infectious diseases service alone. The ASP was implemented during the post-intervention phase. The carbapenem resistance rates of GNB were calculated. The correlation between carbapenem resistance rates and carbapenem day of therapy (DOT) was examined. The outcome metrics were compared by average length of hospitalization, all-cause mortality, and infection-related mortality. RESULTS: A positive correlation was observed between the carbapenem resistance rate in Pseudomonas aeruginosa and DOT (0.76, p=0.04). The carbapenem resistance rate in P. aeruginosa (p<0.01) and DOT (p<0.01) decreased significantly in the post-intervention period. The length of hospitalization (p<0.01) and infection-related mortality (p=0.05) decreased in the post-intervention period. CONCLUSIONS: A sustained ASP with additional consultation with the infectious disease service reduced carbapenem use and resistance in P. aeruginosa, leading to favorable outcomes in terms of length of hospitalization and infection-related mortality.
OBJECTIVE: The impact of pediatric antimicrobial stewardship programs (ASP) on antimicrobial resistance (AMR) remains largely unknown. This study aimed to evaluate the AMR for carbapenem of Gram-negative bacilli (GNB) and carbapenem use with infectious diseases consultation after the implementation of an ASP. METHODS: This quasi-experimental study was conducted at Tokyo Metropolitan Children's Medical Center in Japan. The pre- and post-intervention periods were April 2010 to September 2011 and October 2011 to March 2017, respectively. The pre-intervention phase consisted of consultations with the infectious diseases service alone. The ASP was implemented during the post-intervention phase. The carbapenem resistance rates of GNB were calculated. The correlation between carbapenem resistance rates and carbapenem day of therapy (DOT) was examined. The outcome metrics were compared by average length of hospitalization, all-cause mortality, and infection-related mortality. RESULTS: A positive correlation was observed between the carbapenem resistance rate in Pseudomonas aeruginosa and DOT (0.76, p=0.04). The carbapenem resistance rate in P. aeruginosa (p<0.01) and DOT (p<0.01) decreased significantly in the post-intervention period. The length of hospitalization (p<0.01) and infection-related mortality (p=0.05) decreased in the post-intervention period. CONCLUSIONS: A sustained ASP with additional consultation with the infectious disease service reduced carbapenem use and resistance in P. aeruginosa, leading to favorable outcomes in terms of length of hospitalization and infection-related mortality.
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