Sophida Boonsathorn (Thailand)
Ramathibodi Hospital Mahidol University Department of PediatricsPresenter of 1 Presentation
IMPACT OF CENTER-SPECIFIC ANTIMICROBIAL STEWARDSHIP PROGRAM ON CARBAPENEM CONSUMPTION IN PEDIATRIC CRITICALLY ILL PATIENTS (ID 125)
Abstract
Background
Antimicrobial stewardship programs (ASPs) aim to improve antibiotic utilization. Intensive care unit (ICU) setting encountered a high volume of broad-spectrum antibiotic consumption, particularly carbapenems. The computer-assisted post-prescription authorization has been used to authorize carbapenem prescription in Ramathibodi Hospital, Thailand, since 2011, without systematic evaluation. Handshake stewardship is a distinctive approach, focusing on direct communication and a follow-up review of prescribed antibiotics without antibiotic restriction. We aimed to evaluate the impact and acceptability of center-specific ASP, which integrated handshake stewardship to the current computer-assisted post-prescription authorization, in pediatric critically ill patients.
Methods
We performed a pre-and post-implementation study of center-specific ASP, from July 2017 to December 2018, and April 2019 to September 2020, respectively. The primary outcome was the carbapenem consumption rate, measured by days of therapy (DOT) per 1000 patients-ICU days (DOT/1000-ICU days). Secondary outcomes included length of critical care stay (LOCS), 30-day infection-related mortality, carbapenem resistance rate, and acceptability of ASP recommendations.
Results
Two-hundreds and twelve events (163 patients) and 174 events (110 patients) of carbapenem prescription were enrolled in the pre-and post-implementation group, respectively. Carbapenem consumption rate significantly decreased by 45.4% (p < 0.005) (from 667 to 364 DOT/1000-ICU days) (-303 days, 95% Confidence Interval -201.9, -72.6). LOCS, 30-day infection-related mortality, and carbapenem-resistance rate were not significantly different after implementation of ASP. The acceptability of ASP recommendations was 95.4%. Scheduled duration (55.2%) and de-escalation (31.6%) were the two most common ASP recommendations.
Conclusions
Our center-specific ASP, which integrated handshake stewardship and the current computer-assisted post-prescription authorization, significantly reduced carbapenem consumption in pediatric critically ill patients with a high acceptability rate without a negative impact on patients’ clinical outcomes.