Antimicrobial Stewardship in Pediatric Intensive Care Unit

Vasiliki Komatsiouli, Elisavet Chorafa, Elias Iosifidis, Maria Sdougka, Emmanuel Roilides

Background In hospitalized critically ill children both antimicrobial consumption and prevalence of multidrug resistant bacteria is higher than other pediatric inpatients, increasing the need for development and implementation of Antibiotic Stewardship Programs (ASPs). In this study, we aimed to identify studies implementing ASPs in Pediatric Intensive Care Units (PICUs) and analyze their strategy, structure, implementation and outcome metrics. Methods PUBMED was searched for studies reporting interventions for judicious use of antimicrobials in a PICU setting and published after 2006. Only studies that reported at least one outcome on antimicrobial use were included. Studies that applied ASPs throughout the hospital were included only if they reported separate results for PICUs. A checklist tool was created to assess the strategy of intervention, the structure of ASP team, the implementation and outcomes in all eligible studies. Results From 854 records found, 21 full text articles were reviewed and 11 of them were finally included in the analysis: 9 that applied ASP in PICUs and 2 that applied ASP at the hospital level, but with separate results for PICU. All PICU-dedicated ASPs applied a multimodal intervention combining two or more strategies simultaneously; audit with feedback (6/9 studies) and facility-specific clinical practice guidelines (6/9 studies) were the most common strategies. A multidisciplinary team was formulated in all ASPs except for two that implemented biomarker-based interventions. Six out of 9 studies included techniques to enhance behavior change and 1 ASP implemented a behavior-based intervention. Antibiotic consumption was evaluated in all ASPs, cost in 3/9, antibiotic resistance in 1/9, length of hospitalization in 6/9 and mortality in 7/9. All hospital-wide ASPs used audit with feedback from a multidisciplinary team as a core strategy in addition to the implementation of facility-specific clinical practice guidelines and assessed antimicrobial consumption, expenditures, length of stay and mortality. Conclusion The prevalence of ASPs in pediatric settings is limited and few of the existing programs follow all Infectious Diseases Society of America recommendations. This overview of pediatric ASPs provides a benchmark to measure the implementation of new programs in the future