Quality Analysis of Antimicrobial Restriction Policy in Pediatrics

Abstract

Background: Antimicrobial stewardship programs (ASPs) are coordinated programs developed in recent years to promote the appropriate use of antimicrobials and reduce microbial resistance. One important action for a successful ASP is the implementation of an antimicrobial policy restriction. Objective: The study analyzed the quality of target-antimicrobial requisitions after the introduction of an antimicrobial policy restriction for children. Methods: We conducted a retrospective study in a neonatal intensive care unit (NICU) and three pediatric intensive care units (PICUs). An ASP was implemented in October 2016, and 14 target antimicrobials were selected to be prescribed after pre-approval by a pediatric infectious disease specialist. All requisitions were analyzed according to indication, antimicrobial type, dose, duration, and collection of cultures before administration. There were no exclusion criteria for requisition analysis. Results: Between October 2016 and December 2017, 1,173 patients were admitted to the units with 120 requisitions of target antimicrobials. Sepsis (43/120; 35.8%) was the most common indication, followed by respiratory infections (23/120; 19.2%) and infections in two or more sites (11/120; 9.2%). The most common target antimicrobials requested were meropenem (68/120; 56.7%), amphotericin B lipid formulations (12/120; 10%), teicoplanin (11/120; 9.2%), and linezolid (11/120; 9.2%). In 98 (81.7%) cases, previous cultures before antimicrobial administration were collected. An infectious agent was detected in 52 of the 98 cultures (53.1%), and Gram-negative and Gram-positive bacteria represented 50% and 26.9% of all positive samples, respectively. Besides, 111 (92.5%) requisitions were approved. In five refused requisitions, a narrow-spectrum antimicrobial was prescribed after further discussion; four were refused due to lack of information, and in one case, the de-escalation of the antimicrobial was possible. No mistake regarding dosage and duration was detected. Conclusions: We found a high-quality rate of target antimicrobial requisition. Antimicrobial policy restriction could contribute to improving the quality of antimicrobial prescription, even in NICUs and PICUs.