Clinical diagnoses and antimicrobials predictive of pediatric antimicrobial stewardship recommendations: a program evaluation.

Autor:	Goldman JL; 1Department of Pediatrics,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri., Lee BR; 2Center for Clinical Effectiveness,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri., Hersh AL; 3Department of Pediatrics,University of Utah School of Medicine,Salt Lake City,Utah., Yu D; 4Department of Pharmacy,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri., Stach LM; 5Department of Pharmacy,Ann & Robert H. Lurie Children's Hospital of Chicago,Chicago,Illinois., Myers AL; 1Department of Pediatrics,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri., Jackson MA; 1Department of Pediatrics,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri., Day JC; 1Department of Pediatrics,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri., McCulloh RJ; 1Department of Pediatrics,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri., Newland JG; 1Department of Pediatrics,Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City,Kansas City,Missouri.
Jazyk:	angličtina
Zdroj:	Infection control and hospital epidemiology [Infect Control Hosp Epidemiol] 2015 Jun; Vol. 36 (6), pp. 673-80. Date of Electronic Publication: 2015 Mar 16.
DOI:	10.1017/ice.2015.45
Abstrakt:	Background: The number of pediatric antimicrobial stewardship programs (ASPs) is increasing and program evaluation is a key component to improve efficiency and enhance stewardship strategies. Objective: To determine the antimicrobials and diagnoses most strongly associated with a recommendation provided by a well-established pediatric ASP. Design and Setting: Retrospective cohort study from March 3, 2008, to March 2, 2013, of all ASP reviews performed at a free-standing pediatric hospital. Methods: ASP recommendations were classified as follows: stop therapy, modify therapy, optimize therapy, or consult infectious diseases. A multinomial distribution model to determine the probability of each ASP recommendation category was performed on the basis of the specific antimicrobial agent or disease category. A logistic model was used to determine the odds of recommendation disagreement by the prescribing clinician. Results: The ASP made 2,317 recommendations: stop therapy (45%), modify therapy (26%), optimize therapy (19%), or consult infectious diseases (10%). Third-generation cephalosporins (0.20) were the antimicrobials with the highest predictive probability of an ASP recommendation whereas linezolid (0.05) had the lowest probability. Community-acquired pneumonia (0.26) was the diagnosis with the highest predictive probability of an ASP recommendation whereas fever/neutropenia (0.04) had the lowest probability. Disagreement with ASP recommendations by the prescribing clinician occurred 22% of the time, most commonly involving community-acquired pneumonia and ear/nose/throat infections. Conclusions: Evaluation of our pediatric ASP identified specific clinical diagnoses and antimicrobials associated with an increased likelihood of an ASP recommendation. Focused interventions targeting these high-yield areas may result in increased program efficiency and efficacy.
Databáze:	MEDLINE
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