Use of Prospective Audit and Feedback to Reduce Antibiotic Exposure in a Pediatric Cardiac ICU.

Autor:	Schwenk HT; Lucile Packard Children's Hospital Stanford, Palo Alto, CA.; Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA., Kruger JF; Lucile Packard Children's Hospital Stanford, Palo Alto, CA., Sacks LD; Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA., Wood MS; Lucile Packard Children's Hospital Stanford, Palo Alto, CA., Qureshi L; Lucile Packard Children's Hospital Stanford, Palo Alto, CA., Bio LL; Lucile Packard Children's Hospital Stanford, Palo Alto, CA.
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2021 Mar 01; Vol. 22 (3), pp. e224-e232.
DOI:	10.1097/PCC.0000000000002608
Abstrakt:	Objectives: We sought to determine whether a prospective audit and feedback intervention decreased antibiotic utilization in a pediatric cardiac ICU and to describe the characteristics of prospective audit and feedback audits and recommendations. Design: Before-after study. Setting: Pediatric cardiac ICU of a freestanding children's hospital. Patients: All patients admitted to the cardiac ICU. Interventions: A prospective audit and feedback program was established in our hospital's pediatric cardiac ICU on December 7, 2015. The antimicrobial stewardship program audited IV antibiotics, communicated prospective audit and feedback recommendations to the cardiac ICU, and regularly reviewed recommendation adherence. Mean monthly antibiotic utilization 18 months before ("preprospective audit and feedback"; from June 1, 2014 to November 30, 2015) and 24 months after ("prospective audit and feedback"; from January 1, 2016 to December 31, 2017) prospective audit and feedback implementation was compared. Antibiotic audit data during the prospective audit and feedback period were reviewed to capture the characteristics of prospective audit and feedback audits, recommendations, and adherence. Measurements and Main Results: Mean cardiac ICU IV antibiotic use decreased 20% (701 vs 880 days of therapy per 1,000 patient days, p = 0.001) during the prospective audit and feedback period compared with the preprospective audit and feedback period. There was no difference in mean cardiac ICU length of stay (p = 0.573), mean hospital length of stay (p = 0.722), or the rate of discharge due to death (p = 0.541). There were 988 antibiotic audits and 370 prospective audit and feedback recommendations (37% recommendation rate) during the study period. The most commonly audited antibiotic category was broad-spectrum gram-negative agents and the most common indication for use was sepsis. Broad-spectrum gram-positive agents were more likely to be associated with a recommendation. Conclusions: There was a significant reduction in antibiotic use following implementation of a prospective audit and feedback program in our pediatric cardiac ICU. Over one-third of antibiotics audited in our cardiac ICU were associated with a prospective audit and feedback recommendation, revealing important targets for future antimicrobial stewardship efforts in this population. Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2020 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
Databáze:	MEDLINE
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