The North Wind and the Sun: Pediatric Antimicrobial Stewardship Program Combining Restrictive and Persuasive Approaches in Hematology-Oncology Ward and Hematopoietic Stem Cell Transplant Unit. Issue 2 (February 2018)

• Record Type: Journal Article
• Authors: Horikoshi, Yuho; Kaneko, Tetsuji; Morikawa, Yoshihiko; Isogai, Mihoko; Suwa, Junichi; Higuchi, Hiroshi; Yuza, Yuki; Shoji, Takayo; Ito, Kenta
• Is Part Of: Pediatric infectious disease journal. Volume 37:Issue 2(2018)
• Publication Date: 2018-02
• Subjects: antimicrobial stewardship program -- immunocompromised children -- interrupted time series analysis -- hematopoietic stem cell transplant -- persuasive approach; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000001746
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: The Japanese government's goal for the reduction of antimicrobial consumption is two-thirds of the 2013 rate by 2020. While the antimicrobial stewardship programs (ASPs) are essential in health care facilities, ASP data on pediatric hematology-oncology and hematopoietic stem cell transplant (HSCT) patients are limited. Our aim was to evaluate the impact of restrictive and persuasive ASP on immunocompromised children. Methods: The ASP for hematology-oncology and HSCT patients at Tokyo Metropolitan Children's Medical Center was assessed. Phase 1 was a postprescriptive review of carbapenem conducted between April 2010 and September 2011. Phase 2 consisted of the preauthorization of carbapenem, prospective audit with feedback, a weekly luncheon meeting among physicians, consensus on febrile neutropenia management, and implementation of viral molecular diagnostics between October 2011 and September 2015. Both phases were compared for day-of-therapy per 1, 000 patient-days, cost of intravenous antimicrobial agents, average hospitalization duration, all-cause mortality, infection-related mortality at 30 days, and appropriateness of empirical treatment of bacteremia. Results: The ASP did not differ from phase 1 to phase 2 in terms of average hospitalization length, mortality rate, or appropriateness of empirical treatment for bacteremia. Day-of-therapies of cefepime, piperacillin/tazobactam, meropenem, vancomycin, liposomal amphotericin B, and fosfluconazole decreased by 20%, 45%, 57%, 38%, 85% and 44%, respectively ( P < 0.05). The total cost of antibiotic and antifungal agents decreased by 27%, for a savings of $59, 905 USD annually. Conclusion: Restrictive and persuasive ASP in the hematology-oncology ward and the HSCT unit safely decreased the use of antibacterial and antifungal agents. Abstract : Supplemental Digital Content is available in the text.