Improving paediatric antimicrobial stewardship in hospital-based settings; why, where and how?
Improving paediatric antimicrobial stewardship in hospital-based settings; why, where and how?
Background
Antimicrobial resistance (AMR) is being recognized as a priority by healthcare organizations across the world. However, many children are managed on IV antimicrobials in hospital with very little consideration of antimicrobial stewardship issues.
Objectives
A nurse-led paediatric ambulatory outpatient parenteral antimicrobial therapy (OPAT) service, managing children with common infections being ambulated on short courses of IV antimicrobials, was introduced within Southampton Children’s Hospital in January 2018. We evaluated the impact of this service in terms of the quality of antimicrobial prescribing and timing of ambulation in children presenting with common infections.
Methods
All cases managed within the service were reviewed in two separate 2 month time periods: prior to introduction of the service (September–October 2016) and then prospectively after its introduction (September–October 2018).
Results
A total of 96% of IV antibiotic management decisions at 48 h were deemed appropriate in 2018, compared with 75% in 2016. A total of 64% of patients were ambulated on IV antibiotics at some point during their treatment course in 2018, compared with 19% in 2016. However, a significant proportion of antimicrobial decisions made at the point of presentation to hospital remained suboptimal in 2018.
Conclusions
Children are commonly managed with IV antibiotics in hospital. We demonstrate marked improvements in appropriate antimicrobial use through the introduction of a nurse-led ambulatory OPAT service. In addition, such a service can promote a greater proportion of children being ambulated from hospital, freeing up valuable inpatient beds and potentially delivering cost savings that can be used to fund such services.
1-4
Tanner, E.
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Munro, A.P.S.
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Gray, J.
b0346c64-2be9-40be-a5cc-7de6af3d5d41
Green, H.
3406758c-9679-45db-aa97-792c66ba6ea3
Rutter, M.
30a3501f-6278-44cc-a979-30539340c8cf
Jones, C.E.
48229079-8b58-4dcb-8374-d9481fe7b426
Faust, S.N.
f97df780-9f9b-418e-b349-7adf63e150c1
Alderton, M.
bb09297e-7a23-41ca-9fa9-f73898d9fcb5
Patel, S.V.
bc976df6-0414-459f-8390-3eca85e07d97
Tanner, E.
0586a848-fe9d-43e0-8610-48214b2a68c9
Munro, A.P.S.
59dacf7d-5977-49c4-b562-b2c719c9dcf4
Gray, J.
b0346c64-2be9-40be-a5cc-7de6af3d5d41
Green, H.
3406758c-9679-45db-aa97-792c66ba6ea3
Rutter, M.
30a3501f-6278-44cc-a979-30539340c8cf
Jones, C.E.
48229079-8b58-4dcb-8374-d9481fe7b426
Faust, S.N.
f97df780-9f9b-418e-b349-7adf63e150c1
Alderton, M.
bb09297e-7a23-41ca-9fa9-f73898d9fcb5
Patel, S.V.
bc976df6-0414-459f-8390-3eca85e07d97
Tanner, E., Munro, A.P.S., Gray, J., Green, H., Rutter, M., Jones, C.E., Faust, S.N., Alderton, M. and Patel, S.V.
(2020)
Improving paediatric antimicrobial stewardship in hospital-based settings; why, where and how?
Journal of Antimicrobial Chemotherapy, 2 (1), .
(doi:10.1093/jacamr/dlaa011).
Abstract
Background
Antimicrobial resistance (AMR) is being recognized as a priority by healthcare organizations across the world. However, many children are managed on IV antimicrobials in hospital with very little consideration of antimicrobial stewardship issues.
Objectives
A nurse-led paediatric ambulatory outpatient parenteral antimicrobial therapy (OPAT) service, managing children with common infections being ambulated on short courses of IV antimicrobials, was introduced within Southampton Children’s Hospital in January 2018. We evaluated the impact of this service in terms of the quality of antimicrobial prescribing and timing of ambulation in children presenting with common infections.
Methods
All cases managed within the service were reviewed in two separate 2 month time periods: prior to introduction of the service (September–October 2016) and then prospectively after its introduction (September–October 2018).
Results
A total of 96% of IV antibiotic management decisions at 48 h were deemed appropriate in 2018, compared with 75% in 2016. A total of 64% of patients were ambulated on IV antibiotics at some point during their treatment course in 2018, compared with 19% in 2016. However, a significant proportion of antimicrobial decisions made at the point of presentation to hospital remained suboptimal in 2018.
Conclusions
Children are commonly managed with IV antibiotics in hospital. We demonstrate marked improvements in appropriate antimicrobial use through the introduction of a nurse-led ambulatory OPAT service. In addition, such a service can promote a greater proportion of children being ambulated from hospital, freeing up valuable inpatient beds and potentially delivering cost savings that can be used to fund such services.
Text
Brief report_improving Ab strewardship in secondary care settings_resubmission CLEAN 13_1_2020
- Accepted Manuscript
More information
Accepted/In Press date: 16 January 2020
e-pub ahead of print date: 13 March 2020
Identifiers
Local EPrints ID: 444264
URI: http://eprints.soton.ac.uk/id/eprint/444264
ISSN: 0305-7453
PURE UUID: ec2ca3ac-9631-4ba9-acc5-bf8390c11042
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Date deposited: 06 Oct 2020 22:48
Last modified: 17 Mar 2024 03:45
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Contributors
Author:
E. Tanner
Author:
A.P.S. Munro
Author:
J. Gray
Author:
H. Green
Author:
M. Rutter
Author:
M. Alderton
Author:
S.V. Patel
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