[Effects of an In-House Antibiotic Stewardship Initiative on Diagnosis and Management of Community-Acquired Pneumonia in Childhood and Adolescence].

Abstract

BACKGROUND\n\u2002Pediatric community-acquired pneumonia (pCAP) often leads to prescription of antibiotics and hospital admission of children. Unfortunately, adherence to diagnosis and treatment guidelines is inconsistent, and misuse of antibiotics may occur. Antimicrobial stewardship interventions, which were started in many hospitals during the last decade, can optimize management of pCAP without negative patient outcomes.\n\n\nOBJECTIVES\n\u2002The objective of this retrospective analysis was to assess the influence of a newly implemented in-house pediatric antibiotic stewardship (ABS) initiative on guideline adherence and treatment quality.\n\n\nMATERIALS AND METHODS\n\u2002Retrospective, patients file-based analysis of the effects of an ABS initiative in a pediatric university hospital from January 2017 until March 2020. ABS initiative included creation of a local pCAP guideline for hospitalized children aged 90 days\u200a-\u200a18 years, periodic training and continuous ABS support.\n\n\nRESULTS\n\u2002A total of 230 patients with pCAP were included (145 before and 85 after intervention). Implementation of the ABS program led to reduction of antibiotics prescription without clear indication from 26\u200a% to 10\u200a% (p\u200a<\u200a0.05). The inappropriate use of antibiotics decreased from 64\u200a% to 27\u200a% (p\u200a<\u200a0.05), the rate of incorrect doses declined from 17\u200a% to 10\u200a% (p\u200a<\u200a0.05) and the mean duration of antibiotic treatment declined from 10 to 7 days (p\u200a<\u200a0.05). There were no differences between the two groups regarding length of stay, treatment failure or readmissions for respiratory infection.\n\n\nCONCLUSIONS\n\u2002Pediatric antibiotic stewardship is an appropriate and safe method, and is beneficial to hospitalized patients with pCAP. Application of ABS programs may increase adherence to clinical guidelines and improve appropriate antimicrobial use without negative impact on patient outcomes. Multicenter follow-up studies are needed to clarify long-term effects of ABS programs.