In the Journals

Pediatric EDs report limited adherence to antibiotic stewardship

Despite high antibiotic prescription rates by ED providers, pediatric EDs reported a lack of involvement in antimicrobial stewardship policies, including the creation of antibiotic recommendations, prescription monitoring and regulation of ED antibiotic prescribing, according to a recent survey.

“Each year, approximately 250 million antibiotic prescriptions are written from the ED; as many as 30% of antibiotics prescribed in the ED are considered either inappropriate or unnecessary,” Rakesh D. Mistry, MD, MS, of the Children’s Hospital of Colorado, and colleagues wrote. “ASP implementation for EDs can be challenging because of the unique approach to antibiotic prescribing in this fast-paced clinical setting, where need for empiric antibiotic therapy in the absence of a confirmatory diagnosis is common.”

To ascertain the current involvement of EDs in children’s hospital policies and the preferred methods of use for these ED-based guidelines, Mistry and colleagues conducted a cross-sectional survey of 37 children’s hospitals within the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) collaborative.

Each hospital involved provided two responses to the survey. One response was given by an ASP leader or, in some cases, an infectious diseases specialist or clinical pharmacist. One was also offered by a clinical or medical director within the ED. Topics included views on how antibiotics are prescribed in the ED and resources available to prescribers, policy methods currently used in the department, level of ED participation in ASP activities and how EDs prefer to execute said policies.

With a 91.9% response rate, results indicated that most ASP leaders (97.8%) and ED directors (93.7%) see the necessity of ED-based ASPs, and 29 EDs reported that their main resource for prescribing antibiotics was the internet or EHRs. This reflects the preferred use of policies using “clinical decision support integrated into the EHR.” The survey also showed that the participating EDs’ main use of ASPs include production of antibiograms (77.8%) and creation of clinical care guidelines for pneumonia (83.3%). Although these policies are ED-based, ED representation appeared on only three ASP hospital committees, and no hospital ASPs regularly supervised how antibiotics were prescribed within the department.

“Our findings demonstrate that programmatic involvement of the ED in ASPs was very limited in this sample of pediatric hospitals,” Mistry and colleagues wrote. “Pediatric emergency medicine specialists were rarely engaged in ASP committees, and resources to enhance ED antibiotic prescribing, such as the development of institutional clinical care guidelines and prescription monitoring, were infrequent. Nonetheless, leaders from both hospital ASPs and EDs consistently recognized a need for ED engagement in and implementation of ED-based antimicrobial stewardship.” – by Katherine Bortz

Disclosure: The researchers report no relevant financial disclosures.