An antibiotic protocol that determined antibiotic use based on risk for health care-associated infections increased appropriate prescription of antibiotics in a pediatric ICU.
“The rise of antibiotic-resistant bacteria has made antibiotic decisions more challenging,” researcher Todd J. Karsies, MD, of Nationwide Children’s Hospital, and colleagues wrote. “Particularly challenging are organisms such as methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and other so-called ESKAPE organisms: Enterococcus faecium, S. aureus, Klebsiella pneumoniae, Acinetobacter baumannii, P. aeruginosa and Enterobacter species.”
Todd J. Karsies
Researchers retrospectively evaluated patients with an infection-related diagnosis one year before and after a computer order entry-based empiric antibiotic protocol was implemented in a tertiary pediatric ICU. The protocol utilized risk stratification to place patients at high- or low-risk for healthcare-associated infection (HAI) based on risk factors described in adults for hospital-acquired pneumonia due to multi-drug-resistant pathogens. The protocol was implemented in 2005. Physicians were encouraged but not required to use the protocol. Study participants included 213 patients prior to protocol implementation, who had 252 infectious episodes, and 278 patients during protocol implementation.
According to study results, protocol patients were more likely to receive appropriate antibiotics compared with pre-protocol patients regardless of risk category.
Prior to protocol implementation, 29% of patients were receiving MRSA coverage compared with 85% of patients after protocol implementation (P<.0001).
Among patients with positive cultures, 64% of patients received appropriate antibiotics based on the cultured organisms prior to protocol vs. approximately 90% of patients after protocol.
The amount of appropriate antibiotics prescribed to patients with gram-positive organisms significantly increased after protocol implementation (59% vs. 93%; P<.0001).
Appropriate antibiotic use also increased among patients with gram-negative cultures following protocol implementation (67% vs. 88%; P<.0001). Similarly, appropriate antibiotic use increased significantly among patients with MRSA post-protocol implementation, from 36% to 88% (P=.0013).
Researchers found that time from culture to first risk-appropriate antibiotic was significantly shorter after protocol implementation: median time 4 hours vs 5.9 hours.
“A computerized physician order entry-based antibiotic protocol incorporating risk assessment for resistant organisms can improve antibiotic decisions and timing in critically ill children while limiting broad antipseudomonal antibiotics to those at greatest risk for resistant bacteria,” Karsies and colleagues wrote. “This protocol represents a first step in striking a balance between the need for rapid, correct empiric antibiotic therapy in critically ill children with suspected infection and the growing demand for antibiotic stewardship.”
Disclosure: The researchers report no relevant financial disclosures.