Rather than preauthorizing antibiotics or imposing restriction policies, an antibiotic stewardship program in which a team of pharmacists and physicians evaluated all prescribed antimicrobials and provided in-person feedback — dubbed “handshake stewardship” — decreased use of antibiotics by 10.9%.
“Very few hospitals have a medical doctor involved in the day-to-day running of this kind of program, and very few programs review every single antibiotic prescription. However, the risks associated with antibiotics require that we find an effective way to limit their use,” Sarah Parker, MD, pediatric infectious diseases physician and medical director of the Antimicrobial Stewardship Program at Children’s Hospital Colorado, said in a press release. “Not only do 30% of children who take antibiotics experience a side effect such as diarrhea, but [they] can also kill good bacteria in the body, which can lead to more serious illness down the line.”
Parker also mentioned the importance of innovative stewardship programs due to the current indirect health care costs associated with drug-resistant bacteria in the United States: approximately $20 billion and more than 23,000 deaths per year.
To determine the effectiveness of handshake stewardship and its potential effect on a freestanding children’s hospital, the researchers retrospectively analyzed antimicrobial use at the hospital and included information on each unit prior to implementation, during use, and post-use between October 2010 and September 2014.
Researchers compared days of therapy to 1,000 patient days to measure the monthly use of antimicrobials hospital-wide and by individual units. All antimicrobials prescribed for inpatient services were included in the study.
Within the four years analyzed, researchers observed significant decreases in the administration of antimicrobials (10.9%) and antibacterials (10.3%). Specifically, they noted reduced prescribing of vancomycin (25.7%) and meropenem (22.2%). Fewer antivirals (16.4%) and antifungals (12.1%) were also prescribed. During this time, no antibiotic or antipseudomonal had a perceptible increase. These decreases were demonstrated in individual units and hospital-wide data.
“This type of stewardship [helps] ensure the appropriate use of antibiotics — that is, that they are only used when needed, and that they are given at the right dosage for the right duration of time,” Parker said in the release. “Ultimately, this leads to better patient outcomes.” — by Katherine Bortz
Disclosure: The researchers report no financial disclosures or conflicts of interest.