PHILADELPHIA – Adherence to the recommendations of an antibiotic stewardship program committee decreased 30-day readmissions without increasing length of stay at a freestanding children’s hospital.
Between March 3, 2008, and March 3, 2013, the antibiotic stewardship program (ASP) committee at Children’s Mercy Hospital–Kansas City, Mo., recommended discontinuing a prescribed antibiotic, changing the antibiotic, or reducing the antibiotic dose in 1,240 patients. When the recommendations were followed, no 30-day readmissions occurred, and median length of stay was 79 hours. When they were not followed, readmissions within 30 days occurred in 3% and 4% of otherwise healthy surgical and medical patients and in patients with chronic complex medical conditions, respectively, and median length of stay was 82 hours, Dr. Jason G. Newland reported at an annual scientific meeting on infectious diseases.
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Antibiotic stewardship programs can decrease 30-day readmissions without increasing length of stay at children's hospitals.
The study is the first to demonstrate that a stewardship program designed to control antibiotic prescription and treatment in the hospital setting has beneficial effects on children’s health, Dr. Newland, medical director of patient safety and systems reliability at Children’s Mercy Hospitals and Clinics and the University of Missouri–-Kansas City said during a press briefing at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.
“We obviously were excited to see that we didn’t impact length of stay on a negative basis,” he said, adding that the 0% readmission rates in cases in which the physician agreed with the antibiotic stewardship program (ASP) recommendation was a particularly encouraging finding.
The ASP committee at Children’s Mercy Hospital, like most such programs, is led by epidemiologists and infectious disease physicians who are tasked with promoting the appropriate use of antibiotics in an effort to prevent the development of antibiotic resistance.
In the vast majority of cases included in the current study, the ASP committee’s recommendation was to discontinue the antibiotic, as it was deemed unnecessary, Dr. Newland noted.
ASP interventions occurred most often in patients receiving ceftriaxone/cefotaxime (62%), vancomycin (11%), and meropenem (5%). The most common diagnoses were pneumonia (22%), urinary tract infections (19%), and rule out sepsis (9%).
The findings reinforce the importance of viewing ASP committees as extensions of patient-safety initiatives, “as their presence really exemplifies the idea of do no harm,” said Dr. Pranita D. Tamma of Johns Hopkins Children’s Center, Baltimore, who moderated the press briefing.
Dr. Newland and his colleagues demonstrated the value of ASP committees for reducing the likelihood of further negative sequelae to which a child could be exposed as a result of inappropriate antibiotic use, such as the increased risk of health care associated infections that might come with readmission, having to take further medications, and undergo other interventions, and the cost and other burdens to families and the health care system as a whole, she said.
Dr. Newland reported receiving grant funding from Pfizer.