Impact of pharmacist-led antibiotic stewardship program in a PICU of low/middle-income country

• Published in: BMJ open quality 2018, Vol.7 (1), p.e000180-e000180
• Main Authors: Haque, Anwarul, Hussain, Kashif, Ibrahim, Romesa, Abbas, Qalab, Ahmed, Shah Ali, Jurair, Humaira, Ali, Syed Asad
• Format: Article
• Language: English
• Subjects: Antibiotics; Antimicrobial agents; Audits; Critical care; Data collection; Drug dosages; Drug resistance; Epidemiology; Feedback; Hospitals; Infections; Infectious diseases; Intensive care; Intervention; Mortality; Patients; Pediatrics; Pharmacists; Short Report; Writing
• ISSN: 2399-6641; 2399-6641
• DOI: 10.1136/bmjoq-2017-000180

Correspondence to Dr Qalab Abbas; [e-mail] Introduction The use of antibiotics in paediatric intensive care units (PICU) is very high (ranging from 67% to 97%) due to several reasons including high incidence of community-acquired sepsis, healthcare-associated infections or as a postoperative prophylaxis.1 This high antibiotic use leads to several problems including development of antibiotic resistance, drug toxicity and drug interactions.2 The Infectious Diseases Society of America and Society for Healthcare Epidemiology of America has initiated antibiotic stewardship programme (ASP) for better delivery of antibiotics in hospitalised patients in 2007 and updated in April 2016, was also advocated by other paediatric healthcare agencies.3 The cornerstone for ASP is appropriate selection, dose and duration of antibiotics. The four main components of this programme were1: selection of appropriate agent, based on the patient characteristics’ like where the patient came from (community or another hospital/ward), previous antibiotics received in current illness, nature of disease/infection and microbiological details available if any before the PICU admission2 appropriate dose,3 de-escalation/discontinuation (stop or change to narrow spectrum antibiotic based on definitive diagnosis after 48 hours) and4 recommendation regarding interactions or monitoring of therapy. DOT was defined as the number of antibiotics patient received in a day.8 Basic demographic (age, gender) characteristics, Paediatric Risk of Mortality III score for severity assessment, admitting diagnostic categories, indications of antibiotics, details of ASP, COT (only cost of drug unit) and outcome as alive/dead were recorded. Mortality was 16.2% and 15.7% during the pre-ASP and ASP period, respectively.Table 1 Patients’ characteristics and antibiotics data during the pre-ASP and ASP periods Variable ASP−n (%) ASP+n (%) P value Median age in months (IQR) 26 (93) 24 (65) 0.485 Gender male 150 (62.5) 86 (63) PRISM-III 5.68 ± 5.14 7.4 ± 6.3 Diagnosis Respiratory system diseases 27 (20) 31 (24.4) > 0.05 Cardiovascular system diseases 12 (9) 13 (10.2) Neurological diseases 25 (18.5) 16 (12.6) Surgical disease 58 (43) 41 (32.3) Miscellaneous 13 (9.5) 26 (20.5) Empirical 57 (42) 60 (47.4) Prophylaxis 58 (43) 55 (43.2) Therapeutic 20 (15) 12 (9.4) Intervention None 29 (22.6) Dose None 11 (8.5) Choice None 15 (11.7) Duration/stop 15 % 6 (4.6) Monitor/interaction None 6 (4.6) DOT 1937 651