The effect of Telehealth Antimicrobial Stewardship Program (Tele-ASP) on antimicrobial use in a pediatric intensive care unit: Pre- and post-implementation single center study
Background: Overuse or misuse of antimicrobials is common in pediatric intensive care units (PICU) and may be associated with poor clinical outcomes. Although an antimicrobial stewardship program (ASP) has been found to improve this practice, the required expertise in infectious diseases may be limi...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-09-01
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| Series: | Journal of Infection and Public Health |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1876034123002174 |
| _version_ | 1827874813968908288 |
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| author | Abdulla Alfraij Ahmed Abdelmoniem Mohamed Elseadawy Mohammad Surour Mohamed Basuni Jesse Papenburg Mohammad Alghounaim |
| author_facet | Abdulla Alfraij Ahmed Abdelmoniem Mohamed Elseadawy Mohammad Surour Mohamed Basuni Jesse Papenburg Mohammad Alghounaim |
| author_sort | Abdulla Alfraij |
| collection | DOAJ |
| description | Background: Overuse or misuse of antimicrobials is common in pediatric intensive care units (PICU) and may be associated with poor clinical outcomes. Although an antimicrobial stewardship program (ASP) has been found to improve this practice, the required expertise in infectious diseases may be limited in some centers. We aimed to evaluate the effect of telehealth ASP on the rate of PICU antimicrobial use in a center without a local Infectious Diseases consultation service. Methods: A retrospective cohort study was performed between October 1st, 2018, and October 31st, 2020, in Farwaniya Hospital PICU, a 20-bed unit. All pediatric patients who were admitted to PICU and received systemic antimicrobials during the study period were included and followed until hospital discharge. The ASP team provided weekly prospective audit and feedback on antimicrobial use starting October 8th, 2019. A pediatric infectious diseases specialist joined the ASP rounds remotely. Descriptive analyses and a pre-post intervention comparison of days of therapy (DOT) were used to assess the effectiveness of the ASP intervention. Results: There were 272 and 156 PICU admissions received systemic antimicrobial before and after the initiation of ASP, respectively. Bronchiolitis and pneumonia were the most common admission diagnoses, together compromising 60.7% and 61.2% of cases pre- and post-ASP. The requirement for respiratory support was higher post-ASP (76.5% vs. 91.5%, p < 0.001). Average monthly antimicrobial use decreased from 922 (95%CI 745–1000) to 485 DOT/1000 patient-days (95%CI 246–722, P < 0.05). A decline in DOT was observed across most antibiotic classes, except for ceftriaxone. No effect on the length of PICU stay, length of hospitalization, or mortality was observed. Most (89.7%) ASP recommendations were followed either fully or partially. Conclusion: In settings where Infectious Diseases consultation services are unavailable, PICU telehealth ASP can be effectively implemented and associated with significantly reducing antimicrobial use. |
| first_indexed | 2024-03-12T16:57:15Z |
| format | Article |
| id | doaj.art-ef260663e51b4e9e9a4e076cd8cc6f67 |
| institution | Directory Open Access Journal |
| issn | 1876-0341 |
| language | English |
| last_indexed | 2024-03-12T16:57:15Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Infection and Public Health |
| spelling | doaj.art-ef260663e51b4e9e9a4e076cd8cc6f672023-08-08T04:05:38ZengElsevierJournal of Infection and Public Health1876-03412023-09-0116913611367The effect of Telehealth Antimicrobial Stewardship Program (Tele-ASP) on antimicrobial use in a pediatric intensive care unit: Pre- and post-implementation single center studyAbdulla Alfraij0Ahmed Abdelmoniem1Mohamed Elseadawy2Mohammad Surour3Mohamed Basuni4Jesse Papenburg5Mohammad Alghounaim6Pediatric Intensive Care Unit, Department of Pediatrics, Farwaniya Hospital, Sabah Al-Nasser, Al Farwaniya, Kuwait; Pediatric Intensive Care Unit, Department of Pediatrics, General Ahmadi Hospital, Kuwait Oil Company (KOC), Al-Ahmadi, KuwaitPediatric Intensive Care Unit, Department of Pediatrics, Farwaniya Hospital, Sabah Al-Nasser, Al Farwaniya, KuwaitPediatric Intensive Care Unit, Department of Pediatrics, Farwaniya Hospital, Sabah Al-Nasser, Al Farwaniya, KuwaitPediatric Intensive Care Unit, Department of Pediatrics, Farwaniya Hospital, Sabah Al-Nasser, Al Farwaniya, KuwaitPediatric Intensive Care Unit, Department of Pediatrics, Farwaniya Hospital, Sabah Al-Nasser, Al Farwaniya, KuwaitDepartments of Pediatrics and Medical Microbiology, McGill University Health Centre, Montreal, Quebec, CanadaDepartment of Pediatrics, Amiri Hospital, Kuwait City, Al Asimah, Kuwait; Correspondence to: Department of Pediatrics, Amiri Hospital, 900005 Ibn Misbah St. Sharq block 3, Kuwait City 2436149, Kuwait.Background: Overuse or misuse of antimicrobials is common in pediatric intensive care units (PICU) and may be associated with poor clinical outcomes. Although an antimicrobial stewardship program (ASP) has been found to improve this practice, the required expertise in infectious diseases may be limited in some centers. We aimed to evaluate the effect of telehealth ASP on the rate of PICU antimicrobial use in a center without a local Infectious Diseases consultation service. Methods: A retrospective cohort study was performed between October 1st, 2018, and October 31st, 2020, in Farwaniya Hospital PICU, a 20-bed unit. All pediatric patients who were admitted to PICU and received systemic antimicrobials during the study period were included and followed until hospital discharge. The ASP team provided weekly prospective audit and feedback on antimicrobial use starting October 8th, 2019. A pediatric infectious diseases specialist joined the ASP rounds remotely. Descriptive analyses and a pre-post intervention comparison of days of therapy (DOT) were used to assess the effectiveness of the ASP intervention. Results: There were 272 and 156 PICU admissions received systemic antimicrobial before and after the initiation of ASP, respectively. Bronchiolitis and pneumonia were the most common admission diagnoses, together compromising 60.7% and 61.2% of cases pre- and post-ASP. The requirement for respiratory support was higher post-ASP (76.5% vs. 91.5%, p < 0.001). Average monthly antimicrobial use decreased from 922 (95%CI 745–1000) to 485 DOT/1000 patient-days (95%CI 246–722, P < 0.05). A decline in DOT was observed across most antibiotic classes, except for ceftriaxone. No effect on the length of PICU stay, length of hospitalization, or mortality was observed. Most (89.7%) ASP recommendations were followed either fully or partially. Conclusion: In settings where Infectious Diseases consultation services are unavailable, PICU telehealth ASP can be effectively implemented and associated with significantly reducing antimicrobial use.http://www.sciencedirect.com/science/article/pii/S1876034123002174StewardshipAntimicrobialPediatricIntensive care unit |
| spellingShingle | Abdulla Alfraij Ahmed Abdelmoniem Mohamed Elseadawy Mohammad Surour Mohamed Basuni Jesse Papenburg Mohammad Alghounaim The effect of Telehealth Antimicrobial Stewardship Program (Tele-ASP) on antimicrobial use in a pediatric intensive care unit: Pre- and post-implementation single center study Journal of Infection and Public Health Stewardship Antimicrobial Pediatric Intensive care unit |
| title | The effect of Telehealth Antimicrobial Stewardship Program (Tele-ASP) on antimicrobial use in a pediatric intensive care unit: Pre- and post-implementation single center study |
| title_full | The effect of Telehealth Antimicrobial Stewardship Program (Tele-ASP) on antimicrobial use in a pediatric intensive care unit: Pre- and post-implementation single center study |
| title_fullStr | The effect of Telehealth Antimicrobial Stewardship Program (Tele-ASP) on antimicrobial use in a pediatric intensive care unit: Pre- and post-implementation single center study |
| title_full_unstemmed | The effect of Telehealth Antimicrobial Stewardship Program (Tele-ASP) on antimicrobial use in a pediatric intensive care unit: Pre- and post-implementation single center study |
| title_short | The effect of Telehealth Antimicrobial Stewardship Program (Tele-ASP) on antimicrobial use in a pediatric intensive care unit: Pre- and post-implementation single center study |
| title_sort | effect of telehealth antimicrobial stewardship program tele asp on antimicrobial use in a pediatric intensive care unit pre and post implementation single center study |
| topic | Stewardship Antimicrobial Pediatric Intensive care unit |
| url | http://www.sciencedirect.com/science/article/pii/S1876034123002174 |
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