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Long-term outcomes of an educational paediatric antimicrobial stewardship programme: a quality improvement study
  1. Marta Aboza Garcia1,
  2. Walter Goycochea-Valdivia1,
  3. Germán Peñalva2,3,
  4. Lola Falcon Neyra1,
  5. Marta Moleón Ruiz4,
  6. Angel Rodriguez-Villodres2,3,
  7. Cristina Montero Valladares5,
  8. Peter Olbrich1,
  9. Elia Sánchez-Valderrabanos6,
  10. Francisco Jiménez7,
  11. Maria Molina8,
  12. Gloria Moreno Madueño9,
  13. Raquel Valencia Martin10,
  14. Maria Victoria Gil Navarro3,4,
  15. Jose Molina2,3,
  16. Olaf Neth1,
  17. Jose Miguel Cisneros2,3
  1. 1 Paediatric Infectious Diseases, Rheumatology and Immunology Unit, UniversityHospital Virgen del Rocío, Institute of Biomedicine of Seville (IBIS)/ Universidad deSevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica, Seville, Spain
  2. 2 Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocio, Spanish National Research Council, University of Seville, Seville, Spain
  3. 3 CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
  4. 4 Department of Pharmacy, Hospital Universitario Virgen del Rocio, Seville, Spain
  5. 5 Department of General Paediatrics, University Hospital Virgen del Rocío, Seville, Spain
  6. 6 Department of Paediatric Intensive Care, Hospital Universitario Virgen del Rocio, Seville, Spain
  7. 7 Department of Neonatology, University Hospital Virgen del Rocío, Seville, Spain
  8. 8 Department of Paediatric Surgery, University Hospital Virgen del Rocío, Seville, Spain
  9. 9 Department of Neurosurgery, Virgen del Rocio University Hospital, Seville, Spain
  10. 10 Department of Preventive Medicine, University Hospital Virgen del Rocío, Seville, Spain
  1. Correspondence to Dr Olaf Neth, Paediatric Infectious Diseases, Rheumatology and Immunology Unit. Institute of Biomedicine of Seville (IBIS)/ Universidad de Sevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica RITIP, Virgen del Rocio University Hospital, Sevilla, 41013, Spain; oneth-ibis{at}


Background and objectives Antimicrobial stewardship programmes (ASPs) have resulted in antimicrobial consumption (AMC) reduction and quality of prescription (QOP) improvement. However, evidence of ASP impact in paediatrics is still limited. This study aims to assess a paediatric ASP long-term outcomes.

Methods A quality improvement study assessed by a interrupted time series analysis was conducted in a paediatric tertiary hospital. QOP expressed as proportion of adequate prescriptions, AMC measured by defined daily dose incidence per 1000 occupied bed days, incidence density of bloodstream infections (BSIs) and its related all-cause crude death rate (CDR) were compared between pre (from January 2013 to December 2015) and post (from January 2016 to December 2019) ASP activities intensification, which included a dedicated paediatric infectious diseases physician to actively perform educational interviews with prescribers.

Results Inappropriate prescribing showed a significant downward shift associated to the intervention with a −51.4% (−61.2% to −41.8%) reduction with respect to the expected values. Overall AMC showed no trend change after the intervention. For neonatology a

28.8% (−36.8% to −20.9%) reduction was observed. Overall anti-pseudomonal cephalosporin use showed a −51.2% (−57.0% to −45.4%) reduction. Decreasing trends were observed for carbapenem use, with a quarterly per cent change (QPC) of −2.4% (−4.3% to −0.4%) and BSI-related CDR (QPC=−3.6%; −5.4% to −1.7%) through the study period. Healthcare-associated multi-drug-resistant BSI remained stable (QPC=2.1; −0.6 to 4.9).

Conclusions Intensification of counselling educational activities within an ASP suggests to improve QOP and to partially reduce AMC in paediatric patients. The decreasing trends in mortality remained unchanged.

  • Infectious Disease Medicine
  • Microbiology
  • Paediatrics

Data availability statement

No data are available.

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Data availability statement

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  • MAG and WG-V contributed equally.

  • Contributors MAG, WG-V and GP contributed to the conception of the work and wrote the first draft. JMC and ON edited the manuscript. LF, MMR, AR-V, CMV, PO, ES-V, FJ, MM, GMM, RVM, MVGN and MM participated actively in the day-to-day work of the educational ASP and contributed to the analysis or interpretation of the data and they reviewed the submitted version. ON and JMC are guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.