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Antimicrobial stewardship in a tertiary paediatric hospital
  1. J Aston,
  2. U Nusgen
  1. Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK


Objective To evaluate the impact of an antimicrobial stewardship programme (including audit, education, prescribing guidance, pharmacist referral system and microbiology ward rounds) introduced in November 2009.

Method An evaluation of four point prevalence surveys (PPS) conducted on a single day in January 2009, January 2010, November 2010 and May 2011 and three snap-shot prescribing surveys (SSPS) conducted on a single day in November 2009, February 2010 and May 2010. All inpatients on the days of the surveys were included. Patients' medical notes, medication charts and laboratory data were reviewed and data was collected on diagnosis, antibiotic(s) prescribed, route of administration, duration of treatment, documentation of an indication and duration/review date and compliance with local prescribing guidelines. The data were analysed using Excel.

Results The total number of patients included across all surveys was 1410. 503patients (35.7%) were prescribed treatment courses of antibacterials.

Over the course of four PPS a sustained reduction in cephalosporin use was observed from 26/61 (42.6%) patients prescribed antibacterials in January 2009 to 5/61 (8.2%), 6/77 (7.8%) and 5/60 (8.3%) in the subsequent three PPS. Meropenem use decreased from 9/61 (14.8%) in January 2009 and 15/61 (17.2%) in January 2010 to 9/77 (12%) in November 2010 and 6/60 (10%) in May 2011. The proportion of patients on intravenous antibiotics remained high at 49/61 (82%), 45/61 (74%), 64/77 (83%) and 38/60 (63.3%). However, the number of patients receiving intravenous antibiotics for >48 h decreased from 40/49 (82%) to 33/45 (73%), 37/64 (58%) and 18/60 (30%).

Over the course of the three SSPS, the documentation of an indication on patients' medication charts has increased from 5/53 (9%) patients prescribed antibacterials in November 2009 to 30/60 (50%) in May 2011. The documentation of a duration/review date on patients' medication charts has increased from 7/53 (13%) in November 2009 to 27/60 (45%) in May 2011.

Conclusion A programme of antimicrobial stewardship has been successfully introduced in accordance with national requirements.1 A sustained reduction in agents at high risk of causing Clostridium difficile associated disease, agents with a broad spectrum of activity and the duration of intravenous therapy has been achieved in line with national recommendations.2 3 The quality of antibacterial prescribing has also improved in line with national guidance.2 3 There has been little impact on the proportion of patients treated with intravenous agents although this may be expected in paediatrics.

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