The North Wind and the Sun: Pediatric Antimicrobial Stewardship Program Combining Restrictive and Persuasive Approaches in Hematology-Oncology Ward and Hematopoietic Stem Cell Transplant Unit

被引：19

作者：

Horikoshi, Yuho ^{[1
]}

Kaneko, Tetsuji ^{[2
]}

Morikawa, Yoshihiko ^{[2
]}

Isogai, Mihoko ^{[1
]}

Suwa, Junichi ^{[3
]}

Higuchi, Hiroshi ^{[4
]}

Yuza, Yuki ^{[5
]}

Shoji, Takayo ^{[6
]}

Ito, Kenta ^{[7
]}

机构：

[1] Tokyo Metropolitan Childrens Med Ctr, Dept Pediat, Div Infect Dis, 2-8-29 Musashidai, Fuchu, Tokyo 1838561, Japan

[2] Tokyo Metropolitan Childrens Med Ctr, Div Clin Res Support Ctr, Fuchu, Tokyo, Japan

[3] Tokyo Metropolitan Childrens Med Ctr, Dept Pharm, Fuchu, Tokyo, Japan

[4] Tokyo Metropolitan Childrens Med Ctr, Div Microbiol, Dept Clin Lab, Fuchu, Tokyo, Japan

[5] Tokyo Metropolitan Childrens Med Ctr, Div Hematol Oncol, Dept Pediat, Fuchu, Tokyo, Japan

[6] Shizuoka Childrens Hosp, Dept Pediat, Div Infect Dis, Shizuoka, Shizuoka, Japan

[7] Aichi Childrens Hlth & Med Ctr, Dept Gen Pediat, Obu City, Aichi, Japan

来源：

PEDIATRIC INFECTIOUS DISEASE JOURNAL | 2018年 / 37卷 / 02期

关键词：

antimicrobial stewardship program; immunocompromised children; interrupted time series analysis; hematopoietic stem cell transplant; persuasive approach; INFECTIOUS-DISEASES SOCIETY; HEALTH-CARE EPIDEMIOLOGY; PRACTICE GUIDELINES; 2010; UPDATE; ANTIBIOTICS; MANAGEMENT; AMERICA; AUDIT; NO;

D O I：

10.1097/INF.0000000000001746

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background: The Japanese government's goal for the reduction of antimicrobial consumption is two-thirds of the 2013 rate by 2020. While the antimicrobial stewardship programs (ASPs) are essential in health care facilities, ASP data on pediatric hematology-oncology and hematopoietic stem cell transplant (HSCT) patients are limited. Our aim was to evaluate the impact of restrictive and persuasive ASP on immunocompromised children. Methods: The ASP for hematology-oncology and HSCT patients at Tokyo Metropolitan Children's Medical Center was assessed. Phase 1 was a postprescriptive review of carbapenem conducted between April 2010 and September 2011. Phase 2 consisted of the preauthorization of carbapenem, prospective audit with feedback, a weekly luncheon meeting among physicians, consensus on febrile neutropenia management, and implementation of viral molecular diagnostics between October 2011 and September 2015. Both phases were compared for day-of-therapy per 1,000 patient-days, cost of intravenous antimicrobial agents, average hospitalization duration, all-cause mortality, infection-related mortality at 30 days, and appropriateness of empirical treatment of bacteremia. Results: The ASP did not differ from phase 1 to phase 2 in terms of average hospitalization length, mortality rate, or appropriateness of empirical treatment for bacteremia. Day-of-therapies of cefepime, piperacillin/tazobactam, meropenem, vancomycin, liposomal amphotericin B, and fosfluconazole decreased by 20%, 45%, 57%, 38%, 85% and 44%, respectively (P < 0.05). The total cost of antibiotic and antifungal agents decreased by 27%, for a savings of $59,905 USD annually. Conclusion: Restrictive and persuasive ASP in the hematology-oncology ward and the HSCT unit safely decreased the use of antibacterial and antifungal agents.

引用

页码：164 / 168

页数：5