The Impact of an Antimicrobial Stewardship Program on Days of Therapy in the Pediatric Center: An Interrupted Time-Series Analysis of a 19-Year Study

초록

Background: We aimed to analyze the effects of an antimicrobial stewardship program (ASP) on the proportion of antimicrobial -resistant pathogens in bacteremia, antimicrobial use, and mortality in pediatric patients. Methods: A retrospective single -center study was performed on pediatric inpatients under 19 years old who received systemic antimicrobial treatment from 2001 to 2019. A pediatric infectious disease attending physician started ASP in January 2008. The study period was divided into the pre -intervention (2001-2008) and the post -intervention (2009-2019) periods. The amount of antimicrobial use was defined as days of therapy per 1,000 patientdays, and the differences were compared using delta slope (= changes in slopes) between the two study periods by an interrupted time -series analysis. The proportion of resistant pathogens and the 30 -day overall mortality rate were analyzed by the chi 2 . Results: The proportion of extended -spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae bacteremia increased from 17% (39 of 235) in the pre -intervention period to 35% (189 of 533) in the post -intervention period ( P < 0.001). The total amount of antimicrobial use significantly decreased after the introduction of ASP (delta slope value = -16.5; 95% confidence interval [CI], -30.6 to -2.3; P = 0.049). The 30 -day overall mortality rate in patients with bacteremia did not increase, being 10% (55 of 564) in the pre -intervention and 10% (94 of 941) in the post -intervention period ( P = 0.881). Conclusion: The introduction of ASP for pediatric patients reduced the delta slope of the total antimicrobial use without increasing the mortality rate despite an increased incidence of ESBL-producing gram -negative bacteremia.

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