IMPROVING ANTIBIOTICS USE IN PEDIATRIC HOSPITALS IN ARGENTINA: FEASIBILITY STUDY

Abstract

Background: We aimed to test the feasibility of a multifaceted intervention to enhance the quality of antibiotic prescription by reducing its overuse and increasing the use of narrow-spectrum agents, comprising a range of antimicrobial stewardship strategies in LMIC pediatric hospitals. Methods: We implemented a quality improvement (QI) initiative for the treatment of three groups of infections: acute lower respiratory infections (ALRI), urinary tract infections (UTI), and skin and soft tissue infections (SSTI) in six units of two academic pediatric hospitals. We used an uncontrolled before-and-after design, preceded by a formative phase, to identify barriers and facilitators. The target population was Healthcare workers (HCWs). The strategy comprised an antibiotic audit and feedback, ward- or pathway-specific treatment guidelines, infection-based interventions focused on improving diagnostic accuracy, tailoring therapy to culture results, optimizing treatment duration (antibiotic time out), pharmacy-based interventions, and education. Results: We recruited 617 patients: 249 in the baseline period (BP) and 588 in the implementation period (IP). The patients in the IP group were younger, weighed less, had higher critical care requirements, and had higher ALRI. With implementation, we observed an increase in antibiotic days of therapy (1051 vs. 831; RR: 1.23 (1.14;1.33); p<0.001). After adjusting for age and place of hospitalization, the differences were significant. This increase was at the expense of a higher use of Access group antibiotics (382 vs. 310; RR: 1.23 (1.14;1.33); p<0.001) and lower use of the Watch group according to the WHO classification (552 vs. 623; RR: 0.89 (0.84; 0.94); p<0.001). We observed a decrease in antibiotic resistance in the IP group (5% vs. 13%; p<0.001) at the expense of extended-spectrum β-lactamase. We found no differences in mortality rates between the two periods. Conclusion: Through a QI initiative, the use of antibiotic stewardship programs in pediatric hospitals was shown to be feasible and may improve antibiotic use. We observed a decrease in antibiotic resistance, which may be due to an increase in antibiotic Access group use.