Pharmacist-led antimicrobial stewardship program in the treatment of Staphylococcus aureus bacteraemia in paediatric patients: a multivariate analysis

Abstract

Background

Care bundles are a recognised strategy to improve treatment. When managed through an Antimicrobial Stewardship Program (ASP) based on the pharmacist-led program model, care bundles can be an effective tool to guide decision making in clinical practice and to improve patient outcomes. This study aimed to evaluate the results of a pharmacist-led ASP which included a care bundle based on clinical outcomes of Staphylococcus aureus bacteraemia (SAB) in a paediatric hospital.

Methods

A retrospective cohort study with multivariate analysis was conducted in a paediatric hospital in Brazil. The study comprised 120 paediatric patients with a positive blood culture for S. aureus with occurred between 2014 and 2021 and clinical and laboratory results consistent with infection. The study was classified into two periods: pre-intervention (n=44) and intervention (n=76). A pharmacist-led ASP program with a care bundle was established during the intervention period 2017–2021. The primary outcome assessed was the impact on clinical outcomes, including infection-related mortality and 90-day reinfection rate, both being considered therapeutic failure.

Results

The multivariate analysis demonstrated that the following variables had an impact on primary outcome: infant patients [Odds ratio (OR) 12.998, P=0.044]; use of more than three antimicrobial treatment regimens [OR 0.006, P=0.017]; intervention period [OR 0.060, P=0.034]; bundle item 1 – follow-up blood culture [OR 18.953, P=0.049]; bundle item 2 – early source control [OR 0.002, P=0.018]; bundle item 4 – de-escalation to oxacillin for methicillin-sensitive S. aureus [OR 0.041, P=0.046].

Conclusions

The pharmacist-led ASP model showed an increase in adherence to the care bundle between the two study periods, with reduced probability of a negative outcome. Furthermore, risk factors for S. aureus bacteraemia were identified that may inform management and contribute to better patient outcomes in the paediatric population.