The outcome of implementing antimicrobial stewardship program for hospitalized children

Ahmed A. El-Nawawy, Reham M. Wagdy, Ahmed Kh. Abou Ahmed, Marwa A. Moustafa


Background: An effective approach to improve antimicrobial use for hospitalized patients is an antimicrobial stewardship program (ASP). The present study aimed to implement ASP for inpatient children based on prospective-audit-with-feedback intervention in order to evaluate the impact on patient’s outcome, antimicrobial use, and the hospital cost.

Methods: The study was conducted throughout 6 months over 275 children admitted with different infections at Main Children’s hospital in Alexandria included; group I (with ASP) and group II (standard antimicrobials as controls).

Results: The study revealed that on patient’s admission, single antibiotic use was higher among the ASP group while double antimicrobial therapy was higher among the non-ASP with significant difference (p=0.001). Less percentage of patients who consumed vancomycin, meropenem amoxicillin-clavulanic and metronidazole was observed among ASP group with a significant difference of the last two drugs when compared to controls (p=<0.001, 0.011, respectively). The study reported the higher percent of improved ASP patient’s after 72 hours of admission with a significant difference to controls (73.2% versus 62.5%, p=0.038). Complications occurred more likely for the non-ASP group (odds ratio 7.374 with 95% CI 1.68-32.33). In general, there was a clear reduction of the patient antibiotic cost/day and overall cost per patient, however, it was not significant among the studied patients.

Conclusions:  Our local ASP model provided a high quality of care for hospitalized children and effectively reduced the antimicrobial consumption.


Antimicrobial resistance, Antibiotic misuse, Patient’s outcome, Stewardship program

Full Text:



Huttner A, Harbarth S, Carlet J, Cosgrove S, Goossens H, Holmes A, et al. Antimicrobial resistance: a global view from the 2013 World Healthcare-Associated Infections Forum. Antimicrob Resist Infect Control. 2013;2:31.

Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis. 2006;42(2):82-9.

Levy ER, Swami S, Dubois SG, Wendt R, Banerjee R. Rates and appropriateness of antimicrobial prescribing at an academic children's hospital, 2007-2010. Infect Control Hosp Epidemiol. 2012;33(4):346-53.

Maragakis LL, Perencevich EN, Cosgrove SE. Clinical and economic burden of antimicrobial resistance. Expert Rev Anti Infect Ther. 2008;6(5):751-63.

Gerding DN. The search for good antimicrobial stewardship. Jt Comm J Qual Improv. 2001;27(8):403-4.

Di Pentima MC, Chan S. Impact of antimicrobial stewardship program on vancomycin use in a pediatric teaching hospital. Pediatr Infect Dis J. 2010;29(8):707-11.

Committee on Infectious Diseases AAoP. Kimberlin DW MTB, Jackson MA, Long SS, editor. Red Book. 30th edition. 2015.

Yam P, Fales D, Jemison J, Gillum M, Bernstein M. Implementation of an antimicrobial stewardship program in a rural hospital. Am J Health Syst Pharm. 2012;69(13):1142-8.

Masia M, Matoses C, Padilla S, Murcia A, Sanchez V, Romero I, et al. Limited efficacy of a nonrestricted intervention on antimicrobial prescription of commonly used antibiotics in the hospital setting: results of a randomized controlled trial. Eur J Clin Microbiol Infect Dis. 2008;27(7):597-605.

Avdic E, Cushinotto LA, Hughes AH, Hansen AR, Efird LE, Bartlett JG, et al. Impact of an antimicrobial stewardship intervention on shortening the duration of therapy for community-acquired pneumonia. Clin Infect Dis. 2012;54(11):1581-7.

Talaat M, Saied T, Kandeel A, El-Ata GA, El-Kholy A, Hafez S, et al. A Point Prevalence Survey of Antibiotic Use in 18 Hospitals in Egypt. Antibiotics (Basel). 2014;3(3):450-60.

Zarb P, Amadeo B, Muller A, Drapier N, Vankerckhoven V, Davey P, et al. Identification of targets for quality improvement in antimicrobial prescribing: the web-based ESAC Point Prevalence Survey 2009. J Antimicrob Chemother. 2011;66(2):443-9.

Joseph J, Rodvold KA. The role of carbapenems in the treatment of severe nosocomial respiratory tract infections. Expert Opin Pharmacother. 2008;9(4):561-75.

McCulloh RJ, Queen MA, Lee B, Yu D, Stach L, Goldman J, et al. Clinical Impact of an Antimicrobial Stewardship Program on Pediatric Hospitalist Practice, a 5-Year Retrospective Analysis. Hosp Pediatr. 2015;5(10):520-7.

Akpan MR, Ahmad R, Shebl NA, Ashiru-Oredope D. A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals. Antibiotics (Basel). 2016;5(1).

Liew YX, Lee W, Loh JC, Cai Y, Tang SS, Lim CL, et al. Impact of an antimicrobial stewardship programme on patient safety in Singapore General Hospital. Int J Antimicrob Agents. 2012;40(1):55-60.

Teo J, Kwa AL, Loh J, Chlebicki MP, Lee W. The effect of a whole-system approach in an antimicrobial stewardship programme at the Singapore General Hospital. Eur J Clin Microbiol Infect Dis. 2012;31(6):947-55.

Nilholm H, Holmstrand L, Ahl J, Mansson F, Odenholt I, Tham J, et al. An Audit-Based, Infectious Disease Specialist-Guided Antimicrobial Stewardship Program Profoundly Reduced Antibiotic Use Without Negatively Affecting Patient Outcomes. Open Forum Infect Dis. 2015;2(2):42.

Lee BR, Goldman JL, Yu D, Myers AL, Stach LM, Hedican E, et al. Clinical Impact of an Antibiotic Stewardship Program at a Children's Hospital. Infect Dis Ther. 2017;6(1):103-13.

Hersh AL, De Lurgio SA, Thurm C, Lee BR, Weissman SJ, Courter JD, et al. Antimicrobial stewardship programs in freestanding children's hospitals. Pediatrics. 2015;135(1):33-9.

Di Pentima MC, Chan S, Hossain J. Benefits of a pediatric antimicrobial stewardship program at a children's hospital. Pediatrics. 2011;128(6):1062-70.

Newland JG, Stach LM, De Lurgio SA, Hedican E, Yu D, Herigon JC, et al. Impact of a Prospective-Audit-With-Feedback Antimicrobial Stewardship Program at a Children's Hospital. J Pediatric Infect Dis Soc. 2012;1(3):179-86.

Philmon C, Smith T, Williamson S, Goodman E. Controlling use of antimicrobials in a community teaching hospital. Infect Control Hosp Epidemiol. 2006;27(3):239-44.

Agwu AL, Lee CK, Jain SK, Murray KL, Topolski J, Miller RE, et al. A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center. Clin Infect Dis. 2008;47(6):747-53.

Bantar C, Sartori B, Vesco E, Heft C, Saul M, Salamone F, et al. A hospitalwide intervention program to optimize the quality of antibiotic use: impact on prescribing practice, antibiotic consumption, cost savings, and bacterial resistance. Clin Infect Dis. 2003;37(2):180-6.

Principi N, Esposito S. Antimicrobial stewardship in paediatrics. BMC Infect Dis. 2016;16(1):424.