Pediatr Int. 2021 Mar 19. doi: 10.1111/ped.14703. Online ahead of print.
BACKGROUND: A prospective audit and feedback is a method that allows the antimicrobial stewardship program (ASP) team to interact with the attending physicians to tailor antibiotic therapy, including de-escalation, as appropriate. This study aimed to evaluate the acceptance and outcomes of an ASP de-escalation recommendation in children who received meropenem.
METHODS: A prospective cohort study was conducted in children aged 1 month to 18 years who received meropenem in a tertiary care teaching hospital. The ASP team gave the recommendation between 72 and 120 hours after initiating meropenem therapy. Acceptance of de-escalation recommendation among primary physicians was evaluated within 24 hours of recommendation. Outcomes included clinical success rate at the 7th day and incidence rate of acquisition of carbapenem-resistant Gram-negative bacteria (CR-GNB) within 30 days.
RESULTS: From March to December 2019, 217 children with the median (IQR) age of 2.1 (0.6,9.5) years received meropenem. The ASP team gave the recommendation as 127 (58.5%) cases of continuation and 90 (41.5%) cases of de-escalation. The overall acceptance of ASP de-escalation recommendation was 57.8% (95%CI 46.9-68.1%). The clinical success rates were 85.2% in the accepted group compared to 77.5% in the rejected group (p=0.06). The incidence rate of acquisition CR-GNB within 30 days after treatment was 5.8% in the accepted group and 15.8% in the rejected group (p=0.03).
CONCLUSIONS: About half of the recommendations to de-escalate meropenem prescriptions were accepted through ASP intervention. CR-GNB acquisitions were less likely in the de-escalation group. For carbapenem use to combat multidrug-resistant organisms, a proper de-escalation strategy after the initial 72-hours should be encouraged.