Children's Hospital Benefits from Antibiotic Stewardship Program Limiting Carbapenem Use

In a new study conducted in Japan, researchers found that antibiotic resistance, hospital stays, and infection-related deaths all dropped with the implementation of a pediatric antimicrobial stewardship program in a Tokyo hospital.

The World Health Organization (WHO) calls antibiotic resistance one of the biggest global health threats of our time, a problem fueled by the misuse of antibiotics. As bacteria have become more resistant to antibiotic treatments, the public health sphere has experienced higher medical costs, hospital stays, and infection-related mortality. Antibiotic-resistant infections in children are of particular concern, notes the Centers for Disease Control and Prevention (CDC), as this age group has a higher rate of antibiotic use than adults. A study published earlier this year found that antibiotic resistance has become a growing problem in children’s hospitals in the United States, with certain multidrug-resistant infections up by 700%. Antibiotic stewardship programs in hospitals aim to limit the misuse and overprescribing of antibiotics to stem the problem of resistant superbugs and hard-to-treat infections.

Researchers from the Tokyo Metropolitan Children’s Medical Center conducted a study that assessed a pediatric antibiotic stewardship program at the hospital. The study, which was recently published in the International Journal of Infectious Diseases, examined carbapenem resistance rates, the length of hospital stays, and infection-related mortality rates during the pre-intervention period from April 2010 to September 2011, and the post-intervention period from October 2011 to March 2017.

“A large proportion of children receive medical care due to infections including viral, bacterial, some fungal, and others. In the era of antimicrobial resistance, appropriateness of antimicrobial treatment is extremely important,” said senior author Yuho Horikoshi, MD, in an interview with Contagion^®. “Doctors should know when to treat, how to treat and how long to treat in children. Antimicrobial stewardship is a powerful tool for optimizing those issues. We should do our best to spare current antimicrobial choices for the future of our children.”

The antibiotic stewardship program at the hospital included certain limitations on carbapenem prescriptions, pre-authorization for antibiotic prescription, therapeutic drug monitoring service by pharmacy, management manuals for common infectious diseases, and more. Following implementation of the program, the researchers observed a statistically significant decrease in both the carbapenem resistance rate in Pseudomonas aeruginosa and the length of carbapenem therapy, which dropped by 72.2% and 59.3% respectively. Patients’ length of hospital stays decreased from 20.6 days to 18.6 days, and infection-related mortality declined as well.

Dr. Horikoshi attributes the favorable results to the range of interventions included in the hospital’s stewardship program. “There is no one magic that works,” he told Contagion^®. “A bundle of interventions is needed. However, I can tell establishing mutual trust and good communication is the most important key for success in antimicrobial stewardship program regardless of which feature you chose.”

As the research team continues to evaluate the impact of their stewardship program, Dr. Horikoshi notes that his team is also interested in examining oral antimicrobial use in the outpatient setting, where most antibiotics are used.