Clinical Diagnoses and Antimicrobials Predictive of Pediatric Antimicrobial Stewardship Recommendations: A Program Evaluation

Hospital-based antimicrobial stewardship programs (ASPs) have proven effective in improving the judicious use of antimicrobial therapy.1–3 Stewardship strategies have demonstrated the ability to decrease inappropriate antibiotic use, enhance targeted therapy, reduce the duration of antibiotic therapy, and enhance patient safety, all resulting in cost savings.2,4–9 Multiple professional organizations recommend ASPs in order to promote appropriate antimicrobial use and the implementation of stewardship programs in pediatric settings is growing.10–12 However, few data exist on the evaluation of stewardship program resource utilization and the extent to which a pediatric ASP provides actual recommendations to prescribing clinicians. A better understanding of these factors could improve the efficiency and resource utilization of ASPs. Previously, we described the impact of our prospective audit with recommendation and feedback (PAF) ASP. A decrease in hospital-wide antimicrobial utilization occurred following implementation of the program.5 However, the frequency of ASP reviews and associated recommendations by our program have not fully been evaluated. In order to better understand the factors that are either barriers or facilitators to effective stewardship implementation, we sought to conduct an evaluation that identified the predictors of an ASP recommendation. The primary objective of this study was to determine the antimicrobials and diagnoses most strongly associated with a PAF recommendation. The secondary objective was to determine the likelihood of recommendation agreement by the prescribing clinician.