Published: Oct 9, 2014 | Updated: Oct 10, 2014
PHILADELPHIA -- Following the recommendations of anantibiotics stewardship team reduced the readmission rate among pediatrics patients without increasing their time in the hospital, researchers said here.
Among 176 children treated for nonchronic complex care issues and without underlying medical conditions, none were readmitted within 30 days if the physician accepted the recommendation of the pharmacist-physician antibiotics stewardship team, reported Jason Newland, MD, of Children's Mercy Hospital-Kansas City in Missouri, and colleagues.
In comparison, among the 88 children whose doctors rejected the recommendations, 3.4% required readmission, they said at the annual IDWeek conference.
Newland noted that the difference was statistically significant although his group did not calculate P-values.
The pattern was similar among children who had chronic complex care issues. Of the 149 children whose doctors accepted the recommendations regarding use of antibiotics, there was no 30-day readmission. However, among the children whose doctors said No to the recommendations, the readmission rate was 2.6%, Newland said.
"We are only talking about two or three new admissions," he acknowledged, "but there was none" in the groups where the recommendations were explained and were accepted by the doctors.
Pranita Tamma, MD, who moderated the IDWeek press briefing where the study results were presented, toldMedPage Today that "antimicrobial stewardship programs generally consist of a physician and a pharmacist who oversee, guide, and educate clinicians in their institutions about the appropriate use of antibiotics. The goal of every stewardship program in the U.S. is to ensure that every patient who requires an antibiotic receives the right drug, the right dose, by the right route, and for the right duration of time."
The study of the audit with feedback antimicrobial stewardship program was done from 2008 to 2013. Patients were stratified by complex chronic care codes. Primary outcomes were recommendation versus no recommendation, and agree versus disagree with the recommendation.
Most of the recommendations were to stop antibiotics, either because the children were infected with viruses or because they were being treated with redundant antibiotics, Newland said.
"Generally, treating with more than one antibiotic does not improve outcomes," he said. The second most frequent recommendation was that the treating doctor consult with an infectious diseases specialist.
Among more than 7,000 patient reviews, 18% received a recommendation and disagreement occurred in 18%, the group reported.
The length of stay was similar when evaluated by recommendation or disagreement. For instance, for noncomplex chronic care, the length of stay was around 50 hours for both groups.
Newland pointed out that "while the length of stay was similar, it is important to show that our interventions from our stewardship program didn't make a child's stay longer. More importantly, it prevented kids from coming back to the hospital. For parents, families, and others that are involved in the care of children, that is important."
Newland told MedPage Today that many doctors who did not accept the recommendations said they did not want to consult with other clinicians. Several doctors expressed concerns that the stewardship recommendations had a negative impact on their autonomy.
The study had some limitations, including the fact that it was done at a single center. Also, some patients may have been readmitted at a difference hospital.
Tamma, an assistant professor of pediatric infectious diseases at Johns Hopkins Hospital, said, "the work of Dr. Newland and colleagues is particularly exciting because, until now, no data existed to demonstrate the clinical impact of pediatric antimicrobial stewardship programs."
She noted that the CDC estimates that almost 2 million antibiotic resistant infections occur annually in the U.S. The overuse and misuse of antibiotics has made almost all disease-causing bacteria resistant to some of the antibiotics used to treat them.
"To add to this, pharmaceutical development, which previously kept ahead of antibiotic resistance, has significantly decelerated and many of us worry that in the future lies a post-antibiotic era," Tamma said.
"With this being the case, it is essential that we optimize the use of existing antibiotics, and this can only be effectively achieved by implementation of antimicrobial stewardship programs across the U.S.," she said.
"Ultimately, we believe that this improves the care of children while decreasing the unintended consequences of antibiotic overuse, including allergic reactions, severe diarrheal illnesses, hearing loss, kidney and liver damage, and, of course, antibiotic resistance," she stated.
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