(1279) Improving Antimicrobial Stewardship in a Community Pediatric Intensive Care Unit

Introduction: Antimicrobial misuse leads to antibiotic resistance, a global health threat. Antimicrobial stewardship programs (ASP) improve patient outcomes by reducing prescribing errors, drug toxicities, and Clostridioides infections. An ASP in our community pediatric hospital was established in January 2023; comprised of infectious disease faculty, clinical pharmacists, and pediatric intensivists. Our aim was to reduce the number of antibiotic days of therapy per 1000 patient days in the ICU setting by 15% by June 2023.

Methods: We collected antimicrobial use data in our PICU for two years prior to and during ASP interventions. We conducted didactic review of guidelines and initiated in-person and virtual ASP rounds to provide feedback on antimicrobial use. After meeting key stakeholders to address barriers to accepting ASP recommendations, we identified focal points for ASP recommendations: (1) discontinue antibiotics for viral bronchiolitis, (2) discontinue broad spectrum coverage for uncomplicated community acquired pneumonia (CAP), (3) treat non-severe CAP for five days, and (4) de-escalate unnecessary antimicrobial use after a negative 48-hour sepsis evaluation.

Results: At the start of this program, 23% of virtual ASP recommendations were accepted by PICU teams compared to 89% for hospital medicine and 100% for surgery teams. After targeted education and use of in-person ASP rounds, ASP acceptance rates in the PICU increased to 90%. The most common ASP recommendations were drug change for CAP (61%), and discontinuation of antibiotics for viral bronchiolitis (27%). Following ongoing ASP activities, PICU antimicrobial use has decreased from a median of 18 to 14 days of therapy per 1000 patient days (22% absolute reduction). No patients had worsening clinical status 48 hours after ASP recommendations were accepted.

Conclusions: Inviting stakeholders to improvement initiatives, adapting communication methods, and targeting populations with high antimicrobial misuse improved antimicrobial use in our community PICU hospital setting.