McPherson Christopher, Lee Brian R, Terrill Cindy, Hersh Adam L, Gerber Jeffrey S, Kronman Matthew P, Newland Jason G
Department of Pharmacy, St. Louis Children's Hospital, 1 Children's Place, St. Louis, MO 63110, USA.
Department of Pediatrics, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA.
Antibiotics (Basel). 2018 Jan 25;7(1):4. doi: 10.3390/antibiotics7010004.
In response to the growing epidemic of antibiotic-resistant bacterial infections, antimicrobial stewardship programs (ASP) have been rapidly implemented in the United States (US). This study examines the prevalence of the Centers for Disease Control and Prevention's (CDC) seven core elements of a successful ASP within a large subset of US Children's Hospitals. In 2016, a survey was conducted of 52 pediatric hospitals assessing the presence of the seven core elements: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. Forty-nine hospitals (94%) had established ASPs and 41 hospitals (79%) included all seven core elements. Physician accountability (87%) and a dedicated ASP pharmacist or drug expert (88%) were present in the vast majority of hospitals. However, substantial variability existed in the financial support allotted to these positions. This variability did not predict program actions, tracking, reporting, and education. When compared with previous surveys, these results document a dramatic increase in the prevalence and resources of pediatric stewardship programs, although continued expansion is warranted. Further research is required to understand the feasibility of various core stewardship activities and the impact on patient outcomes in the setting of finite resources.
为应对抗生素耐药性细菌感染的不断蔓延,美国迅速实施了抗菌药物管理计划(ASP)。本研究调查了美国儿童医院的一个大子集中疾病控制与预防中心(CDC)成功实施ASP的七个核心要素的流行情况。2016年,对52家儿科医院进行了一项调查,评估七个核心要素的存在情况:领导承诺、问责制、药物专业知识、行动、跟踪、报告和教育。49家医院(94%)已建立ASP,41家医院(79%)包含所有七个核心要素。绝大多数医院都有医师问责制(87%)和专门的ASP药剂师或药物专家(88%)。然而,分配给这些职位的财政支持存在很大差异。这种差异并不能预测计划的行动、跟踪、报告和教育。与之前的调查相比,这些结果表明儿科管理计划的普及率和资源有了显著增加,尽管仍需继续扩大。需要进一步研究以了解各种核心管理活动的可行性以及在资源有限的情况下对患者结局的影响。