Pharmacist-led antimicrobial stewardship program in the treatment of bacteraemia in paediatric patients: a multivariate analysis.

BACKGROUND

Care bundles are a recognised strategy to improve treatment. When managed through an Antimicrobial Stewardship Program (ASP) based on the pharmacist-led program model, care bundles can be an effective tool to guide decision making in clinical practice and to improve patient outcomes. This study aimed to evaluate the results of a pharmacist-led ASP which included a care bundle based on clinical outcomes of bacteraemia (SAB) in a paediatric hospital.

METHODS

A retrospective cohort study with multivariate analysis was conducted in a paediatric hospital in Brazil. The study comprised 120 paediatric patients with a positive blood culture for with occurred between 2014 and 2021 and clinical and laboratory results consistent with infection. The study was classified into two periods: pre-intervention (n=44) and intervention (n=76). A pharmacist-led ASP program with a care bundle was established during the intervention period 2017-2021. The primary outcome assessed was the impact on clinical outcomes, including infection-related mortality and 90-day reinfection rate, both being considered therapeutic failure.

RESULTS

The multivariate analysis demonstrated that the following variables had an impact on primary outcome: infant patients [Odds ratio (OR) 12.998, =0.044]; use of more than three antimicrobial treatment regimens [OR 0.006, =0.017]; intervention period [OR 0.060, =0.034]; bundle item 1 - follow-up blood culture [OR 18.953, =0.049]; bundle item 2 - early source control [OR 0.002, =0.018]; bundle item 4 - de-escalation to oxacillin for methicillin-sensitive [OR 0.041, =0.046].

CONCLUSIONS

The pharmacist-led ASP model showed an increase in adherence to the care bundle between the two study periods, with reduced probability of a negative outcome. Furthermore, risk factors for bacteraemia were identified that may inform management and contribute to better patient outcomes in the paediatric population.