Pharmacist-led Antimicrobial Stewardship Program in the Treatment of Bacteraemia in Paediatric Patients: a Multivariate Analysis

Overview

Journal Infect Prev Pract

Specialty Infectious Diseases

Date 2024 Dec 18

PMID 39691838

Authors

Stella Caroline Schenidt Bispo da Silva

Mariana Millan Fachi

Marinei Campos Ricieri

Fabio de Araujo Motta

Affiliations

Soon will be listed here.

Abstract

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.

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