Strategies, personnel, and diversity of pediatric antimicrobial stewardship programs in the United States: Strategies and composition of US pediatric ASPs

Abstract

Objective: We sought to characterize US pediatric antimicrobial stewardship programs (ASPs), including their hospital demographics, staffing, funded full-time equivalents (FTEs) by hospital size, and relative emphasis on recommended stewardship strategies. We examined the self-reported characteristics of ASP personnel with regard to discipline, race, ethnicity, gender identity, and years of experience in antimicrobial stewardship.

Design: Descriptive two-part survey.

Setting: Pediatric ASPs at hospitals participating in Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS), a pediatric quality improvement collaborative of >70 children's hospitals.

Participants: Survey distributed to 82 US pediatric ASPs, excluding hospitals without pediatric ASPs. Part I completed by ASP leader (physician or pharmacist). Part II distributed to ASP team members.

Methods: Part I addressed hospital demographics, ASP funding, and program choices related to the CDC's 2019 Core Elements of Hospital Antibiotic Stewardship Programs. Part II requested that participants anonymously self-identify race, ethnicity, gender identity, training, and duration of ASP experience. Descriptive statistics performed.

Results: Sixty-two ASPs responded: 61 (98%) with formal ASP, 40 (65%) from freestanding children's hospitals. 40 (65%) co-led by an ASP physician and pharmacist. 60 (97%) reported dedicated inpatient physician FTE, 57 (92%) dedicated inpatient pharmacist FTE. Most programs (35 [58%]) reported inadequate staffing support. The 125 ASP professionals who completed Part II predominantly self-reported as White (89 [71%]), with fewer self-reporting as Asian (9 [15%]) or Black (4 [3%]).

Conclusion: US pediatric ASPs have achieved substantial progress in meeting the CDC Core Elements, but many report insufficient resources. We identified underrepresentation in the ASP workforce.

Figure 1.

Survey responses per American Hospital Association Region. States with programs that responded to the survey are colored and labeled with their corresponding AHA region. Table to right of map reports number of responses per AHA region. ASP, antimicrobial stewardship program; AHA, American Hospital Association.

Figure 2.

Inpatient dedicated full-time equivalents (FTE) for antimicrobial stewardship program staff by hospital size (number of beds), stratified by hospital type. (A) Total inpatient FTE. (B) Inpatient physician FTE. (C) Inpatient pharmacist FTE. ASP, antimicrobial stewardship program; FTE, full-time equivalent.

Figure 3.

Frequency of use of preauthorization (Panel A) or prospective audit and feedback (PAF) by antibiotic class/antibiotic. The percentage displayed for each antibiotic class is the percentage of programs that required preauthorization or performed audit and feedback for any drug within that class. Red denotes increased frequency of use of the strategy, whereas green denotes decreased frequency of use. For individual antibiotics, darker blue denotes increased frequency of use of the strategy, whereas lighter blue denotes decreased frequency of use.