Impact of paediatric antimicrobial stewardship program in haematogenous bone and joint infections

Abstract

Antimicrobial stewardship programs (ASP) reduce the inappropriate use of antimicrobial agents. Traditionally, paediatric osteoarticular infections have been treated with prolonged intravenous antibiotics; however, evidence suggests that shorter intravenous therapy followed by oral narrow-spectrum antibiotics is effective. The aim of this study is to assess the impact of an ASP on the treatment of acute haematogenous bone and joint infections (AH-BJI) in children.We performed a single-centre quasi-experimental study comparing antibiotic use in paediatric [0-18 years] inpatients with AH-BJI before (2015-2016 period 1 [P1]) and after (2017-june 2023 period 2 [P2]) the implementation of a multifaceted hospital ASP with post-prescription review with feedback as the primary strategy. ASP also promoted a first-line empiric antibiotics change in the local protocol in June 2020. The study describes and compares the demographic and clinical characteristics among patients who were recruited prospectively during their hospital admission or in outpatient clinics. The primary outcomes were the length of antibiotic therapy, length of hospital stay, sequelae, readmission and fatality rates. Two-hundred-eighty-five patients were included (60 in P1 and 225 in P2). The length of parenteral antibiotic treatment and the length of hospital stay were significantly lower in P2 (median [IQR] days, P1: 8.5[7.0-12.0] vs P2: 7[4.5-8.0], p < 0.001; and P1: 8.5[7.0-11.0] vs P2: 7[5.0-9.0], p < 0.001, respectively). After June 2020, 3rd generation cephalosporin use decreased in patients < 5 years old (96/119[81%] vs 6/57[10%] cases; p < 0.001). The rates of sequelae, readmission (2/60[3.3%] in P1 and 8/225[3.6%] in P2) and mortality remained unchanged.

Conclusion: After ASP implementation, the length of parenteral antibiotic treatment, length of hospital stay, and 3rd generation cephalosporin use in children with AH-BJI were reduced safely.

What is known: • Antimicrobial Stewardship Programmes (ASPs) have been shown to be effective for optimising antibiotic prescriptions and reducing antimicrobial resistance. There is still limited literature about ASPs in the paediatric population. • Paediatric bone and joint infections were traditionally treated with prolonged intravenous antibiotics. However, current evidence suggests that shorter intravenous therapy followed by oral narrow-spectrum antibiotics is equally effective.

What is new: • Implementing an ASP with post-prescription review with feedback as main strategy, in a tertiary paediatric hospital, safely reduced the duration of intravenous treatment and length of hospital stay for children with acute haematogenous bone and joint infections (AH-BJI). • The ASP helped to reduce the use of 3rd generation cephalosporin in children with AH-BJI.

Keywords: Antibiotics; Bone and joint infections; Infectious diseases; Paediatric care.