A whole of country analysis of antimicrobial stewardship resources, activities and barriers for children in Australian hospitals pre- and post COVID-19

Abstract

Background/aim: We aimed to assess and identify any gaps in antimicrobial stewardship (AMS) resources and activities for all hospitalised children in Australia pre- and post- the COVID-19 pandemic.

Methods: A comprehensive data collection tool adapted from a 2014 study of tertiary paediatric hospitals by the ANZPID-ASAP group, was applied in 2017 and 2024. Every public hospital with paediatric inpatients was included. The most appropriate representative for paediatric AMS at each hospital provided information.

Results: There are 106 hospitals treating children in Australia and data was completed for 100%. Paediatric beds ranged from three to 360, with a total of 4142 beds. Seventeen (35%) tertiary/metropolitan hospitals had paediatric AMS, compared with five (9%) regional/rural hospitals (P=0.001). There was an AMS pharmacist in 38 (81%) tertiary/metropolitan compared with 27 (53%) regional/rural hospitals (P=0.003). Fifty-one (48%) hospitals had local paediatric empirical antibiotic guidelines, fewer had specialty guidelines. One hundred and two (96%) hospitals had restrictions on broad-spectrum antimicrobials, though formal approval systems were fewer: 44 (90%) tertiary/metropolitan versus 35 (66%) regional/rural hospitals (P=0.004). AMS education was poor: 25 (24%) hospitals provided education for senior physicians, 24 (23%) had none for any staff. The commonest barriers to successful AMS were lack of infectious diseases and microbiology services (N = 64 (60%)), dedicated pharmacists (N = 62 (59%)), and education for clinicians (N = 53 (50%)). Little has changed since the COVID-19 pandemic.

Conclusion: There are large gaps in paediatric-specific AMS resources and expertise, particularly in regional and rural hospitals. Increased resourcing, paediatric AMS education for clinicians and improved sharing of guidelines/resources are vital to ensure all hospitalised children receive optimal care.

Keywords: Antibiotics; Antimicrobial; Audit; Benchmarking.