Evaluation of the Clinical Impact of the Antimicrobial stewardship Program at Gertrude’s Children’s Hospital 2014-2021

Abstract

Background: Inappropriate use of antimicrobials is becoming a significant issue, particularly in low- and middle-income countries, contributing to antimicrobial resistance. As a response, there is a growing emphasis on implementing antimicrobial stewardship programs in hospitals to address the increasing antimicrobial resistance. Limited research has been conducted to assess the clinical effects of pediatric antimicrobial stewardship programs, particularly in the African context. Objective: The main objective of the study was to evaluate the effectiveness and clinical outcomes following the implementation of the antimicrobial stewardship program at Gertrude’s Children’s Hospital. This included analyzing the impact on antibiotic usage and patient outcomes. Methodology: The study design was a hospital-based pre-post quasi-experimental study. The pre-phase period was four years before implementation of the program and the post phase was four years after implementation of the program. The study population was pediatric patients admitted to the hospital with a diagnosis of any bacterial infections and on antibiotics. Data was abstracted from patient electronic records and entered in an Excel version 10 spreadsheet. The measures of clinical impact included antibiotic prescribing patterns, duration of stay in the hospital, prevalence of hospital readmissions, and mortality rates. Data was analyzed using R version 4.3.1. Categorical variables were summarized using frequencies and percentages, while continuous variables were assessed for normality using the Shapiro-Wilk test. Unpaired t-tests were employed to compare the two study periods. Regression analysis was conducted on the length of stay variable, utilizing negative binomial regression due to its right-skewed Poisson nature. Results: Following the implementation of antimicrobial stewardship, there was an increase in the utilization of antibiotics from the Access group, while there was a slight decrease in the use of antibiotics from the Watch group. Interestingly, cefuroxime remained the most frequently prescribed antibiotic throughout both study periods. The median length of hospital stay remained consistent at 3.00 days [IQR 2.00, 5.00] before and after the implementation of ASP. However, a statistically significant difference (p<0.001) between the two periods was observed. Additionally, despite an increase in readmissions post-ASP, this difference was not statistically significant (p= 0.4). xv Fewer deaths were reported post-ASP versus pre-ASP (44% versus 56%) and the difference was statistically significant (p<0.001). Conclusion: This study established that there was no significant difference in the median LOS in the days following the implementation of the ASP at Gertrude’s Children’s Hospital. It was noted that LOS was affected by the patient's age group, diagnosis, and causative organism. Mortality attributed to infections reduced post-implementation of ASP. There was an increase in readmissions post-ASP. The study revealed a marginal decrease in the utilization of WATCH antibiotics and a concurrent increase in the usage of ACCESS antibiotics, while the overall usage of WATCH antibiotics remained high. Overall, this study demonstrated that these programs offer meaningful benefits thus giving reasons to promote a wider adoption of these programs