Improving Antibiotic Use in Pediatric Hospitals in Argentina: A Quality Improvement Study

Abstract

OBJECTIVE: We aimed to achieve a 15% reduction in days of antibiotic therapy (DOT) and a 20% increase in access antibiotic group (narrower spectrum of the World Health Organization classification) units after 24 weeks of implementing an antibiotic stewardship program (ASP) in 2 pediatric hospitals. METHODS: We implemented a quality improvement (QI) initiative preceded by a formative phase to identify barriers and facilitators. The strategy included developing an antibiotic management program, establishing a data management and learning system, and fostering teamwork and effective communication. The intervention spanned 2 learning sessions, each with an action period, and was supported by coaching and QI training. Primary outcomes included DOT per 1000 hospital days and the access antibiotic group use percentage. We examined the implementation of change ideas and adherence to clinical pathways for process measures using mortality rates as a balancing measure. Run charts tracked follow-up outcomes, with control charts employed once sufficient data points were collected. RESULTS: We gathered data from 249 patients during the baseline period (BP) (Jan 2022 to June 2022) and from 588 patients during the implementation period (IP) (July 2022 to January 2023). The IP group included younger patients with higher rates of acute lower respiratory tract infections and more severe clinical conditions. Access antibiotic group consumption was 30.7% in BP and 37.9% in IP. Concerning antibiotic DOT, throughout time, we observed variable results with many points outside the control limits, with an average of 854 in BP and 1068 in IP. CONCLUSION: The QI initiative demonstrated that ASP implementation in pediatric hospitals was associated with antibiotic narrow-spectrum selection.