Fran Lowry

July 06, 2015

A pilot antimicrobial stewardship program in a pediatric long-term care facility reduced the use of the topical antibiotic mupirocin (multiple brands) by more than 50% and eliminated the majority of the orders for antibiotics that were issued without proper documentation during a 6-month period.

"The pediatric long-term care population is understudied, and we need data to inform our decision-making in the management of infections in pediatric long-term care," Olivia Jackson, RN, from the Elizabeth Seton Pediatric Center, in Yonkers, New York, told Medscape Medical News.

"Antimicrobial stewardship programs have been shown to decrease the length of hospitalization and risk of readmission in pediatric acute-care facilities and decrease morbidity and mortality. Our children suffer from many chronic health conditions, and any way that we can reduce the potential for antibiotic resistance will be beneficial for them in the long run," Jackson said at the Association for Professionals in Infection Control and Epidemiology (APIC) 2015 Annual Meeting, in Nashville, Tennessee.

Her team noticed that certain antibiotics were being prescribed for a prolonged period, and for reasons other than infection. They decided to launch a trial program to improve antibiotic prescribing and reduce the risk for antibiotic-resistant infections in their vulnerable patient population.

The team conducted monthly audits of all antibiotics that were ordered at their 137-bed facility for the 6-month period. They met regularly with physicians, pharmacists, nurses, and administrators to review the data and enlisted staff support to reduce inappropriate antibiotic prescribing.

Olivia Jackson

The program was designed to decrease the number of prescriptions without a documented indication and to decrease the use of mupirocin for noninfectious conditions, such as skin rashes and abrasions.

They compared outcomes in the first 3 months of the program with those in the second 3 months to assess effectiveness.

From the first to the second 3-month period, there was a 59% decrease in mupirocin use and an 83% decrease in orders without an indication. By the end of the 6-month period, all mupirocin orders were for appropriate indications.

"Before we transitioned to an electronic medical records system, our providers often failed to document a reason for antibiotic prescriptions or failed to discontinue treatment when an appropriate duration had been completed," Jackson said.

"With a new barrier built into the electronic medical records, providers are required to document the specific condition that dictates the need for the antibiotic they want to order. Once this was in place, there was a sharp decline in prescription numbers," she reported.

"Antimicrobial resistance is a major public health issue of our time," said Irena Kenneley, PhD, from the Frances Payne Bolton School of Nursing at Case Western Reserve University, in Cleveland, Ohioi.

"Programs like this are critical to promoting correct and optimal antibiotic prescribing practices in all healthcare settings," she told Medscape Medical News.

 
Antimicrobial resistance is one of the most pressing issues facing healthcare today. Dr Mary Lou Manning
 

"I hope this study will encourage others in long-term care facilities to find ways to develop easy-to-implement, effective antimicrobial stewardship programs," Dr Kenneley added.

"Poor antibiotic prescribing practices put patients at risk for superresistant infections for which there are few treatment options," Mary Lou Manning, PhD, from the Thomas Jefferson University School of Nursing, in Philadelphia, Pennsylvania, said in a statement.

"Antimicrobial resistance is one of the most pressing issues facing healthcare today, and programs that steward the correct use of antibiotics, such as the pilot program described in this abstract, are a vital strategy to protect our patients in the future," said Dr Manning, who is president of APIC.

Dr Manning represented APIC at a recent White House forum on antibiotic stewardship, which was convened by the Obama administration to discuss activities that would ensure the responsible use of antibiotics.

"According to the Centers for Disease Control and Prevention, every year at least 2 million people become infected with antibiotic-resistant bacteria, and at least 23,000 people die as a direct result of these infections. We must ensure that antibiotics are used appropriately and wisely," she said.

Olivia Jackson, Dr Kenneley, and Dr Manning have disclosed no relevant financial relationships.

Association for Professionals in Infection Control and Epidemiology (APIC) 2015 Annual Meeting: Abstract 82176. Presented June 27, 2015.

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