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Implementation of an antimicrobial stewardship program (ASP) was associated with a significant reduction in antibiotic consumption and antimicrobial resistance in children with severe bacterial pneumonia at a pediatric intensive care unit (PICU) in China, researchers reported yesterday in the Journal of Global Antimicrobial Resistance.

In the single-center study, researchers from Beijing Children’s Hospital set out to examine the impact of ASP 2018, a set of guidelines issued by China’s National Health Commission that emphasize strict control of antibiotic use, particularly for vulnerable populations such as children, the elderly, and pregnant women. Under those guidelines, the hospital created a management team of pharmacists, clinicians, infectious disease specialists, microbiologist, and administrators to regularly inspect the use of antibiotics.

To assess the impact of the ASP, the researchers compared resistance rates, antibiotic consumption, and clinical outcomes among children with severe pneumonia in the PICU before and after implementation of the program. The study evaluated data on 287 children, including 165 before the intervention (May 2016 to April 2018) and 122 after the intervention (May 2018 to April 2020).

Decline in resistance rates, antibiotic consumption

After the ASP implementation, Staphylococcus aureus replaced Streptococcus pneumoniae as the predominant gram-positive bacterium and Klebsiella pneumoniae replaced Pseudomonas aeruginosa as the most common gram-negative bacterium. The resistance of S pneumoniae to clindamycin, erythromycin, and tetracycline was significantly reduced, while S aureus resistance to tetracycline was reduced from 59.1% to 32.5% after ASP implementation.

Resistance rates of K pneumoniae to amoxicillin/clavulanic acid and trimethoprim/sulfamethoxazole (SXT), and Acinetobacter baumannii to cefotaxime and SXT, also declined significantly. The isolation rate of multidrug-resistant strains decreased significantly as well, from a high of 16.8% before intervention to 6.7% after intervention.

Meanwhile, total consumption (defined daily doses [DDD] per 100 patient-days) of five antimicrobials (cephalosporins, carbapenems, macrolides, antifungal agents, and linezolid) decreased by 21.9% overall. No increase in length of hospital stay or mortality was observed.

The study authors say that while only a small number of PICUs in China have the staff to implement the ASP, the experience at their hospital “may provide some references for its promotion and application nationwide.”