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Clinical Diagnoses and Antimicrobials Predictive of Pediatric Antimicrobial Stewardship Recommendations: A Program Evaluation

  • Jennifer L. Goldman (a1), Brian R. Lee (a2), Adam L. Hersh (a3), Diana Yu (a4), Leslie M. Stach (a5), Angela L. Myers (a1), Mary Anne Jackson (a1), James C. Day (a1), Russell J. McCulloh (a1) and Jason G. Newland (a1)...



The number of pediatric antimicrobial stewardship programs (ASPs) is increasing and program evaluation is a key component to improve efficiency and enhance stewardship strategies.


To determine the antimicrobials and diagnoses most strongly associated with a recommendation provided by a well-established pediatric ASP.


Retrospective cohort study from March 3, 2008, to March 2, 2013, of all ASP reviews performed at a free-standing pediatric hospital.


ASP recommendations were classified as follows: stop therapy, modify therapy, optimize therapy, or consult infectious diseases. A multinomial distribution model to determine the probability of each ASP recommendation category was performed on the basis of the specific antimicrobial agent or disease category. A logistic model was used to determine the odds of recommendation disagreement by the prescribing clinician.


The ASP made 2,317 recommendations: stop therapy (45%), modify therapy (26%), optimize therapy (19%), or consult infectious diseases (10%). Third-generation cephalosporins (0.20) were the antimicrobials with the highest predictive probability of an ASP recommendation whereas linezolid (0.05) had the lowest probability. Community-acquired pneumonia (0.26) was the diagnosis with the highest predictive probability of an ASP recommendation whereas fever/neutropenia (0.04) had the lowest probability. Disagreement with ASP recommendations by the prescribing clinician occurred 22% of the time, most commonly involving community-acquired pneumonia and ear/nose/throat infections.


Evaluation of our pediatric ASP identified specific clinical diagnoses and antimicrobials associated with an increased likelihood of an ASP recommendation. Focused interventions targeting these high-yield areas may result in increased program efficiency and efficacy.

Infect Control Hosp Epidemiol 2015;00(0): 1–8


Corresponding author

Address correspondence to Jennifer Goldman, MD, Department of Pediatrics, Divisions of Pediatric Infectious Diseases & Clinical Pharmacology, Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108 (


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Presented in part: IDWeek; Philadelphia, Pennsylvania; October 9, 2014; abstract 46704.



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