Pediatric Inpatient Antimicrobial Stewardship Program Safely Reduces Antibiotic Use in Patients with Bronchiolitis Caused by Respiratory Syncytial Virus: A Retrospective Chart Review

Abstract

Introduction: Bronchiolitis is a common lower respiratory tract illness in young children often caused by the respiratory syncytial virus (RSV). Antimicrobials are not recommended in infants with bronchiolitis unless there is strong evidence that a bacterial coinfection exists. Methods: We conducted a retrospective chart review comparing antimicrobial use and outcomes in previously healthy infants ≤24 months of age with RSV bronchiolitis at a single Canadian tertiary pediatric hospital during RSV seasons (December-April) from 2011 to 2016. An audit and feedback antimicrobial stewardship program was introduced in this hospital in August 2014. Results: Compared with the 2011-2012 cohort, the 2015-2016 cohort showed a decrease of 46% in mean days of therapy per 1,000 patient-days in the >28 days old age group of patients. There was also a 15.1% absolute reduction in the proportion of patients who received any antimicrobials in the hospital between the 2 cohorts (neonates included). The proportion of patients receiving antimicrobial prescriptions at discharge also decreased from 33.5% to 19%. The use of second-generation cephalosporins was eliminated in the 2016 cohort. There was a significant decrease in length of stay between the 2011-2012 and 2015-2016 cohorts, and no readmissions were documented. Conclusions: This study adds to the accumulating literature that antimicrobial stewardship program interventions along with guidelines and order sets can safely contribute to a reduction in antimicrobial use both in hospital and at discharge in children <2 years of age hospitalized due to RSV. Further research in identifying those who would or would not benefit from antibiotics should be promoted.