Pediatric Inpatient Antimicrobial Stewardship Program Safely Reduces Antibiotic Use in Patients with Bronchiolitis Caused by Respiratory Syncytial Virus: A Retrospective Chart Review
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".