The effect of Antibiotic Stewardship targeted against vancomycin and carbapenems in pediatric intensive care unit of Doctor Sheikh hospital

The inappropriate use of Broad- Spectrum antimicrobials in intensive care units (ICU) is a universal problem. The main goal of this study was to implement antibiotic stewardship program (ABS) concentrated on vancomycin and carbapenems، in pediatric ICU (PICU) of Sheikh hospital. As an accessory purpose we looked for the effect of ABS on the rate of antibiotic administration، length of hospital stay and mortality This study was performed in 2 stages، at the first phase; we determined the causes of nosocomial sepsis and their antibiotic (AB) resistance pattern in the PICU، and then according to those findings a guideline for administration of vancomycin and carbapenems was performed. In the second stage the files of PICU patients were reviewed every other day (for 3 months)، and recommendations about the compatibility of the prescriptions with the guideline were given to the responsible doctor. At the end، we compared the effects of the intervention with one month of prospective record of AB prescriptions without any recommendation. We recorded 1676 and 673 patient/days during 3 month of ABS and 1 month of control. During ABS period، vancomycin use decreased from 294 to 178 for 1000 patient/days (P=0. 001)، carbapenems administration changed from 433 to 193 for 1000 patient/ days (P=0. 001)، the LHS decreased from 11. 4 to 8. 4 days (P=0. 06) and mortality rate decreased from 10. 2% to 7% (P=0. 4). In a situation like Dr Sheikh PICU، implementation of ABS for vancomycin and carbapenems hasafavorable effect on AB usage rate.