Antimicrobial stewardship resources and activities for children in tertiary hospitals in Australasia: a comprehensive survey

OBJECTIVE: To identify current antimicrobial stewardship (AMS) resources and activities for children in hospitals throughout Australasia, to identify gaps in services.

DESIGN, SETTING AND PARTICIPANTS: Tertiary paediatric hospitals (children's hospitals and combined adult and paediatric hospitals that offer tertiary paediatric care) in every state and territory of Australia and the North and South Islands of New Zealand were surveyed in June 2013 regarding AMS resources and activities.

MAIN OUTCOME MEASURE: A description of AMS resources and activities for children in tertiary hospitals.

RESULTS: We surveyed 14 hospitals, with paediatric bed numbers ranging from 40 to 300. Seven had a dedicated paediatric AMS team or AMS team with a paediatric representative and 11 had an AMS pharmacist position, although only four had committed ongoing funding for a permanent paediatric AMS pharmacist and only two had committed funding for a paediatric infectious diseases physician for AMS. All hospitals had empirical antimicrobial prescribing guidelines, and all 10 hospitals with haematology and oncology services had febrile neutropenia guidelines. However, most did not have guidelines for antifungal prophylaxis, surgical prophylaxis, neonatology or paediatric intensive care. All hospitals had restricted drugs but only four had electronic approval systems. Auditing methods differed widely but were mostly ad hoc, with results fed back in an untargeted way. There was a paucity of AMS education: no hospitals provided education for senior medical staff, and four had no education for any staff. The commonest perceived barriers to successful AMS were lack of education (11 hospitals) and lack of dedicated pharmacy (eight) and medical (seven) staff.

CONCLUSIONS: Australasian paediatric hospitals have implemented some AMS activities, but most lack resources. There was consensus among the staff who completed our survey that barriers to successful AMS include lack of education and lack of personnel.