Stewardship Cuts IV Treatment for Paediatric Bone Infections

TOPLINE:

A hospital-based antimicrobial stewardship program (ASP) using post-prescription review and feedback (PPRF) significantly decreased intravenous (IV) antibiotic duration, length of hospital stay, and reliance on third-generation cephalosporin in paediatric bone and joint infections over 5 years.

METHODOLOGY:

• This single-centre, quasi-experimental study evaluated the effect of a PPRF-based multifaceted ASP on antibiotic use, treatment duration, and length of hospital stay in paediatric acute haematogenous bone and joint infections (AH-BJIs).
• This study included 285 children: 60 in the pre-ASP (2015-2016; mean age, 1.9 years; 50% boys) and 225 in the post-ASP (2017-2023; mean age, 2.9 years; 67.5% boys).
• Data on demographics, clinical features, microbiology, and treatment were collected from electronic medical records.
• Primary outcomes were parenteral/oral antibiotic duration, length of hospital stay, and clinical outcomes (sequelae, readmission, and mortality).

TAKEAWAY:

• The median IV antibiotic duration and length of hospital stay in children with AH-BJIs were both significantly reduced after ASP implementation, dropping from 8.5 (interquartile range [IQR], 7.0-12.0) to 7 (IQR, 4.5-8.0) days and from 8.5 (IQR, 7.0-11.0) to 7 (IQR, 5.0-9.0) days, respectively (P < .001 for both).
• Post-2020, broad-spectrum antibiotic use significantly declined, with third-generation cephalosporin use fell from 81% to 10% in children aged 5 years or younger and cloxacillin use declined by 60.0% in children older than 5 years in favour of narrower spectrum cefazolin (P < .001 for both).
• Methicillin-susceptible Staphylococcus aureus was the most common pathogen (22.8%), followed by Kingella kingae (10.9%), which was found in only children younger than 4 years. Blood cultures were positive in 29.3% of cases.
• Among 52 children with soft-tissue/subperiosteal abscesses (46 occurring post-ASP), the median oral antibiotic duration was 41 days, with total treatment lasting 47 days; the ASP maintained safety, with no increase seen in sequelae (6.3% overall), readmissions (3.3% in the pre-ASP vs 3.6% in the post-ASP), and mortality (0%).

IN PRACTICE:

“After ASP implementation, the length of parenteral antibiotic treatment, length of hospital stay, and 3rd generation cephalosporin use in children with AH-BJI were reduced safely,” the authors wrote.

SOURCE:

This study was led by Aina Font, Pharmacy Department, Consorci Hospitalari de Vic, Vic, Spain. It was published online on June 18, 2025, in the European Journal of Pediatrics.

LIMITATIONS:

This single-centre study had several limitations, such as the unbalanced sample size and inclusion of neonates, which may have affected generalisability; the findings based on local epidemiology may not apply to other settings. This study did not evaluate treatment days per 1000 admissions, cost-effectiveness, COVID-19 impact, diagnostic advances, and staff turnover effects, nor it systematically monitor prescriber adherence or satisfaction with the stewardship program.

DISCLOSURES:

No funding was secured for this study. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.