Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Clincal and Chemical Pathology

Background and objective: There is high antibiotics use in pediatric intensive care units (PICU) which could result into emergence of antibiotic resistance, spread of infections caused by multidrug resistant organisms, bad clinical outcome of patients, increase length of stay in hospitals, and increase drugs expenditure. The objective of this study was to set clinical practice guidelines customized according to local epidemiology of diseases and local cumulative antimicrobial susceptibility and implement ASP in the PICU and evaluate the ASP in optimizing antibiotics use, decreasing antibiotics expenditure, improving antimicrobial resistance patterns, decreasing patients{u2019} length of therapy and length of stay, and improving their clinical outcomes. Methods: A prospective study was conducted on a PICU in the Specialized Pediatric Hospital, Cairo University, to compare the pre-ASP implementation phase (April-September 2016) and the post-ASP implementation phase (January-June 2017). The antimicrobial stewardship team set facility-specific clinical practice guidelines and implemented the ASP through preauthorization and prospective-audit-with-feedback. Then the ASP was evaluated through measuring adherence of physicians to the guidelines, ASP interventions and recommendations and acceptance of them, the overall rate of mortality, length of stay (LOS), drug costs, antibiotics days of therapy (DOT), and length of therapy (LOT)

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