A whole of country analysis of antimicrobial stewardship resources, activities and barriers for children in Australian hospitals pre- and post COVID-19.

BACKGROUND/AIM: We aimed to assess and identify any gaps in antimicrobial stewardship (AMS) resources and activities for all hospitalised children in Australia pre- and post- the COVID-19 pandemic.

METHODS

A comprehensive data collection tool adapted from a 2014 study of tertiary paediatric hospitals by the ANZPID-ASAP group, was applied in 2017 and 2024. Every public hospital with paediatric inpatients was included. The most appropriate representative for paediatric AMS at each hospital provided information.

RESULTS

There are 106 hospitals treating children in Australia and data was completed for 100%. Paediatric beds ranged from three to 360, with a total of 4142 beds. Seventeen (35%) tertiary/metropolitan hospitals had paediatric AMS, compared with five (9%) regional/rural hospitals (P=0.001). There was an AMS pharmacist in 38 (81%) tertiary/metropolitan compared with 27 (53%) regional/rural hospitals (P=0.003). Fifty-one (48%) hospitals had local paediatric empirical antibiotic guidelines, fewer had specialty guidelines. One hundred and two (96%) hospitals had restrictions on broad-spectrum antimicrobials, though formal approval systems were fewer: 44 (90%) tertiary/metropolitan versus 35 (66%) regional/rural hospitals (P=0.004). AMS education was poor: 25 (24%) hospitals provided education for senior physicians, 24 (23%) had none for any staff. The commonest barriers to successful AMS were lack of infectious diseases and microbiology services (N = 64 (60%)), dedicated pharmacists (N = 62 (59%)), and education for clinicians (N = 53 (50%)). Little has changed since the COVID-19 pandemic.

CONCLUSION

There are large gaps in paediatric-specific AMS resources and expertise, particularly in regional and rural hospitals. Increased resourcing, paediatric AMS education for clinicians and improved sharing of guidelines/resources are vital to ensure all hospitalised children receive optimal care.