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The North Wind and the Sun: Pediatric Antimicrobial Stewardship Program Combining Restrictive and Persuasive Approaches in Hematology-Oncology Ward and Hematopoietic Stem Cell Transplant Unit

Horikoshi Yuho MD; Kaneko, Tetsuji MS; Morikawa, Yoshihiko MD; Isogai, Mihoko MD; Suwa, Junichi PharmM; Higuchi, Hiroshi; Yuza, Yuki MD, PhD; Shoji, Takayo MD; Ito, Kenta MD
The Pediatric Infectious Disease Journal: Post Acceptance: August 17, 2017
doi: 10.1097/INF.0000000000001746
Antimicrobial Reports: PDF Only


The Japanese government’s goal for the reduction of antimicrobial consumption is two-thirds of the 2013 rate by 2020. While the antimicrobial stewardship programs (ASP) are essential in health care facilities, ASP data on pediatric hematology-oncology and hematopoietic stem cell transplant (HSCT) patients are limited. Our aim was to evaluate the impact of restrictive and persuasive ASP on immunocompromised children.


The ASP for hematology-oncology and HSCT patients at Tokyo Metropolitan Children’s Medical Center was assessed. Phase 1 was a post-prescriptive review of carbapenem conducted between April, 2010 and September, 2011. Phase 2 consisted of the preauthorization of carbapenem, prospective audit with feedback, a weekly luncheon meeting among physicians, consensus on febrile neutropenia management, and implementation of viral molecular diagnostics between October, 2011 and September, 2015. Both phases were compared for day-of-therapy (DOT) per 1,000 patient-days, cost of intravenous antimicrobial agents, average hospitalization duration, all-cause mortality, infection-related mortality at 30 days, and appropriateness of empirical treatment of bacteremia.


The ASP did not differ from phase 1 to phase 2 in terms of average hospitalization length, mortality rate, or appropriateness of empirical treatment for bacteremia. DOTs of cefepime, piperacillin/tazobactam, meropenem, vancomycin, liposomal amphotericin B, and fosfluconazole decreased by 20%, 45%, 57%, 38%, 85% and 44%, respectively (p<0.05). The total cost of antibiotic and antifungal agents decreased by 27%, for a savings of $59,905 USD annually.


Restrictive and persuasive ASP in the hematology-oncology ward and the HSCT unit safely decreased the use of antibacterial and antifungal agents.

Authors had no disclosure related to this submitted work.

Acknowledgement: We would like to thank James Robert Valera for his assistance in editing this manuscript.

Corresponding author: Yuho Horikoshi, MD, 2-8-29 Musashidai, Fuchu, Tokyo 183-8561, Japan. Tel +81-42-300-5111; Fax +81-42-312-8162,

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.