After a brief warm welcome from our host Jason Newland, MD, from Washington University in St. Louis, the conference began with the much requested “ASP Basic Workshop”. Sarah Parker, MD, Children’s Hospital Colorado, explained how to use the antimicrobial stewardship “elevator speech” to develop a business plan and described successful strategies to pitch antimicrobial stewardship to the C-suite. Her pharmacy counterpart from Children’s Hospital Colorado, Amanda Hurst, PharmD, then outlined the ASP pharmacists’ role(s) as a jack of all trades, explained to new ASP pharmacists basic tools and understanding of what this role can accomplish, while illustrated to experienced ASP pharmacists concrete examples of the “handshake stewardship” model that has been so successful at her institution. Pranita Tamma, MD, from Johns Hopkins led a case-based discussion reviewing resistance mechanisms among gram negative bacteria and highlighted the latest literature supporting treatment options for patients with multidrug resistant gram negative infections including new antibiotics on the horizon such as plazomicin, fosfomycin, and aztretonam-avibactam. The addition of breakout sessions this year allowed an opportunity for physicians, pharmacists, and trainees to bring forth questions to their individual breakout groups for free discussion. These unstructured discussions facilitated the opportunity to informally benchmark and gauge how our peers approach common antimicrobial stewardship challenges and provided volumes of useful information.

In the afternoon, the “ASP Academic Conference” started off with duo David Hyun, MD, and Holly Maples, PharmD, returned for the popular annual “Literature Support for Antimicrobial Stewardship", and reviewed their selected “top ten” papers of the year relevant to pediatric antimicrobial stewardship. Dr. Hurst returned to the podium to discuss how to maximize pharmacokinetics and pharmacodynamics (including a compare/contrast of oral third generation cephalosporins) for the treatment of infections.

The PIDS Antimicrobial Stewardship Fellowship Award supports the development of future researchers in pediatric antimicrobial stewardship by providing mentorship to complete a scholarly research project during fellowship or residency. The project(s) awarded should be completed in one year, and the award provides travel funds to present their work at this annual conference.

The 2016 awardees delivered outstanding presentations of their work:

  • Kathleen Chiotos, MD, Children’s Hospital of Philadelphia “Empiric Antibiotic Use in Pediatrics: A Potential Opportunity for Antibiotic Stewardship”
  • Dustin Flannery, MD, Children’s Hospital of Philadelphia “Temporal Trends in Antibiotic Use for Risk of Early-Onset Sepsis Among Very Premature Infants Across the United States” and
  • Anna Sick-Samuels, MD, Johns Hopkins University “Characterizing Risk Factors for Multidrug-Resistant Gram-Negative Bloodstream Infections in Children”.

Concluding the first day of the conference, panel members Drs. Parker, Hurst, Tamma, and Maples answered live and tweeted questions addressing current issues in antimicrobial stewardship. Networking and fun continued through the evening as Washington University hosted a dinner at the Westin hotel (and several groups migrated thereafter to watch NBA finals and/or the Spelling Bee Championship.)

The second day of the conference focused on national efforts in antimicrobial stewardship. Barbara Warner, MD, Washington University/St. Louis Children’s Hospital, discussed the relationship between the neonatal microbiome and neonatal enterocolitis and the difficult balance between promoting “good” organisms while preventing “bad” organisms. Jeffrey Linder, MD, MPH, Northwestern, presented developments in outpatient antimicrobial prescribing and behavioral approaches, including a brief overview of the BEARI trial (“You are a top performer” vs. “You are not a top performer”). Katherine Fleming-Dutra, MD, returned with an update on the CDC’s continuing national antimicrobial stewardship efforts. She demonstrated the CDC’s interactive map of antimicrobial prescribing and the rate of acute care hospitals meeting the proposed core elements. She also informed the audience that “Get Smart about Antibiotics Weeks” is going to undergo some rebranding (to “Antibiotic Awareness Week”) and asked us to join in on the efforts November 13-19. David Hyun, MD, in a return performance,  presented on the changing legislative and policy landscape affecting antimicrobial stewardship, highlighting potential effects of altering the Affordable Healthcare Act as well as Centers for Medicaid and Medicare Services proposed hospital requirements for antimicrobial stewardship that appear to be on hold.

Several abstracts are submitted for poster presentation and a few are selected for oral presentation in the afternoon. This year, abstracts were presented by:

  • Heidi Andersen, MD, MS, Cincinnati Children’s Hospital Medical Center “Precision metagenomics detects colonization, invasion and transmission of multidrug-resistant bacteria”
  • Kevin Messacar, MD, Children’s Hospital Colorado “Development of an integrated diagnostic and antimicrobial stewardship approach to rapid diagnostic testing in children with suspected central nervous system infections”
  • Katherine Cook, PharmD, Monroe Carell Jr. Children’s Hospital at Vanderbilt, “Incidence of Nephrotoxicity among pediatric patients receiving vancomycin with either piperacillin/tazobactam or cefepime”
  • Jason Child, PharmD, Children’s Hospital Colorado, “Pharmacokinetic and pharmacodynamics properties of metronidazole in pediatric patients with acute appendicitis”
  • Kathryn Timberlake, PharmD,The Hospital for Sick Children, “Reducing vancomycin in the neonatal intensive care unit” 

Jason Newland, MD, MEd rounded out the meeting with an update of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) collaborative. The collaborative initially started with handful of children’s hospitals throughout the US and now has grown to include 45 pediatric institutions! Participants in the SHARPS collaborative attend a monthly webinar presented by other members of the group and meet annually prior to the pediatric antimicrobial stewardship meeting.

After eight years and a change in location (bye, Kansas City – hello, St. Louis!), the International Pediatric Antimicrobial Stewardship Conference continues to grow and expand. Additionally, with an increasing legislative and regulatory support for antimicrobial stewardship, it continues to be a wonderful resource for both new and experienced practitioners.

Written By: 

Rana Hamdy, MD, MPH, Children's National Health System
Diana Yu, PharmD, Doernbecher Children's Hospital