Pediatric ASP Toolkit

Research Gaps

The Society for Healthcare Epidemiology of America (SHEA) White Paper addressing research needs in antibiotic stewardship identifies four major categories of research gaps:

Clinical evidence to define optimal antibiotic use

  • well-designed studies to determine whether all mild to moderate community acquired pneumonia requires antibiotic therapy
  • research focusing on the sensitivity and specificity of UTI symptoms to reduce antibiotic use for asymptomatic bacteriuria
  • studies evaluating the optimal treatment duration of skin and soft tissue infections
  • research on the role of antibiotic prophylaxis for recurrent UTIs

Antibiotic stewardship implementation

  • evaluating which combinations of strategies are most effective for hospital-based antibiotic stewardship programs
  • evaluating the utility of ASPs in the emergency department
  • evaluating sustainability of stewardship interventions
  • evaluating effective ways to train healthcare personnel to support stewardship activities
  • quantification of human resource needs of different stewardship strategies and their relative impact

Standardized outcome and process metrics

  • defining and validating definitions for antibiotic use such as “targeted,” “de-escalated,” “appropriate,” and “adequate” therapy
  • developing a core set of standardized clinical outcome variables for which stewardship studies can be appropriately designed and powered
  • evaluation of post-discharge events such as acquisition of resistant pathogens, impact on intestinal bacterial diversity, unintended or avoidable ED or clinic visits, and readmissions

Antibiotic stewardship study designs and methods

  • Studies should standardize antibiotic stewardship-focused process metrics and report important patient-focused outcomes as well as process and implementation metrics
  • Studies should evaluate new initiatives in the context of established ongoing antibiotic stewardship activities

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