Development of a prediction model for antimicrobial stewardship pharmacy consultations to identify high-risk pediatric patients: a retrospective study across two centers

Background: Antimicrobial Stewardship Pharmacy Consultation (ASPC) in China has been shown to reduce patients' length of stay (LOS). However, prolonged LOS remains a challenge, resulting in unnecessary psychological and financial burden for patients. Objective: This study aimed to develop a prediction model using ASPC parameters to identify high-risk pediatric patients with infectious diseases. These patients received ASPC interventions but still experienced prolonged LOS, which defined their high-risk status. Methods: Predictors for the ASPC model were selected using lasso regression, a nomogram was developed using multivariate logistic regression, and internal validation was performed using tenfold cross-validation. The data set consisted of 474 electronic medical records of pediatric patients with infectious diseases from two hospitals. LOS was dichotomized at the median, and patients with LOS greater than the median were considered to have achieved the outcome. Results: The proportion of outcome events was set at 50% by design. Five independent predictors were identified in the ASPC model: (1) the suggestions from the crucial consultation (OR: 1.74; 95% CI: 1.10 to 2.74), (2) weight (OR: 0.98; 95% CI: 0.97 to 1.00), (3) whether the patient received first aid (OR: 0.54; 95% CI: 0.3 to 1.00), (4) the aim of the crucial consultation (OR: 0.15; 95% CI: 0.03 to 0.66), and (5) whether the patient was critically ill (OR: 0.22; 95% CI: 0.12 to 0.41). The ASPC model showed good discrimination with a C-statistic of 0.772 (95% CI: 0.748 to 0.797) and good calibration performance with intercept and slope values of 0.00 (95% CI: -0.12 to 0.12) and 0.93 (95% CI: 0.82 to 1.04), respectively, under tenfold cross-validation. Conclusions: The antimicrobial stewardship pharmacy consultation model has good discrimination and calibration, and effectively identifies patients at risk for prolonged length of stay. © The Author(s) 2025.; Extensive research on clinical pharmacy practice has highlighted the important role that clinical pharmacists play in patient care and their valuable contributions to personalized medical treatment. However, the quality of pharmacy consultations in China still requires improvement to gain wider recognition from clinicians. Our study examined the impact of Antimicrobial Stewardship Pharmacy Consultations (ASPCs) on the length of stay (LOS) among pediatric patients with infectious diseases and developed a risk prediction model to identify the high-risk patients who received ASPC interventions yet still experienced prolonged LOS. This model has the potential to enhance the quality of ASPC, reduce patients' psychological and financial burdens, and support the advancement of clinical pharmacy practice in China. © The Author(s) 2025.