Strategies, personnel, and diversity of pediatric antimicrobial stewardship programs in the United States: Strategies and composition of US pediatric ASPs

Objective: We sought to characterize US pediatric antimicrobial stewardship programs (ASPs), including their hospital demographics, staffing, funded full-time equivalents (FTEs) by hospital size, and relative emphasis on recommended stewardship strategies. We examined the self-reported characteristics of ASP personnel with regard to discipline, race, ethnicity, gender identity, and years of experience in antimicrobial stewardship. Design: Descriptive two-part survey. Setting: Pediatric ASPs at hospitals participating in Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS), a pediatric quality improvement collaborative of >70 children's hospitals. Participants: Survey distributed to 82 US pediatric ASPs, excluding hospitals without pediatric ASPs. Part I completed by ASP leader (physician or pharmacist). Part II distributed to ASP team members. Methods: Part I addressed hospital demographics, ASP funding, and program choices related to the CDC's 2019 Core Elements of Hospital Antibiotic Stewardship Programs. Part II requested that participants anonymously self-identify race, ethnicity, gender identity, training, and duration of ASP experience. Descriptive statistics performed. Results: Sixty-two ASPs responded: 61 (98%) with formal ASP, 40 (65%) from freestanding children's hospitals. 40 (65%) co-led by an ASP physician and pharmacist. 60 (97%) reported dedicated inpatient physician FTE, 57 (92%) dedicated inpatient pharmacist FTE. Most programs (35 [58%]) reported inadequate staffing support. The 125 ASP professionals who completed Part II predominantly self-reported as White (89 [71%]), with fewer self-reporting as Asian (9 [15%]) or Black (4 [3%]). Conclusion: US pediatric ASPs have achieved substantial progress in meeting the CDC Core Elements, but many report insufficient resources. We identified underrepresentation in the ASP workforce.