Structure, personnel, and initiatives of antimicrobial stewardship programs in pediatric hospitals in the United States based on on-call participation: a cross-sectional survey

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Background: Antimicrobial stewardship programs (ASPs) promote optimal antimicrobial use in pediatrics; however, data describing structure, personnel effort allocation, and activity distribution across regular and after-hours workflows remain limited. Methods: We conducted a cross-sectional survey of pediatric ASPs across the U.S. from September to October 2024 using ASP/ID-related listservs. Respondents reported institutional structure, personnel effort allocation, initiatives, and participation in an after-hours ASP on-call model, with additional details from programs reporting on-call participation. Results: Twenty-two pediatric ASP responses were included, most from academic medical centers (81.8%) and programs covering 101-250 beds (41%). Median physician full-time equivalents (FTEs) increased with institutional size, ranging from 0.1 for institutions with < 100 beds to 0.8 for those with >500 beds. Pharmacist FTEs were a median of 1 for institutions with ≤ 500 beds and increased to 2.25 for programs >500 beds. Most programs reported to Quality and Safety (45%) or discipline-specific departments (41%), with funding primarily attributed to Pharmacy (73%). During regular working hours, nearly all programs performed prospective audit and feedback (100%), responded to ASP-related inquiries (95.5%), and facilitated antimicrobial de-escalation (90.9%). Six programs (27.4%) reported participation in an ASP on-call model, most commonly providing remote coverage during evenings, weekends, and holidays. After-hours activities were largely limited to time-sensitive interventions, including preauthorization and responding to inquiries. Conclusions: Pediatric ASPs demonstrate variability in structure, personnel effort allocation, and stewardship activities. ASP on-call coverage remains uncommon and is typically focused on time-sensitive interventions, reflecting targeted deployment of stewardship resources outside regular working hours.

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