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Multilevel logistic regression models and propensity score matching (PSM) analysis were used to assess risk factors for infections caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and the impact of ASP intervention. The prevalence of ESBL-producing Enterobacteriaceae infection was 32.9% in the three pediatric hospitals of this study. Prior antibiotic use (adjusted Odds Ratio, aOR 5.82) and the presence of a central venous catheter (aOR 2.10) were the main patient-level risk factors. Higher ASP maturity at the hospital level was associated with a lower likelihood of ESBL infection (aOR 0.85). PSM analysis revealed that direct ASP intervention was associated with a significant reduction in hospital length of stay (median of 3 days), 30-day mortality (4.2% difference), and time to appropriate therapy. In conclusion, pediatric AMR in Peru is a severe problem, but investment in and strengthening of ASPs constitute an evidence-based, highly effective strategy with a measurable impact on improving clinical outcomes and hospital efficiency.<\/jats:p>","DOI":"10.1556\/030.2026.02825","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T10:36:53Z","timestamp":1770979013000},"page":"78-85","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":1,"title":["Impact of antimicrobial stewardship maturity on resistance and pediatric clinical outcomes: A\u00a0multicenter cohort study"],"prefix":"10.1556","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0696-9384","authenticated-orcid":true,"given":"Mar\u00eda Eugenia","family":"Gallosa Palacios","sequence":"first","affiliation":[{"name":"Universidad Nacional de Piura, Piura, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5728-0651","authenticated-orcid":true,"given":"Israel Barrutia","family":"Barreto","sequence":"additional","affiliation":[{"name":"Universidad Nacional Federico Villarreal, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"425","reference":[{"key":"B1","series-title":"eClinicalMed","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2024.102512","article-title":"Antimicrobial resistance in Enterobacteriaceae infections among children in sub-Saharan Africa: a systematic review and meta-analysis","volume":"70","author":"Kowalski M","year":"2024","unstructured":"Kowalski M, Obama B, Catho G, Dewez J, Isaac A, Jacobs J, et\u00a0al. 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