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1803. Pediatric Antimicrobial Stewardship: Beyond the Core Elements

BACKGROUND: Facility treatment guidelines for antibiotic choice and duration are a priority in the CDC Core Elements of hospital antimicrobial stewardship (AMS). Urinary tract infection (UTI) and community acquired pneumonia (CAP) are common pediatric diagnoses with potential for AMS impact in both...

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Autores principales: Fernandez, Marisol, Downey, Rachel, Gilbreath, Peter, Wakefield, Toni, Keyburn, Hanh, Schwartz, Joanna, Cossey, Melissa, Sapozhnikov, Julia, Whitaker, Winnie, Kienstra, Andrew, Floyed, Rebecca, Pillay, Devika, Robles, Tiffany, Woerner, David, Forbes, Marion
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9752568/
http://dx.doi.org/10.1093/ofid/ofac492.1433
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author Fernandez, Marisol
Downey, Rachel
Gilbreath, Peter
Wakefield, Toni
Keyburn, Hanh
Schwartz, Joanna
Cossey, Melissa
Sapozhnikov, Julia
Whitaker, Winnie
Kienstra, Andrew
Floyed, Rebecca
Pillay, Devika
Robles, Tiffany
Woerner, David
Forbes, Marion
author_facet Fernandez, Marisol
Downey, Rachel
Gilbreath, Peter
Wakefield, Toni
Keyburn, Hanh
Schwartz, Joanna
Cossey, Melissa
Sapozhnikov, Julia
Whitaker, Winnie
Kienstra, Andrew
Floyed, Rebecca
Pillay, Devika
Robles, Tiffany
Woerner, David
Forbes, Marion
author_sort Fernandez, Marisol
collection PubMed
description BACKGROUND: Facility treatment guidelines for antibiotic choice and duration are a priority in the CDC Core Elements of hospital antimicrobial stewardship (AMS). Urinary tract infection (UTI) and community acquired pneumonia (CAP) are common pediatric diagnoses with potential for AMS impact in both inpatient and outpatient settings. We describe a project at a free-standing children’s hospital that was implemented through a collaboration of multidisciplinary providers who participated in the national Value in Inpatient Pediatrics (VIP) program. One aim of this project is to evaluate baseline and improve antibiotic duration for CAP and UTI. METHODS: This is a retrospective/prospective chart review study that compares baseline and post-intervention duration of antibiotic prescribing for UTI and CAP cases from July 2019-December 2021 based on data collected through the VIP program. Figure 1 describes the timeline of events and results. Patients included were identified by diagnosis code for CAP and UTI. Each case was randomized for inclusion and manually reviewed to ensure it met the diagnosis clinical definition. Cases with underlying chronic medical conditions were excluded from this analysis. Duration of antibiotics prescribed was compared for each group using Wilcoxon rank-sum testing. [Figure: see text] RESULTS: Among the 351 patients included, 163 had a diagnosis of CAP (98 pre-, 65 post- implementation); 188 with UTI (121 pre-, 67 post- implementation). Post Implementation, there was a significant decrease in median duration of antibiotic prescribing from 10 to 7 days in both groups (p< 0.001). [Figure: see text] CONCLUSION: Institutional implementation of guidelines is an important step in local AMS. Guideline implementation alone is not enough to ensure practice change and going beyond the CDC core elements has become important. In our case, participation in a national project with local multidisciplinary involvement was successful in improving duration of therapy for CAP and UTI not previously achieved by the local guidelines. Changes were made to the electronic medical record in the ED to ensure sustainability of this change. DISCLOSURES: All Authors: No reported disclosures.
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spelling pubmed-97525682022-12-16 1803. Pediatric Antimicrobial Stewardship: Beyond the Core Elements Fernandez, Marisol Downey, Rachel Gilbreath, Peter Wakefield, Toni Keyburn, Hanh Schwartz, Joanna Cossey, Melissa Sapozhnikov, Julia Whitaker, Winnie Kienstra, Andrew Floyed, Rebecca Pillay, Devika Robles, Tiffany Woerner, David Forbes, Marion Open Forum Infect Dis Abstracts BACKGROUND: Facility treatment guidelines for antibiotic choice and duration are a priority in the CDC Core Elements of hospital antimicrobial stewardship (AMS). Urinary tract infection (UTI) and community acquired pneumonia (CAP) are common pediatric diagnoses with potential for AMS impact in both inpatient and outpatient settings. We describe a project at a free-standing children’s hospital that was implemented through a collaboration of multidisciplinary providers who participated in the national Value in Inpatient Pediatrics (VIP) program. One aim of this project is to evaluate baseline and improve antibiotic duration for CAP and UTI. METHODS: This is a retrospective/prospective chart review study that compares baseline and post-intervention duration of antibiotic prescribing for UTI and CAP cases from July 2019-December 2021 based on data collected through the VIP program. Figure 1 describes the timeline of events and results. Patients included were identified by diagnosis code for CAP and UTI. Each case was randomized for inclusion and manually reviewed to ensure it met the diagnosis clinical definition. Cases with underlying chronic medical conditions were excluded from this analysis. Duration of antibiotics prescribed was compared for each group using Wilcoxon rank-sum testing. [Figure: see text] RESULTS: Among the 351 patients included, 163 had a diagnosis of CAP (98 pre-, 65 post- implementation); 188 with UTI (121 pre-, 67 post- implementation). Post Implementation, there was a significant decrease in median duration of antibiotic prescribing from 10 to 7 days in both groups (p< 0.001). [Figure: see text] CONCLUSION: Institutional implementation of guidelines is an important step in local AMS. Guideline implementation alone is not enough to ensure practice change and going beyond the CDC core elements has become important. In our case, participation in a national project with local multidisciplinary involvement was successful in improving duration of therapy for CAP and UTI not previously achieved by the local guidelines. Changes were made to the electronic medical record in the ED to ensure sustainability of this change. DISCLOSURES: All Authors: No reported disclosures. Oxford University Press 2022-12-15 /pmc/articles/PMC9752568/ http://dx.doi.org/10.1093/ofid/ofac492.1433 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstracts
Fernandez, Marisol
Downey, Rachel
Gilbreath, Peter
Wakefield, Toni
Keyburn, Hanh
Schwartz, Joanna
Cossey, Melissa
Sapozhnikov, Julia
Whitaker, Winnie
Kienstra, Andrew
Floyed, Rebecca
Pillay, Devika
Robles, Tiffany
Woerner, David
Forbes, Marion
1803. Pediatric Antimicrobial Stewardship: Beyond the Core Elements
title 1803. Pediatric Antimicrobial Stewardship: Beyond the Core Elements
title_full 1803. Pediatric Antimicrobial Stewardship: Beyond the Core Elements
title_fullStr 1803. Pediatric Antimicrobial Stewardship: Beyond the Core Elements
title_full_unstemmed 1803. Pediatric Antimicrobial Stewardship: Beyond the Core Elements
title_short 1803. Pediatric Antimicrobial Stewardship: Beyond the Core Elements
title_sort 1803. pediatric antimicrobial stewardship: beyond the core elements
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9752568/
http://dx.doi.org/10.1093/ofid/ofac492.1433
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