A national quality improvement (QI) initiative was associated with increases in appropriate antibiotic prescribing for pediatric infections at 118 US hospitals, researchers reported yesterday in Pediatrics.
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The initiative, implemented at hospitals participating in the American Academy of Pediatrics Value in Inpatient Pediatrics Network, aimed to increase the proportion of children receiving appropriate empiric, definitive, and duration of antibiotic therapy for community-acquired pneumonia, skin and other soft-tissue infection, and urinary tract infection—the three most common infections for which children receive care in the emergency department (ED) or hospital. Interventions included monthly audit with feedback, educational webinars, peer coaching, order sets, and a mobile app containing site-specific, antibiogram-based treatment recommendations.
The study included 43,916 encounters of children from 60 days to 18 years who were evaluated in the ED or hospital. Appropriate prescribing was measured during an 18-month baseline (30,799 encounters) and a 10-month intervention period (13,117 encounters) from 2020 to 2022.
Improved empiric prescribing and duration of therapy
The overall median adherence to empiric, definitive, and duration of antibiotic therapy for all infections combined was 67%, 74%, and 61%, respectively, at baseline and 72%, 79%, and 71%, respectively, during the intervention period. Interrupted time series analysis revealed a 13% (95% confidence interval [CI], 1% to 26%) intercept change at intervention for empirical therapy and a 1.1% (95% CI, 0.4% to 1.9%) monthly increase in adherence per month for antibiotic duration above baseline rates. No change was observed for definitive antibiotic therapy.
Although the goal of 85% or higher adherence to appropriate prescribing was not achieved, the study authors say the observed rates of appropriate prescribing observed in the study were higher than reported in previous studies.
"Our project's results highlight the potential for multisite QI collaboratives to effectively improve antimicrobial prescribing across diverse settings," they wrote.