Improving Antibiotic Use in Pediatric Preseptal Cellulitis Using a Clinical Practice Guideline.

Autor:	Cooper BJ; Department of Pediatrics, Medical College of Wisconsin., Mitchell ML; Department of Pediatrics, Medical College of Wisconsin.; Children's Wisconsin, Milwaukee, Wisconsin., Melamed S; Children's Minnesota, Minneapolis, Minnesota., Liegl M; Department of Pediatrics, Division of Quantitative Health Services, Medical College of Wisconsin, Milwaukee, Wisconsin., Pan AY; Department of Pediatrics, Division of Quantitative Health Services, Medical College of Wisconsin, Milwaukee, Wisconsin., Burek AG; Department of Pediatrics, Medical College of Wisconsin.; Children's Wisconsin, Milwaukee, Wisconsin.
Jazyk:	angličtina
Zdroj:	Hospital pediatrics [Hosp Pediatr] 2024 Oct 01; Vol. 14 (10), pp. 791-798.
DOI:	10.1542/hpeds.2023-007581
Abstrakt:	Objectives: The purpose of this study was to evaluate the impact of a clinical practice guideline (CPG) on antibiotic use and resource utilization for pediatric preseptal cellulitis. Methods: This retrospective quasiexperimental study included patients between the age of 2 months and 17 years admitted for preseptal cellulitis between January 2013 and December 2023. The preseptal cellulitis CPG was implemented in December 2020 using a multifaceted strategy that included buy-in from key stakeholders, education of frontline providers, the official CPG launch, and stakeholder check-ins. The primary outcome was the use of broad-spectrum antibiotics, including dual/triple therapy and methicillin-resistant Staphylococcus aureus (MRSA) active antibiotics. The secondary outcome was resource utilization including blood testing and imaging. Outcomes were compared pre- and post-CPG implementation using the Fisher exact test and logistic regressions. Results: Of 236 patients meeting inclusion criteria, 175 and 61 patients composed the pre- and post-CPG cohorts, respectively. Median age (interquartile range) was 4.0 (1.8-8.3) years and 46% of the population were female. Post-CPG implementation changes in empirical antibiotic use included decreases in broad-spectrum use from 100% to 66% (P < .001), dual/triple therapy from 47% to 16% (P < .001), and MRSA active agents from 86% to 26% (P < .001). There was a decrease in complete blood count and blood culture orders from 75% to 57% (P = .014) and 32% to 18% (P = .047), respectively. Conclusions: Use of broad-spectrum antibiotics, including dual/triple therapy and MRSA active antibiotics for the treatment of pediatric preseptal cellulitis, decreased after CPG implementation. Competing Interests: CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest to disclose. (Copyright © 2024 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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