Work

Effect of Clinical Pathways on Antibiotic Prescriptions in an Emergency Department: Italian Pediatric Antimicrobial Stewardship Starts Here

Year: 2016

Type: article

Abstract: Background. Italian pediatric antimicrobial prescription rates are among the highest in Europe (EU). Although prudent antibiotic prescribing has been a high priority in the EU, focused, organized efforts to improve prescribing are lacking. The objective of this study is to determine the effect of clinical pathways (CPs) as tools for antimicrobial stewardship (AS). Methods. CPs outlining standard of care for acute otitis media (AOM), group A streptococcus (GAS) pharyngitis and community acquired pneumonia (CAP) were developed in collaboration with Children's Hospital of Philadelphia and implemented with accompanied training in the emergency department (ED) at the Department for Woman and Child Health of Padua, Italy, on 1 October 2015. We collected data from children with AOM, GAS pharyngitis, and CAP from 15 October 2014 to 15 April 2015 (pre-intervention period) and 15 October 2015 to 15 April 2016 (post-intervention period). We assessed differences in timing, and breadth of spectrum of antibiotic prescribing using chi-square, t-tests and standard process control p-chart. Amoxicillin-clavulanate, cephalosporins and macrolides were considered broad-spectrum antibiotics. Results. A total of 295 pre- and 278 post-intervention clinic visits were identified for AOM. After CP implementation there was an increase in: watchful waiting without antibiotics (21.7% versus 33.1%, p < 0.01), and use of narrow spectrum first line therapy (25.1% versus 34.5%, p < 0.01), with a decrease from 53.2% to 32.4% (p < 0.01) in overall prescription of broad-spectrum antibiotics (Figure 1). A total of 156 pre- and171 post-implementation clinic visits were identified for GAS pharyngitis, with an increase in narrow spectrum antibiotic prescription (51.9% versus 90.7%, p < 0.01) and decrease in broad-spectrum prescription (48.1% versus 9.3%, p < 0.01) (Figure 2). 68 children with CAP were enrolled pre-intervention and 60 post-intervention. Overall, a significant reduction was seen in broad-spectrum antibiotic prescriptions for inpatient and clinic visits after CP introduction and training (p = 0.01). Figure 1. Broad-spectrum antibiotic prescriptions for AOM. Figure 2. Broad-spectrum antibiotic prescriptions for GAS pharyngitis. Conclusion. Reductions of broad-spectrum antibiotic prescriptions for AOM, GAS pharyngitis and CAP as well as increased watchful waiting without antibiotics for AOM indicate promise of CPs for AS in this setting. Disclosures. All authors: No reported disclosures

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.1447