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Quality improvements shorten antibiotic therapy duration for uSSTIs
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Researchers at Cincinnati Children’s Hospital Medical Center implemented four quality improvement methods that shortened the duration of antibiotic therapy for uncomplicated skin and soft tissue infections, according to recent findings in Pediatrics.
“Given that children at our institution sometimes receive longer courses of antimicrobial therapy for [skin and soft tissue infections (SSTIs)] than may be necessary … our objective was to decrease duration of antibiotics prescribed in children hospitalized for uncomplicated SSTIs [uSSTIs] by using quality improvement (QI) methods,” Christine L. Schuler, MD, MPH, assistant professor in the department of pediatrics at the University of Cincinnati, and colleagues wrote. “We sought to accomplish this goal by increasing prescriptions for short courses of antibiotic therapy upon discharge.”
The Infectious Diseases Society of America guideline for SSTIs suggests that antibiotic courses of 5 days are effective in cases of nonpurulent cellulitis and that treatment may be extended if there is no improvement. In addition, lack of consensus on the difference between complicated skin and soft tissue infections vs. uSSTIs may contribute to variation in therapy duration for SSTIs, according to the investigators.
Schuler and colleagues used their four QI methods to increase outpatient prescriptions for courses of therapy shorter than 8 days for uSSTIs, which would decrease the overall duration of antibiotics upon hospital discharge. Across 23 months, the researchers identified 641 index admissions for uSSTIs for patients aged 90 days to 18 years. Their four QI interventions included:
- two 15-minute didactic sessions for attending and resident physicians;
- distributing lanyard cards that contained information about optimal antibiotic duration and treatment regimens;
- changing the default duration of therapy from 14 days to 7 days for electronic prescription orders; and
- case-by-case identification and mitigation of the other three QI.
The researchers found that the proportion of children with uSSTIs discharged with courses of therapy shorter than 8 days and sustained for 6 months increased from a baseline median of 23% to 74%.
For electronic order sets, reducing the default therapy from 14 days to 7 days was the most instrumental QI, according to the researchers. This change forced physicians to manually enter longer durations, making it more difficult for providers to prescribe long courses of antibiotics.
“Our study is an example of how antibiotic stewardship efforts may be implemented in a health care system and how they can be made successful with input from individuals across multiple disciplines,” Schuler told Infectious Diseases in Children. “All health care professionals — including physicians, nurses and pharmacists — have an obligation to remain cognizant of antibiotic use and support appropriate use whether prescribing, educating families or in other capacities depending on professional roles.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
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