O2131: Antibiotic Stewardship: One Year After Basic

Purpose/Objectives: Community acquired pneumonia (CAP), urinary tract infection (UTI), and skin and soft tissue infections (SSTI) are common pediatric diagnoses with potential for antimicrobial stewardship impact in both the inpatient and outpatient settings.

The Better Antibiotic Selection in Children (BASiC) project implemented through the national Value in Inpatient Pediatrics (VIP) initiative evaluated the effect of improving antibiotic choice and duration of therapy for CAP, UTI, and SSTI. We now aim to evaluate if appropriate antibiotic duration continues one year after study completion.

Design/Methods: This is a retrospective chart review study one year after BASiC project completion to measure the ongoing effect on duration of antibiotic treatment for CAP, UTI, and SSTI from March 2022 to February 2023. Baseline data on antibiotic prescribing by emergency department and inpatient physicians was collected from July 2019 to February 2021 and compared to post-implementation data from March 2021 to December 2021. Figure 1 describes this timeline of events. Patients included were identified by a diagnosis code for CAP, UTI or SSTI. 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 Mann-Whitney U testing.

Results: 763 patients were included in this study. 231 had a diagnosis of CAP (98 pre-, 65 post-, 68 one year post-implementation); 255 had UTI (121 pre-, 67 post-, 67 one year post-implementation); and 277 had SSTI (129 pre-, 73 post, 75 one year post-implementation). Between the pre- and post-implementation cases, there was a significant decrease in the mean duration of antibiotic prescribing from ~9 to 7 days in all three groups (p < 0.001). One year later, this decrease in mean duration of antibiotic prescribing was sustained.

Conclusion/Discussion: Participation in national projects can be an important step in improving the duration of antimicrobial treatment at a local level by promoting multidisciplinary collaboration with the antimicrobial stewardship team. In addition to implementing institutional guidelines, EMR-integrated order sets for antibiotic prescribing helped ensure practice change in the original BASiC study. These changes contributed to improved duration of antibiotic therapy for CAP, UTI, and SSTI with ongoing success one year after study completion.