Category: Antimicrobial Stewardship: Program Development and Implementation

Poster Session: Antimicrobial Stewardship: Program Development and Implementation

151 - An Electronic Algorithm to Better Target Antimicrobial Stewardship Program (ASP) Efforts for Children Hospitalized with Community-Acquired Pneumonia (CAP)

Presenting Author(s)

Jeffrey Gerber

Associate Professor of Pediatrics
Children's Hospital of Philadelphia
Philadelphia, PA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

RG

Robert Grundmeier

Associate Professor
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Keith W. Hamilton

Professor of Clinical Medicine
University of Pennsylvania Perelman School of Medicine
Philadelphia, PA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Lauri A. Hicks

Director, Office of Antibiotic Stewardship
Centers for Disease Control and Prevention
Atlanta, GA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MN

Melinda M. Neuhauser

Pharmacist and Acute Care Lead
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention,
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
NF

Nicole Frager

Project Manager
University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MM

Muida Menon

Research Coordinator
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
EK

Ellen Kratz

Project Manager
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AJ

Anne Jaskowiak

Project Manager
University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LC

Leigh Cressman

Senior Data Analyst
University of Pennsylvania Perelman School of Medicine
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
TJ

Tony James

Research Assistant
University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JO

Jacqueline Omorogbe

Research Coordinator
University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Ebbing Lautenbach

Professor of Medicine and Epidemiology
University of Pennsylvania
Philadelphia, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Pediatric antibiotic stewardship programs (ASPs) have been successful in decreasing inappropriate antibiotic use. However, they require considerable time and effort. Approaches to increase ASP efficiency are urgently needed. We developed and validated an electronic algorithm to identify inappropriate antibiotic use in children hospitalized with community-acquired pneumonia (CAP).

Methods: At Children’s Hospital of Philadelphia (CHOP), we used ICD-10 diagnostic codes to identify inpatient patient encounters for pneumonia between 3/15/17 – 3/14/18 for which patients received a systemic antibiotic in the first 48 hours of hospitalization. Exclusion criteria included transfer from another facility, intensive care unit admission or death in first 48 hours, immunocompromising condition, or specific comorbidities. We randomly selected 150 subjects. Inappropriate antibiotic use based on chart review served as the basis for assessment of the electronic algorithm which was constructed using only data in the electronic health record (EHR). Criteria for appropriate prescribing, choice of antibiotic, and duration of therapy were based on established CHOP and IDSA/PIDS guidelines.

Results: Of 148 eligible subjects, median age was 3.8, 48% were female, and 129 (86%) were admitted to a general pediatrics service. On chart review, 147 (99%) subjects were correctly diagnosed with CAP. Of these subjects, the choice of initial antibiotic(s) was appropriate in 133 (90%). Of the 147 subjects, 137 (93%) had an appropriate duration of therapy. Test characteristics of the EHR algorithm (compared to chart review) are noted in the Table.

Conclusion: In pediatric patients hospitalized with CAP, the electronic algorithm for identifying inappropriate prescribing, antibiotic choice, and duration was highly accurate. This algorithm could have considerable utility in targeting ASP initiatives. The impact of interventions based on this algorithm should be tested in the futureTest Characteristics of Electronic Algorithm for Inappropriate Prescribing, Agent, and Duration