O2049: Better Antibiotic Section in Children (BASiC): Results from a National Quality Improvement Collaborative

Purpose/Objectives: Up to half of antibiotics prescribed to children are inappropriate or unnecessary, which subjects children and families to avoidable risks, including adverse medication effects, antibiotic resistance, and cost. Quality improvement collaboratives can play an effective role in shared learning and disseminating best practices. This project aimed to increase appropriate antibiotic use (defined as empiric antibiotic, definitive antibiotic, and duration) to 85% of eligible encounters for three common pediatric infections seen in the emergency department (ED) and inpatient settings: community-acquired pneumonia (CAP), skin and soft tissue infections (SSTIs), and urinary tract infections (UTIs) in hospitals participating in the Better Antibiotic Selection in Children (BASiC) project endorsed by the American Academy of Pediatrics Value in Inpatient Pediatrics Network.

Design/Methods: Eligible children were >60 days old evaluated in the ED or hospitalized with one of the target conditions. For the intervention, sites received resources that included academic detailing, order sets, run charts, a mobile application, live webinars, coaching, and access to a project LISTSERV. Prior to the intervention, participating sites submitted 18 months of baseline data (July 2019-December 2020), followed by a 2-month wash-out period after initiation of the intervention, and 12 additional months of intervention data (March 2021-Feb 2022). We performed interrupted time series analyses for each of the project performance metrics and exploratory sub-analyses using run charts by diagnosis.

Results: A total of 132 participating hospitals provided data on 43,758 children as of month 12 of the intervention period. Average site adherence to the antibiotic duration metric increased 1.31%/month during the intervention period (95%CI: 0.22, 2.47%), while there was no increase during the baseline period (-0.07%/month 95%CI: -0.36%, 0.15%). Empiric and definitive antibiotic selection did not significantly differ from baseline overall, but subanalysis showed improvement for CAP and UTI for both metrics. There was no change noted in escalation of care or revisit/readmission. Final data for all months is expected May 2022.

Conclusion/Discussion: The BASiC project observed significant improvement in appropriate duration of antibiotic therapy for CAP, SSTI, and UTI. Empiric and definitive antibiotic selection did not change from baseline overall; subanalysis of CAP and UTI demonstrated improvement. The success in changing antibiotic prescription practices highlights the potential value of a multi-site learning collaborative to promote antimicrobial stewardship best practices.