PC1218: Antibiotic Stewardship Improvements in Treating Pediatric Patients with UTI: A Multidisciplinary and VIP Network Guided Approach

Purpose/Objectives: Urinary tract infection (UTI) is the most common serious bacterial infection in childhood. Due to this prevalence, UTI was one of three diagnoses targeted in the national AAP QI study Better Antibiotic Selection in Children (BASiC), part the the Value in Inpatient Pediatrics (VIP) network. Through participating in BASiC, our institution's goals were to increase the prescribing rate of narrow spectrum antibiotics and to decrease the duration of therapy in patients diagnosed with UTI in the Emergency Department (ED) or inpatient setting.

Design/Methods: As part of the BASiC study protocols, this project was a retrospective chart review which took place at a free standing children’s hospital in Central Texas. Members of this study group included ED physicians, pediatric hospitalists, infectious disease specialists and pharmacists. Children aged 2 months to 18 years who were admitted to the ED or inpatient service from June 2019 to December 2021 with the diagnosis of UTI were included in the study. Children who were ill-appearing, immunocompromised, or had a diagnosis of cystic fibrosis were excluded. The primary outcomes were to 1) decrease empiric use of third generation cephalosporins for treating UTIs and 2) decrease antibiotic duration to ≤ 10 days for patients aged ≤ 24 months and ≤ 7 days for > 24 months. The preferred first-line antibiotic based on local susceptibilities was cephalexin for oral route and cefazolin for intravenous (IV) route. Our interventions included updating ED electronic order sets to reflect the decreased duration of treatment, in addition to providing physician education using national recommendations provided through the VIP network. All interventions were implemented in our institution by June 2021.

Results: 118 patient’s charts were analyzed in the pre-implementation group and 38 were in the post group. After our interventions, IV empiric cefazolin utilization increased from 7% to 43% and empiric ceftriaxone decreased from 92% to 57% (p value of 0.14, per chi square). Empiric oral cephalexin improved from 53% to 91%, and cefdinir use decreased from 42% to 9% (p of 0.0004). Mean duration of therapy decreased from 9.4 to 7.8 days for children ≤ 24 months (p of 0.05, per t-test), and decreased from 9.3 to 8 days for children >24 months (p of 0.00004). The decreased number of patients receiving IV therapy and less than 24 months old likely contributed to the statistical insignificance.

Conclusion/Discussion: Our study showed that implementing updated ED electronic order sets can aid in decreasing antibiotic treatment duration. Additionally, interprofessional collaboration and physician education backed by national recommendations led to an increased prescribing rate of narrow spectrum antibiotics, showing that a multidisciplinary approach is key for successful antimicrobial stewardship initiatives.