Diaz Maria Carmen G, Handy Lori K, Crutchfield James H, Cadilla Adriana, Hossain Jobayer, Werk Lloyd N
Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE, USA.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Clin Pediatr (Phila). 2020 Oct;59(11):988-994. doi: 10.1177/0009922820928054. Epub 2020 Jun 2.
Antibiotic choice for pediatric community-acquired pneumonia (CAP) varies widely. We aimed to determine the impact of a 6-month personalized audit and feedback program on primary care providers' antibiotic prescribing practices for CAP. Participants in the intervention group received monthly personalized feedback. We then analyzed enrolled providers' CAP antibiotic prescribing practices. Participants diagnosed 316 distinct cases of CAP (214 control, 102 intervention); among these 316 participants, 301 received antibiotics (207 control, 94 intervention). In patients ≥5 years, the intervention group had fewer non-guideline-concordant antibiotics prescribed (22/103 [21.4%] control; 3/51 [5.9%] intervention, < .05) and received more of the guideline-concordant antibiotics (amoxicillin and azithromycin). Personalized, scheduled audit and feedback in the outpatient setting was feasible and had a positive impact on clinician's selection of guideline-recommended antibiotics. Audit and feedback should be combined with other antimicrobial stewardship interventions to improve guideline adherence in the management of outpatient CAP.
小儿社区获得性肺炎（CAP）的抗生素选择差异很大。我们旨在确定一项为期6个月的个性化审核与反馈计划对基层医疗服务提供者治疗CAP时抗生素处方行为的影响。干预组的参与者每月收到个性化反馈。然后，我们分析了登记参与者治疗CAP时的抗生素处方行为。参与者诊断出316例不同的CAP病例（214例为对照组，102例为干预组）；在这316名参与者中，301人接受了抗生素治疗（207例为对照组，94例为干预组）。在≥5岁的患者中，干预组开具的不符合指南的抗生素较少（对照组22/103 [21.4%]；干预组3/51 [5.9%]，P<0.05），且更多地接受了符合指南的抗生素（阿莫西林和阿奇霉素）。门诊环境中的个性化定期审核与反馈是可行的，并且对临床医生选择指南推荐的抗生素有积极影响。审核与反馈应与其他抗菌药物管理干预措施相结合，以提高门诊CAP管理中对指南的依从性。
