Department of Pediatrics, Division of Urgent Care, Children's Mercy Kansas City, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
University of Missouri-Kansas City, Kansas City, MO; Department of Pediatrics, Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO.
Am J Infect Control. 2023 May;51(5):520-526. doi: 10.1016/j.ajic.2022.07.027. Epub 2022 Aug 6.
Many antimicrobial stewardship programs (ASPs) focus on decreasing unnecessary antibiotics. We describe the impact of an outpatient ASP on choice, dose, and duration of antibiotics when used for common infections in pediatric urgent care (PUC) centers.
We reviewed encounters at 4 PUC centers within our organization for patients 6 months to 18 years old with acute otitis media, group A streptococcal pharyngitis, community-acquired pneumonia, urinary tract infection, and skin and soft tissue infections who received systemic antibiotics. We determined appropriate antibiotic choice, dose, and duration for each diagnosis. Pearson's χ² test compared appropriate prescribing before ASP implementation (July 2017-July 2018) and postimplementation (August 2018-December 2020). Control charts trended improvement over time.
Our study included 35,917 encounters. The percentage of prescriptions with the recommend agent at the appropriate dose and duration increased from a mean of 32.7% to 52.4%. The center lines for appropriate agent, dose, and duration all underwent upward shifts. The most substantial changes were seen in antibiotic duration (63.2%-80.5%), and appropriate dose (64.6%-77%).
Implementation of an outpatient ASP improved prescribing patterns for choosing the appropriate agent, duration, and dose for many common infections in our PUCs.
许多抗菌药物管理项目（ASPs）侧重于减少不必要的抗生素使用。我们描述了在我们组织内的 4 个儿科急诊（PUC）中心中，一个门诊 ASP 对常见感染性疾病（如急性中耳炎、A 组链球菌性咽炎、社区获得性肺炎、尿路感染和皮肤软组织感染）患者在门诊使用抗生素时的选择、剂量和持续时间的影响。
我们回顾了本组织内 4 个 PUC 中心 6 个月至 18 岁的急性中耳炎、A 组链球菌性咽炎、社区获得性肺炎、尿路感染和皮肤软组织感染接受全身抗生素治疗的患者的就诊情况。我们确定了每种诊断的适当抗生素选择、剂量和持续时间。采用 Pearson χ²检验比较 ASP 实施前（2017 年 7 月至 2018 年 7 月）和实施后（2018 年 8 月至 2020 年 12 月）的适当处方情况。控制图显示，随着时间的推移，趋势逐渐改善。
我们的研究共纳入 35917 例就诊。合适剂量和持续时间的推荐药物处方比例从 32.7%提高到 52.4%。合适药物、剂量和持续时间的中心线均呈上升趋势。抗生素持续时间（63.2%-80.5%）和合适剂量（64.6%-77%）的变化最为显著。
在我们的 PUC 中，实施门诊 ASP 改善了常见感染性疾病选择合适药物、剂量和持续时间的处方模式。
