Department of Pediatrics, Division of Emergency Medicine, Washington University in St Louis, St Louis, Missouri.
Department of Pediatrics, Divisions of Infectious Diseases.
Pediatrics. 2022 Oct 1;150(4). doi: 10.1542/peds.2021-053197.
The objective was to optimize antibiotic choice and duration for uncomplicated skin/soft tissue infections (SSTIs) discharged from pediatric emergency departments (EDs) and urgent cares (UCs).
Pediatric patients aged 0 to 18 years discharged from 3 pediatric EDs and 8 UCs with a diagnosis of uncomplicated SSTIs were included. Optimal treatment was defined as 5 days of cephalexin for nonpurulent SSTIs and 7 days of clindamycin or trimethoprim/sulfamethoxazole for purulent SSTIs. Exclusion criteria included erysipelas, folliculitis, felon, impetigo, lymphangitis, paronychia, perianal abscess, phlegmon, preseptal or orbital cellulitis, and cephalosporin allergy. Baseline data were collected from January 2018 to June 2019. Quality improvement (QI) interventions began July 2019 with a revised SSTI guideline, discharge order set, and maintenance of certification (MOC) QI project. MOC participants received 3 education sessions, monthly group feedback, and individual scorecards. Balancing measures included return visits within 10 days requiring escalation of care. Data were monitored through March 2021.
In total, 9306 SSTIs were included. The MOC QI project included 50 ED and UC physicians (27% of eligible physicians). For purulent SSTI, optimal antibiotic choice, plus duration, increased from a baseline median of 28% to 64%. For nonpurulent SSTI, optimal antibiotic choice, plus duration, increased from a median of 2% to 43%. MOC participants had greater improvement than non-MOC providers (P < .010). Return visits did not significantly change pre- to postintervention, remaining <2%.
We improved optimal choice and reduced duration of antibiotic treatment of outpatient SSTIs. MOC participation was associated with greater improvement and was sustained after the intervention period.
优化儿科急诊部门（ED）和急症护理（UC）出院的简单皮肤/软组织感染（SSTI）的抗生素选择和持续时间。
纳入 2018 年 1 月至 2019 年 6 月期间，3 家儿科 ED 和 8 家 UC 出院诊断为简单 SSTI 的 0 至 18 岁儿科患者。最佳治疗方法定义为非脓性 SSTI 用头孢氨苄治疗 5 天，脓性 SSTI 用克林霉素或复方磺胺甲噁唑治疗 7 天。排除标准包括丹毒、毛囊炎、脓性指头炎、脓疱疮、淋巴管炎、甲沟炎、肛周脓肿、蜂窝织炎、眶前蜂窝织炎和头孢菌素过敏。从 2019 年 7 月开始，基线数据收集，采用修订的 SSTI 指南、出院医嘱集和维持认证（MOC）QI 项目进行质量改进（QI）干预。MOC 参与者接受了 3 次教育课程、每月的小组反馈和个人记分卡。平衡措施包括 10 天内需要升级护理的复诊。数据监测至 2021 年 3 月。
共纳入 9306 例 SSTI。MOC QI 项目包括 50 名 ED 和 UC 医生（合格医生的 27%）。对于脓性 SSTI，最佳抗生素选择加上持续时间，从基线中位数的 28%增加到 64%。对于非脓性 SSTI，最佳抗生素选择加上持续时间，从中位数的 2%增加到 43%。MOC 参与者的改善程度大于非 MOC 提供者（P<.010）。干预前后复诊没有显著变化，仍<2%。
我们改善了门诊 SSTI 的最佳抗生素选择和减少了抗生素治疗时间。MOC 参与与更大的改善相关，并在干预期后持续。
