Development and implementation of the Antimicrobial Stewardship Intervention Scoring Tool at a single pediatric institution.

Objective: The primary objective was to grade the potential impact of antimicrobial stewardship program (ASP) interventions on patient safety at a single center using a newly developed scoring tool, the Antimicrobial Stewardship Impact Scoring Tool (ASIST).

Design: Retrospective descriptive study.

Setting: A 367-bed free-standing, pediatric academic medical center.

Improving Short Course Treatment of Pediatric Infections: A Randomized Quality Improvement Trial.

Background And Objectives: Short courses of antibiotic treatment are effective for pediatric community-acquired pneumonia (CAP) and skin and soft tissue infections (SSTI). We compared the effectiveness of education with performance feedback, clinical decision support (CDS), and the combination in encouraging appropriately short treatment courses by primary care clinicians.

Methods: We designed a site-randomized, quality improvement trial within a large pediatric primary care network.

One size does not fit all: advanced practice provider considerations for the antimicrobial steward.

Advanced practice providers are a diverse and established group of antimicrobial prescribers in both ambulatory and inpatient settings. We outline important considerations for antimicrobial stewardship programs and stewards to consider when engaging this important group of providers.

Characteristics and Outcomes of Culture-Positive and Culture-Negative Pediatric Sepsis.

Objectives: To compare the outcomes of pediatric severe sepsis and septic shock among patients with culture-positive and culture-negative sepsis and to determine if there are differentiating markers of disease severity between these 2 populations during their initial presentation and emergency department (ED) stay.

Study Design: Retrospective cohort study of patients ≤21 years of age who presented to the ED of a single children's hospital with severe sepsis or septic shock from June 1, 2017 to June 5, 2019.

Results: There were 235 patients who met criteria for severe sepsis or septic shock.

Benchmarking of Outpatient Pediatric Antibiotic Prescribing: Results of a Multicenter Collaborative.

Background: Most antibiotic use occurs in ambulatory settings. No benchmarks exist for pediatric institutions to assess their outpatient antibiotic use and compare prescribing rates to peers. We aimed to share pediatric outpatient antibiotic use reports and benchmarking metrics nationally.

The Antibiotic Likelihood Index: A New Measure of Antimicrobial Stewardship for Pediatric Primary Care Based on Reason for Visit.

Background: Quality metrics for antibiotic prescribing by pediatricians are limited. We sought to define a novel measure that assesses clinicians' overall antibiotic prescribing.

Methods: Using electronic health record (EHR) data from 2018 to 2019 for children 3 months to 17 years of age from 53 practices within a large pediatric network, we grouped encounters into Reason for Visit categories using the classification system of the National Ambulatory Medical Care Survey and analyzed the proportion of encounters with an antibiotic prescription.

Utility of specific laboratory biomarkers to predict severe sepsis in pediatric patients with SIRS.

Objective: To identify the association between readily available laboratory biomarkers and the development of severe sepsis in children presenting to the emergency department (ED) with systemic inflammatory response syndrome (SIRS).

Methods: In this retrospective cohort study, ED patient encounters from June 2018 to June 2019 that triggered an automated sepsis alert based on SIRS criteria were analyzed. Encounters were included if the patient had any of the following laboratory tests sent within 6 h of ED arrival: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lactic acid, and procalcitonin.

Use of clinical data to augment healthcare worker contact tracing during the COVID-19 pandemic.

Objective: This work examined the secondary use of clinical data from the electronic health record (EHR) for screening our healthcare worker (HCW) population for potential exposures to patients with coronavirus disease 2019 (COVID-19).

Materials And Methods: We conducted a cross-sectional study at a free-standing, quaternary care pediatric hospital comparing first-degree, patient-HCW pairs identified by the hospital's COVID-19 contact tracing team (CTT) to those identified using EHR clinical event data (EHR Report). The primary outcome was the number of patient-HCW pairs detected by each process.

Variability in Ceftriaxone Dosing Across 32 US Acute Care Children's Hospitals.

Ceftriaxone is one of the most common antibiotics prescribed for hospitalized children in the United States. However, ceftriaxone is not dosed consistently. Sepsis/serious bacterial infection had high dosing variability.

Performance of Saliva, Oropharyngeal Swabs, and Nasal Swabs for SARS-CoV-2 Molecular Detection: a Systematic Review and Meta-analysis.

Nasopharyngeal (NP) swabs are considered the highest-yield sample for diagnostic testing for respiratory viruses, including SARS-CoV-2. The need to increase capacity for SARS-CoV-2 testing in a variety of settings, combined with shortages of sample collection supplies, have motivated a search for alternative sample types with high sensitivity. We systematically reviewed the literature to understand the performance of alternative sample types compared to NP swabs.

A pilot program to improve vaccination status for hospitalized children.

Objectives: Screening of immunization status at each health care encounter is recommended to improve immunization coverage rates but is often limited to primary care practices. A pilot intervention study was performed to ascertain the immunization status of hospitalized children and determine if development of an immunization plan before discharge would improve the vaccination status for such children.

Methods: On the basis of power calculations estimated to detect an increase in immunization status from 60% to 70% with 80% power, 356 randomly selected children were enrolled between March 6, 2012 and June 14, 2012.

Antibiotic Management of Animal Bites in Children During the Methicillin-Resistant Staphylococcus aureus Era.

Children presenting to an emergency department following an animal bite were found to be at risk for infection if they had puncture wounds, crush wounds, or were bitten by a cat. Of the infected wounds that were cultured, methicillin-resistant Staphylococcus aureus was not isolated as a pathogen.

Trends in adverse reactions to trimethoprim-sulfamethoxazole.

Objective: To examine temporal trends of adverse drug reactions (ADRs) associated with trimethoprim-sulfamethoxazole (TMP-SMX) use in children.

Methods: We performed a retrospective observational study to characterize TMP-SMX ADRs in children between 2000 and 2009. We completed a chart review at our institution by identifying children diagnosed with TMP-SMX ADRs.

Clinicians' Attitudes Towards an Antimicrobial Stewardship Program at a Children's Hospital.

Background: In pediatrics, limited data are available on how to develop and implement an antimicrobial stewardship program (ASP). In addition, no data exist on clinicians' impression of such programs. The objectives of this study were to describe the development and implementation of an ASP in a children's hospital and to describe the thoughts and attitudes of the clinicians interacting with the ASP.

Impact of a Prospective-Audit-With-Feedback Antimicrobial Stewardship Program at a Children's Hospital.

Background: The emergence of antibiotic-resistant organisms and the lack of development of new antimicrobials have made it imperative that additional strategies be developed to maintain the effectiveness of these existing antibiotics. The objective of this study was to describe the impact of a prospective-audit-with-feedback antimicrobial stewardship program (ASP) on antibiotic use in a children's hospital.

Method: A quasi-experimental study design with a control group was performed to assess the impact of a prospective-audit-with-feedback ASP.

Impact of a guideline on management of children hospitalized with community-acquired pneumonia.

Objectives: We sought to describe the impact a clinical practice guideline (CPG) had on antibiotic management of children hospitalized with community-acquired pneumonia (CAP).

Patients And Methods: We conducted a retrospective study of discharged patients from a children's hospital with an ICD-9-CM code for pneumonia (480-486). Eligible patients were admitted from July 8, 2007, through July 9, 2009, 12 months before and after the CAP CPG was introduced.

Antibiotic management of Staphylococcus aureus infections in US children's hospitals, 1999-2008.

Objectives: The objective of this study was to describe trends in antibiotic management for Staphylococcus aureus infections among hospitalized children from 1999 to 2008.

Methods: A retrospective study was conducted by using the Pediatric Health Information Systems database to describe antibiotic treatment of inpatients with S aureus infection at 25 children's hospitals in the United States. Patients who were admitted from 1999 to 2008 with International Classification of Diseases, Ninth Revision, Clinical Modification codes for S aureus infection were included.