A Rare Case of Adolescent Epiglottitis Secondary to Streptococcus dysgalactiae Septicemia.

()is a relatively uncommon pathogen in the pediatric populations, often overshadowed by ()in causing diseases such as cellulitis, severe seep tissue necrotizing infections, and streptococcal toxic shock syndrome. This case report presents the case of a 15-year-old recent immigrant male patient from Egypt who developed an extensive neck infection with complications from septicemia. Initially misdiagnosed as viral pharyngitis, the patient was later admitted with high fevers, dysphagia, and progressive respiratory distress.

Increasing Safety Net Antibiotic Prescriptions for Acute Otitis Media in Urgent Care Clinics.

Objective: To evaluate the effectiveness of multifaceted interventions in improving the use of safety net antibiotic prescriptions (SNAPs) for nonsevere acute otitis media (AOM).

Study Design: We used quality improvement methodology to develop iterative Plan-Do-Study-Act cycles to increase the use of SNAP for nonsevere AOM in 3 pediatric urgent care centers from October 2021 to June 2023. Interventions included education, electronic health record changes, audits and feedback, and a time-limited financial incentive.

Retrospective Investigation of Pediatric Histoplasmosis Diagnosed at a Tertiary Children's Hospital in an Endemic Area over 11 years.

Background: Most histoplasmosis data are from adults. We describe pediatric histoplasmosis diagnosed at a tertiary pediatric care center in an endemic area.

Methods: We performed a retrospective chart review of patients birth-18 years seen in our institution (January 1, 2010 - August 15, 2022) with histoplasmosis identified by International Classification of Disease (ICD) codes.

Sociodemographic differences in treatment of acute respiratory infections in pediatric urgent cares.

Objective: To determine whether differences exist in antibiotic prescribing for respiratory infections in pediatric urgent cares (PUCs) by patient race/ethnicity, insurance, and language.

Design: Multi-center cohort study.

Setting: Nine organizations (92 locations) from 22 states and Washington, DC.

A National Quality Improvement Collaborative to Improve Antibiotic Use in Pediatric Infections.

Background: Nearly 25% of antibiotics prescribed to children are inappropriate or unnecessary, subjecting patients to avoidable adverse medication effects and cost.

Methods: We conducted a quality improvement initiative across 118 hospitals participating in the American Academy of Pediatrics Value in Inpatient Pediatrics Network 2020 to 2022. We aimed to increase the proportion of children receiving appropriate: (1) empirical, (2) definitive, and (3) duration of antibiotic therapy for community-acquired pneumonia, skin and soft tissue infections, and urinary tract infections to ≥85% by Jan 1, 2022.

"Give Me Five": The Case for 5 Days of Antibiotics as the Default Duration for Acute Respiratory Tract Infections.

Acute respiratory tract infections (ARTIs) account for most antibiotic prescriptions in pediatrics. Although US guidelines continue to recommend ≥10 days antibiotics for common ARTIs, evidence suggests that 5-day courses can be safe and effective. Academic imprinting seems to play a major role in the continued use of prolonged antibiotic durations.

Ambulatory amoxicillin use for common acute respiratory infections during a national shortage: Results from the SHARPS-OP benchmarking collaborative.

We quantified antibiotic prescribing for ambulatory pediatric acute respiratory illness at 22 institutions in "pre-shortage" (Jan 2019-Sep 2022) and "shortage" (Oct 2022-Mar 2023) periods for amoxicillin. While acute respiratory illness prescribing increased across settings, the proportion of amoxicillin prescriptions decreased. Variation was seen within and between institutions.

Socioeconomic differences in antibiotic use for common infections in pediatric urgent-care centers-A quasi-experimental study.

Objective: To investigate differences in the rate of firstline antibiotic prescribing for common pediatric infections in relation to different socioeconomic statuses and the impact of an antimicrobial stewardship program (ASP) in pediatric urgent-care clinics (PUCs).

Design: Quasi-experimental.

Setting: Three PUCs within a Midwestern pediatric academic center.

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.

Appropriateness of Diagnosis and Management for Otitis Media With Effusion in Pediatric Urgent Care Clinics.

Background: Otitis media with effusion (OME)'s clinical presentation is often confused with acute otitis media (AOM) by clinicians. Despite OME guidelines recommending watchful waiting with no antibiotics, rates of antibiotic use remain elevated. The aim of this study was to determine the clinician diagnosis validity and the rates of antibiotics prescribed among pediatric OME patients evaluated in 3 urgent care clinics within a pediatric health care system.

New insights into the treatment of acute otitis media.

Introduction: Acute otitis media (AOM) affects most (80%) children by 5 years of age and is the most common reason children are prescribed antibiotics. The epidemiology of AOM has changed considerably since the widespread use of pneumococcal conjugate vaccines, which has broad-reaching implications for management.

Areas Covered: In this narrative review, we cover the epidemiology of AOM, best practices for diagnosis and management, new diagnostic technology, effective stewardship interventions, and future directions of the field.

Increasing cefazolin use for surgical prophylaxis in penicillin-allergy-labeled patients.

Objective: Penicillin (PCN) allergy labels affect antimicrobial selection for surgical prophylaxis. We aimed to increase the percentage of cefazolin usage in patients with PCN allergy labels undergoing orthopedic surgery from 50% to 80%.

Design: Quality improvement initiative.

Improving Duration of Antibiotics for Skin and Soft-tissue Infections in Pediatric Urgent Cares.

Background And Objectives: National guidelines recommend a 5- to 7-day course of antibiotics for most skin and soft-tissue infections (SSTIs). Our aim was to increase the percentage of pediatric patients receiving 5 to 7 days of oral antibiotics for SSTIs in our pediatric urgent care clinics (UCCs) from 60% to 75% by December 31, 2021.

Methods: We performed cause-and-effect analysis and surveyed UCC providers to uncover reasons for hesitation with short antibiotic courses for SSTIs.

Impact of an antibiotic stewardship program on antibiotic choice, dosing, and duration in pediatric urgent cares.

Background: 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.

Methods: 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.

Improving Pneumococcal Vaccination Rates in High-risk Children in Specialty Clinics.

Background And Objectives: Pediatric patients with immunocompromising or certain chronic medical conditions have an increased risk of acquiring invasive pneumococcal disease (IPD). The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is recommended for patients ≥2 years at high risk for IPDs. The aim of this project was to improve PPSV23 vaccination rates for children at high risk for IPD who were seen in 3 specialty clinics from ∼20% to 50% over a 12-month period.

Improving Emergency Department Use of Safety-Net Antibiotic Prescriptions for Acute Otitis Media.

Objectives: Acute otitis media (AOM) is the most common reason for pediatric antibiotic prescriptions. The 2013 American Academy of Pediatrics' AOM guidelines recommend observation for nonsevere AOM. Our aim was to increase the percentage safety-net antibiotic prescription (SNAP) offered to patients 6 months of age or older diagnosed with AOM in 2 pediatric emergency departments (EDs) from a baseline of 0.

Outpatient antimicrobial stewardship programs in pediatric institutions in 2020: Status, needs, barriers.

Objective: To assess current resources, interventions, and obstacles of pediatric outpatient antimicrobial stewardship programs (ASP).

Design: Cross-sectional study.

Setting: Institutions from the Sharing Antimicrobial Reports for Pediatric Stewardship OutPatient collaborative (SHARPS-OP).

Proposed metrics to benchmark antibiotic prescribing in pediatric outpatient settings.

Metrics to track and compare outpatient pediatric antibiotic prescribing are needed to improve antibiotic use and prevent unwanted consequences of antibiotic overuse. We have considered the impact and feasibility of available metrics and propose select high-priority measures for electronic reporting of pediatric outpatient antibiotic use. Streamlined use of antibiotic prescribing metrics will allow for national benchmarking, monitoring and identification of targets and goals for improvement.

Considerations for implementation: Pediatric outpatient antimicrobial stewardship program.

It is encouraging that most acute care centers have formal antimicrobial stewardship (AS) programs; though, most antibiotic use occurs in outpatient settings where access to infectious diseases specialists are limited. Stewardship programs often target dichotomous populations (adult or pediatric), but most children receive care in nonacademic, community outpatient settings. We propose 3 considerations for adult providers and infection preventionists seeking to incorporate outpatient AS elements and implement quality improvement initiatives that optimize pediatric care.