Methods: Infants ≤60 days old with a documented or caregiver-reported fever ≥38.0C from 1/1/09 – 1/31/11 (pre-CPG) and 2/1/11 – 1/31/13 (post-CPG) were included. Data on patient demographics, clinical presentation (including whether children met CPG-determined low-risk criteria for SBI), diagnostic tests, medications administered, and patient outcomes were collected. Febrile infants were further divided into two age groups: 0-28 days and 29-60 days old, due to CPG recommendations differing based on this age criterion. Management practices and outcomes were compared between pre- and post-CPG periods.
Results: A total of 967 infants were identified pre-CPG and 843 infants post-CPG. Evaluation of infants 0-28 days old including complete blood count (CBC), blood and urine cultures, lumbar puncture (LP) and herpes simplex virus (HSV) testing did not significantly change after CPG implementation. Post-CPG, more infants 29-60 days old underwent LP (60% pre-CPG vs 69% post-CPG, p=0.0008) while fewer infants underwent HSV testing (14% pre-CPG vs 9% post-CPG, p=0.0055). Other testing (CBC, blood and urine cultures) remained unchanged for older infants. Antibiotic use decreased among low-risk infants 29-60 days old (83% pre-CPG vs 62% post-CPG, p <0.0001). Diagnosed SBI, hospital admission prevalence, and length of stay did not change after CPG implementation.
Conclusion: Antibiotic use and HSV testing decreased and LP obtainment increased for infants 29-60 days old after CPG implementation, representing changes toward adherence to CPG recommendations. These results suggest that CPG implementation reduced practice variation at our institution.
J. Newland, Pfizer/Joint Commission: Grant Investigator , Research grant
RPSdiagnostics: Consultant , Consulting fee
K. Mann, None
J. Michael, None
J. Bartlett, None
M. Barnes, None
R. Mcculloh, None