1530. Pediatric Acute Musculoskeletal Infection Clinical Care Guideline Improves Outcomes
Session: Poster Abstract Session: Clinical Infectious Diseases: Soft Tissue Infections (ABSSSIs)
Saturday, October 10, 2015
Room: Poster Hall
Background:

Acute musculoskeletal (MSK) infections are a common cause of pediatric hospitalization, and care of these patients often involves multiple subspecialties. At Children’s Hospital Colorado (CHCO), practice variation and inter-specialty acrimony was felt to impede care. As a remedy, multidisciplinary stakeholders worked to create a consensus-based guideline.  The group addressed pathogen identification, directed antimicrobials, and use of clinical criteria to transition to oral antimicrobials, even in bacteremia.  CHCO implemented this guideline in July, 2012.

Methods:

A single-center, retrospective review compared clinical characteristics and outcomes of patients with MSK infection in the pre (PRE, 6/2009-6/2011) vs. the post (POST, 9/2012-7/2014) era.  Patients with acute osteomyelitis, septic arthritis and/or pyomyositis were identified by ICD9 codes. Demographic, clinical, laboratory, and radiologic data were collected from patient charts, and patients were assigned a severity score. Data were statistically analyzed, with and without severity adjustment.

Results:

82 patients were identified in each of the PRE and POST cohorts. When adjusted for severity of illness, all three primary outcomes were statistically improved in the POST group, including length of stay (median 5.56 vs. 4.94 days, p=0.04), length of IV therapy (median 8.3 vs. 4.3 days, p<0.0001), and days of IV therapy (median 10.2 vs. 3.8, p<0.0002). For secondary clinical outcomes, the post group had an earlier time to first culture (p=0.04), shorter time to afebrile (median 63 vs. 48 hours), earlier return to normal CRP (median 10 vs. 6 days), fewer days of vancomycin (149 vs. 59 DOT), fewer central lines (p<0.0001), and fewer related readmissions (p=0.02).  Pathogens were recovered in 67% of PRE and 79% of POST groups (NS), and notably of the positives, 25% were from source culture only. MSSA was the most common pathogen; 8% of these were clindamycin resistant, discordant with our hospital’s overall rate of 30%.

Conclusion:

Implementation of a pediatric MSK infection clinical care guideline focused on identification of the causative pathogen, tailored antibiotic therapy, and use of clinical parameters for transition to oral antimicrobials, regardless of bacteremia, improves outcomes.  Improvement in inter-specialty relations was also a noted benefit that extends beyond this patient population.

Sarah Parker, MD1, Murray Spruiell, MD2, Laura Pyle, PhD3, Erin Wylie, BA4, Kelly Pearce, BA5, Jaime Stewart, MD6, Heather Heizer, PA-C1, Nathan Donaldson, DO4, Jason Child, PharmD7, Halden Scott, MD8, Jennifer Reese, MD9, Jesse Roberts, MD2, Travis Heare, MD4 and Children's Hospital Colorado Musculoskeletal Infection Working Group, (1)Pediatric Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, (2)Orthopedic Residency, University of Colorado School of Medicine, Aurora, CO, (3)Pediatrics and Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, (4)Orthopedics, University of Colorado School of Medicine, Aurora, CO, (5)Epidemiology, Children's Hospital Colorado, Aurora, CO, (6)Pediatric Radiology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, (7)Pharmacy, Children's Hospital of Colorado, Aurora, CO, (8)Pediatric Emergency Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, (9)Pediatric Hospitalist Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO

Disclosures:

S. Parker, None

M. Spruiell, None

L. Pyle, None

E. Wylie, None

K. Pearce, None

J. Stewart, None

H. Heizer, None

N. Donaldson, None

J. Child, None

H. Scott, None

J. Reese, None

J. Roberts, None

T. Heare, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.