1918. Successful Reduction in Medication Use in RSV Bronchiolitis by Repeated PDSA Cycles
Session: Poster Abstract Session: Antibiotic Stewardship: Pediatrics
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • 1918_IDWPOSTER.pdf (712.5 kB)
  • Background:

    We have previously demonstrated a reduction in antibiotic utilization for RSV bronchiolitis at our institution after instituting an antimicrobial stewardship program (ASP) during the 2012-13 season (Makvana et al. ID week 2013). Our pre-intervention data showed excessive antibiotic use of 67 % in RSV infection during 2011-12 in children admitted to the hospital. After ASP intervention with education, prospective audit and feedback by pharmacists and physicians, a significant reduction to 45 % (p<0.007) was achieved. Data of antibiotic utilization in the Emergency Room was not included in the initial study.

    • Demonstrate reduction in unnecessary antibiotic use during 2014-15 season.

    • Demonstrate reduction in bronchodilator and steroid use during the 2014-15 RSV season

      Methods: In 2012 an ASP program targeted excessive antibiotic use in pediatric patients admitted to the hospital with RSV. During the following RSV seasons (2014 through 2015), the ASP were expanded to the emergency department. In 2014, the intervention was expanded to include the revised clinical practice guidelines for bronchiolitis management from AAP to target inappropriate bronchodilator and steroid use. Charts of infants and children < 5 years with a positive RSV result on Film Array (BioFire) were reviewed. We compared i) antibiotic, ii) bronchodilator, iii) and steroid use between 2013-14 and 2014-15 RSV seasons.

      P-values < 0.05 are considered significantly different. The study was approved by Winthrop’s IRB.

      Results:

    July 2013-May 2014

    July 2014-May 2015

    Total

    P-value

    Number of Participants

    243

    310

    553

    Age (Months)

    14.1 ± 14.5

    14.5 ± 14.6

    14.3 ± 14.6

    0.698

    Gestational Age (Weeks)

    36.6 ± 3.9

    37.7 ± 2.9

    37.2 ± 3.4

    0.006

    Admitted (N, % )

    126 (51%)

    140 (45%)

    -

    -

    Antibiotic (N, %)

    91 (37.4%)

    81 (26.2%)

    172 (31.2%)

    0.006

    Steroids (N, %)

    58 (23.9%)

    52 (16.8%)

    110 (19.9%)

    0.042

    Bronchodilators (N, %)

    144 (59.3%)

    149 (48.7%)

    41 (14.3%)

    0.040

    Conclusion:

     We demonstrated an overall reduction in antibiotic utilization in the pediatric in-patient unit and the pediatric emergency room from 37.4 % to 26.2 % with implementation of the ASP. We also observed significant reduction in utilization of steroids (7%) and bronchodilators (10 %) after inclusion of the 2014 AAP Bronchiolitis Guideline.

    Asif Noor, M.D.1, Leonard R. Krilov, MD2, Andre Rebaza, MD3 and Lyn Quintos, M.D.1, (1)Pediatrics, Winthrop University Hospital, Mineola, NY, (2)Stony Brook University School of Medicine, Stony Brook, NY, (3)Department of Pediatrics, Winthrop University Hospital, Mineola, NY

    Disclosures:

    A. Noor, None

    L. R. Krilov, AstraZeneca: Investigator , Grant recipient
    Regeneron: Investigator , Grant recipient

    A. Rebaza, None

    L. Quintos, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.