1899. Effect of clinical pathways on antibiotic prescriptions in an emergency department: Italian pediatric antimicrobial stewardship starts here
Session: Poster Abstract Session: Antibiotic Stewardship: Outpatient and ED
Saturday, October 29, 2016
Room: Poster Hall
  • Poster_IDweek_10-20_DD.pdf (999.5 kB)
  • Background:  Italian pediatric antimicrobial prescription rates are among the highest in Europe (EU). Although prudent antibiotic prescribing has been a high priority in the EU, focused, organized efforts to improve prescribing are lacking. The objective of this study is to determine the effect of clinical pathways (CP) as tools for antimicrobial stewardship (AS).

    Methods:  CPs outlining standard of care for acute otitis media (AOM), group A streptococcus (GAS) pharyngitis and community acquired pneumonia (CAP) were developed in collaboration with Children’s Hospital of Philadelphia and implemented with accompanied training in the emergency department (ED) at the Department for Woman and Child Health of Padua, Italy on 1 October 2015. We collected data from children with AOM, GAS pharyngitis, and CAP from 10/15/2014-04/15/2015 (pre-intervention period) and 10/15/2015-04/15/2016 (post-intervention period). We assessed differences in timing, and breadth of spectrum of antibiotic prescribing using chi-square, t-tests and standard process control p-chart. Amoxicillin-clavulanate, cephalosporins and macrolides were considered broad-spectrum antibiotics.

    Results:  295 pre and 278 post-intervention clinic visits were identified for AOM. After CP implementation there was an increase in: watchful waiting without antibiotics (21.7% vs. 33.1%, p<0.01) 2),use of narrow spectrum first line therapy (25.1% vs. 34.5%, p<0.01), with a decrease from 53.2% to 32.4% (p<0.01) in overall prescription of broad-spectrum antibiotics (Fig 1). 156 pre and171 post-implementation clinic visits were identified for GAS pharyngitis, with an increase in narrow spectrum antibiotic prescription (51.9% vs. 90.7%, p<0.01) and decrease in broad-spectrum prescription (48.1% vs. 9.3%, p<0.01)(Fig 2). 68 children with CAP were enrolled pre-intervention and 60 post-intervention. Overall, a significant reduction was seen in boad-spectrum antibiotic prescriptions for inpatient and clinic visits after CP introduction and training (p=0.01).

    Conclusion:  Reductions of broad-spectrum antibiotic prescriptions for AOM, GAS pharyngitis and CAP as well as increased watchful waiting without antibiotics for AOM indicate promise of CPs for AS in this setting.

    Fig. 1 Broad-spectrum antibiotic prescriptions for AOM

    Fig. 2 Broad-spectrum antibiotic prescriptions for GAS pharyngitis

    Daniele Dona, MD1,2, Maura Baraldi, MD3, Giulia Brigadoi, MD3, Silvia Zingarella, MD3, Rebecca Lundin, ScD, MPH4, Rana F. Hamdy, MD, MPH1, Theoklis Zaoutis, MD, MSCE5, Liviana Da Dalt, MD3 and Carlo Giaquinto, MD2, (1)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy, (3)Pediatric Emergency Department, Department for Woman and Child Health, University of Padua, Padua, Italy, (4)PENTA Foundation, Padua, Italy, (5)The Children's Hospital of Philadelphia, Philadelphia, PA


    D. Dona, None

    M. Baraldi, None

    G. Brigadoi, None

    S. Zingarella, None

    R. Lundin, None

    R. F. Hamdy, None

    T. Zaoutis, None

    L. Da Dalt, None

    C. Giaquinto, 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.