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Clinical Pathway Revision Increases Amoxicillin Monotherapy and 5-Day Durations of Therapy for Pediatric Community-Acquired Pneumonia in the Emergency Department and Urgent Care: A Quality Improvement Initiative.
Authors:Weber MJ et al
Abstract
Study objective: The American Academy of Pediatrics recommends 5-day amoxicillin monotherapy as first-line treatment for pediatric uncomplicated community-acquired pneumonia. It was aimed to use local quality improvement interventions to increase first-line amoxicillin use, reduce azithromycin use, and increase 5-day therapy durations for uncomplicated community-acquired pneumonia. Methods: A quality improvement initiative took place at a pediatric hospital network, including 4 emergency departments (EDs) and 5 urgent care centers. Children discharged between July 2018 and July 2022 with a community-acquired pneumonia diagnosis and an antibiotic prescribed were included. A 2-part intervention was implemented: (1) an electronic health record order set that preselected 5-day antibiotic therapy (August 2020) and (2) a revised community-acquired pneumonia pathway newly integrated into the electronic health record (April 2021). Proportions of antibiotic encounters receiving amoxicillin, azithromycin, and antibiotic durations of 5 days or fewer were analyzed using statistical process control charts to identify special cause variation. Results: Order set implementation had no effect on pediatric community-acquired pneumonia prescribing. After pathway revision, amoxicillin prescribing increased from 60.6% to 70.9%, azithromycin prescribing decreased from 12.5% to 3.7%, and durations for 5 days or fewer increased from 2.0% to 66.1%. Conclusion: A revised, electronic health record-integrated community-acquired pneumonia pathway was associated with improving already high adherence to guideline-recommended antibiotic choice and reducing antibiotic durations for pediatric community-acquired pneumonia in ED and urgent care settings. Local quality improvement efforts, when adapted to institutional workflows and culture, can effectively implement clinical pathways to support evidence-based prescribing for uncomplicated community-acquired pneumonia across diverse health care settings.
Other specific DSP article suggested by Editorial Board
New fever in adults in the intensive care unit: current insights from the 2024 Society of Critical Care Medicine and Infectious Diseases Society of America guidelines.
DOI: 10.20452/pamw.17121
Authors: Alhazzani W et al
Abstract
Fever is among the most frequent clinical signs encountered in the intensive care unit. It often triggers broad diagnostic evaluation and empiric treatment, with implications for patient outcomes and resource use. The 2024 joint guidelines from the Society of Critical Care Medicine and the Infectious Diseases Society of America offer updated, evidence-based recommendations for the evaluation of new-onset fever in adults in the intensive care unit. Replacing the 2008 guideline, this iteration integrates advances in diagnostic methods, a structured guideline development process, and renewed emphasis on antimicrobial stewardship. The panel issued one strong recommendation, 12 weak recommendations, nine best practice statements, and identified four areas where no recommendation was feasible. This review distills the guideline’s most relevant insights, clarifies points of uncertainty, and presents a practical framework for applying its recommendations at the bedside.
Other specific DSP article suggested by Editorial Board
Diagnostic Innovations to Combat Antibiotic Resistance in Critical Care: Tools for Targeted Therapy and Stewardship.
Authors:Alatawi AD et al
Abstract
Antibiotic resistance is a growing global health threat, with critical care settings representing one of the most vulnerable arenas due to the high burden of infection and frequent empirical antibiotic use. Rapid and precise diagnosis of infectious pathogens is crucial for initiating appropriate therapy, minimizing unnecessary antimicrobial exposure, and supporting effective stewardship programs. This review explores how innovative diagnostic technologies are reshaping infection management and antimicrobial stewardship in critical care. We examine the clinical utility of molecular assays, multiplex PCR, MALDI-TOF mass spectrometry, metagenomic sequencing, point-of-care (POC) diagnostics, and emerging tools like biosensors and AI-powered predictive models. These platforms enable earlier pathogen identification and resistance profiling, facilitating timely and targeted therapy while minimizing unnecessary broad-spectrum antibiotic use. By integrating diagnostics into stewardship frameworks, clinicians can optimize antimicrobial regimens, improve patient outcomes, and reduce resistance selection pressure. Despite their promise, adoption is challenged by cost, infrastructure, interpretation complexity, and inequitable access, particularly in low-resource settings. Future perspectives emphasize the need for scalable, AI-enhanced, and globally accessible diagnostic solutions. In bridging innovation with clinical application, diagnostic advancements can serve as pivotal tools in the global effort to curb antimicrobial resistance in critical care environments.
Other specific DSP article suggested by Editorial Board
Impact of an antimicrobial stewardship program on optimizing linezolid consumption and susceptibility in intensive care unit patients with methicillin-resistance staphylococcus aureus: a retrospective cohort study.
Authors: Swidan H et al
Abstract
Background: The empirical use of linezolid as a first-line agent for Methicillin-Resistant Staphylococcus Aureus (MRSA) without a clear indication is of high concern. This study aims to investigate the impact of an Antimicrobial Stewardship Program (ASP) on linezolid consumption and susceptibility in Intensive Care Unit (ICU). In particular, for patients with MRSA infection, ensuring optimized anti-MRSA therapy to align with international/national guidelines.
Methods: A retrospective cohort study was conducted from 01.10.2022 to 31.03.2024 in the ICU of Al-Gomhoreya General Hospital, Alexandria, Egypt. This study included a total of 168 ICU adult patients; older than 18 years old and whom were prescribed anti-MRSA therapy (vancomycin, teicoplanin, or linezolid). The present study assessed the impact of ASP implementation by comparing six months before ASP, i.e. from 01.10.2022 to 31.03.2023 and following ASP implementation from 01.10.2023 to 31.03.2024. Hence, evaluating adherence to hospital protocol for MRSA management and antibiotic timeout process. One of the principal elements that this study focused on was to quantify the consumption of Linezolid before and after ASP implementation, which was measured utilizing the World Health Organization (WHO) standardized Daily Defined Dose (DDD) per 100 patient days. Thus, enabling evaluating the effect of reducing linezolid usage on MRSA susceptibility to Linezolid and analyzing the overall expenditure on anti-MRSA therapy. The comparative analyses were performed using Permutation Welch Two Sample T-test for the continuous measures, while Chi-squared test or Fisher’s exact test were utilized for categorical outcomes. Results: Following ASP implementation, it was found that adherence to MRSA indication and timeout process significantly increased by approximately 74.3% and 57.9%, with (p values < 0.001 for both), standardized effect sizes (φ) of 0.70 and 0.55, respectively, Linezolid consumption decreased by approximately 85.8% and MRSA sensitivity to Linezolid improved by 18.3%. Furthermore, a reduction of 43% in the overall cost of anti-MRSA therapy was observed.
Conclusion: It was found that implementing an ASP contributes to a substantial reduction in Linezolid consumption and preserving its efficacy by maintaining MRSA susceptibility, while improving adherence to hospital protocols and timeout process. Additionally, it reduces overall expenditures on anti-MRSA therapy. These findings highlight ASP as a viable strategy for combating antibiotic resistance, particularly in resource-limited settings.