Optimizing Antibiotic Stewardship for Treatment of Urinary Tract Infections through Implementation of the AAP Value in Pediatrics (VIP) Network Better Antibiotic Selection in Children (BASiC) Initiative

From the 2022 HVPA National Conference

Umar Qadri MD (Johns Hopkins Bayview Medical Center), Rachel Cane MD, PHD, Margaret Sarezky MD, Edith Dietz MD, Sheila Hofert MD, Jeffrey Tornheim MD, MPH, Amita Ghuman MD, Mackenzie Mahr Masters Degree, Katelyn Williams PA-C

Background

Data suggest that more than 50% of children in an ambulatory setting and nearly 33% of hospitalized children are prescribed an antibiotic. Multiple studies demonstrate that as many as 50% of these treatment regimens are inappropriate either in drug choice or duration of treatment. This excessive antibiotic prescription contributes to adverse medication effects, increased healthcare costs, and the growth of antibiotic-resistant bacteria. However, most institutions do not have standardized antibiotic stewardship protocols or consensus among providers, leading to significant variability in antibiotic prescribing patterns.

Objective

We sought to increase the appropriate use of antibiotics for urinary tract infections (UTI) and attempted to standardize initial antibiotic therapy and treatment duration among the pediatric providers in our community hospital. Our initiative was part of the AAP Value in Pediatrics (VIP) Network Better Antibiotic Selection in Children (BASiC) project which was developed to optimize antibiotic prescribing patterns for common pediatric bacterial infections.

Methods

We conducted retrospective chart reviews for 18 months (July 2019-December 2020) looking at both appropriate antibiotic choice and treatment duration for UTI to determine baseline prescribing practice. Subsequently, project leaders educated front line providers on the AAP and IDSA guidelines for antibiotic use and distributed guideline summaries in charts located at clinical workstations.

We then conducted a 12-month implementation phase (Jan 2021-Dec 2021) to incorporate AAP and IDSA guidelines into clinical practice. Balancing measures included no increase in the proportion of children experiencing ED revisits or hospitalization, transfer to higher levels of care, or increased length of hospital stay. All data were entered into the AAP QI Data Aggregator (QIDA) to compare monthly cycles among our practice with process and balancing measures set by the AAP as well as with aggregate data from other participating institutions.

Results

Based on process measures of 85% for antibiotic duration, we found higher rates of appropriate duration of therapy for UTI (ie: 5 days) during our implementation phase as compared to our baseline data prior to intervention (Fig 1). This shorter treatment duration was not associated with increased readmissions for the same diagnosis (Fig 2).

Conclusions

We demonstrated that through focused educational sessions and visual guidelines, institutions can optimize treatment duration for UTI. Our findings suggest that a shorter 5-day antibiotic course for UTI treatment is not inferior to 7, 10, or 14 day courses.

Clinical Implications

Optimization of antibiotic use can prevent overprescribing, protect patients from unnecessary antibiotic side effects, limit antibiotic resistance, and reduce healthcare costs while still effectively treating UTI. Further initiatives should include evaluating antibiotic selection, establishing standardized ordering sets through the electronic medical record to reduce provider variability, and expanding the scope of this project to other commonly treated infections.

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