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. 2021 Apr 3;10(3):282-288.
doi: 10.1093/jpids/piaa058.

Impact of a Best Practice Advisory for Pediatric Patients With Staphylococcus aureus Bacteremia

Elizabeth C Lloyd  1 , Emily T Martin  2 , Nicholas Dillman  3 , Jerod Nagel  3 , Robert Chang  4 , Tejal N Gandhi  5 , Alison C Tribble  1
Affiliations

Impact of a Best Practice Advisory for Pediatric Patients With Staphylococcus aureus Bacteremia

Elizabeth C Lloyd et al. J Pediatric Infect Dis Soc. .

Abstract

Background: Infectious diseases (ID) consultation and optimal antibiotic therapy improve outcomes in Staphylococcus aureus bacteremia (SAB). Data on strategies to improve adherence to these practices in children are limited.

Methods: This was a quasi-experimental study evaluating the impact of an electronic medical record (EMR)-based best practice advisory (BPA) for SAB, recommending ID consult and optimal antibiotic therapy based on rapid mecA gene detection. Inpatients < 21 years old with SAB before (January 2015-July 2017) and after (August 2017-December 2018) BPA implementation were included. Primary outcome was receipt of ID consult. Secondary outcomes included receipt of optimal therapy, time to ID consult and optimal therapy, recurrent SAB, and 30-day all-cause mortality. ID consultation rates pre- and postimplementation were compared using interrupted time series (ITS) analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) for time to optimal therapy were calculated using Cox regression.

Results: We included 99 SAB episodes (70 preintervention, 29 postintervention). Preintervention, 48 (68.6%) patients received an ID consult compared to 27 (93.1%) postintervention, but this was not statistically significant on ITS analysis due to a preexisting trend of increasing consultation. Median hours to optimal therapy decreased from 26.1 to 5.5 (P = .03), most notably in patients with methicillin-sensitive S. aureus (MSSA) (42.2 to 10.8; P < .01). On Cox regression, BPA implementation was associated with faster time to optimal therapy (HR, 3.22 [95% CI, 1.04-10.01]).

Conclusions: Implementation of an EMR-based BPA for SAB resulted in faster time to optimal antibiotic therapy, particularly for patients with MSSA. ID consultation increased throughout the study period and was not significantly impacted by the BPA.

Keywords: Staphylococcus aureus bacteremia; antimicrobial stewardship; best practice advisory; pediatrics; rapid diagnostics.

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