关键词: antibiotic guideline infection osteomyelitis pediatric

Mesh : Abscess / drug therapy Acute Disease Anti-Bacterial Agents / therapeutic use Arthritis, Infectious / drug therapy Central Venous Catheters / statistics & numerical data Child Child, Preschool Drug Utilization Drug Utilization Review / standards statistics & numerical data Female Fever Guideline Adherence / statistics & numerical data Hospitals, Pediatric Humans Infections / drug therapy Length of Stay / statistics & numerical data Male Medical Records Musculoskeletal Diseases / diagnosis drug therapy Osteomyelitis / drug therapy Patient Readmission / standards statistics & numerical data Practice Guidelines as Topic Pyomyositis / drug therapy Quality of Health Care / standards statistics & numerical data Retrospective Studies Treatment Outcome

来  源:   DOI:10.1093/jpids/pix014   PDF(Sci-hub)

Abstract:
UNASSIGNED: Acute pediatric musculoskeletal infections are common, leading to significant use of resources and antimicrobial exposure. In order to decrease variability and improve the quality of care, Children\'s Hospital Colorado implemented a clinical care guideline (CCG) for these infections. The purpose of this study is to evaluate clinical and resource outcomes PRE and POST this CCG.
UNASSIGNED: Retrospective chart review evaluated patients admitted to a large pediatric quaternary referral center (CHCO) diagnosed with acute osteomyelitis, septic arthritis, pyomyositis, and/or musculoskeletal abscess prior to and after guideline implementation. Primary outcomes included length of stay and overall antibiotic use, with additional secondary clinical, process, and therapeutic outcomes examined.
UNASSIGNED: 82 patients were identified in both the pre-CCG and post-CCG cohorts. There was a reduction in the median of all primary outcomes, including length of stay (0.6 median days decrease, P = .04), length of IV antibiotic therapy (4.9 median days decrease, P < .0001), and days of IV antibiotic therapy (6.4 median days decrease, P = .0004). Our median length of stay post-CCG was 4.9 days, the shortest reported length of stay for pediatric acute musculoskeletal infections to date. Additionally, there was a 24.5 hour reduction in median length of fever (P = .02), faster CRP normalization (P < .0001), 50% decrease in the number of related readmissions (P = .02), 34% decrease in central venous catheters placed (P < .0001), decreased time to first culture (P = .02), and 79% pathogen identification post-CCG (P = .056).
UNASSIGNED: Implementation of a CCG for acute musculoskeletal infections improves patient, process and resource outcomes.
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