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Evaluating the Impact of Implementing a Clinical Practice Guideline for Febrile Infants With Positive Respiratory
Adrienne DePorre1, David D Williams2, Jennifer Schuster3
1Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; and Departments of adeporre@cmh.edu.
Insights
Clinical practice guidelines reduced antibiotic use and hospital stays for infants with enterovirus meningitis. However, guidelines did not impact care for infants with respiratory syncytial virus infection.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Practice Guidelines
Background:
- Febrile infants require careful management to differentiate serious infections from viral illnesses.
- Clinical practice guidelines (CPGs) aim to standardize care and improve outcomes for common pediatric conditions.
- Respiratory Syncytial Virus (RSV) and Enterovirus (EV) are common causes of febrile illness in infants.
Purpose of the Study:
- To evaluate the impact of a clinical practice guideline on the management and outcomes of febrile low-risk infants with RSV infection or EV meningitis.
- To assess changes in diagnostic testing, antibiotic exposure, and length of hospital stay post-CPG implementation.
Main Methods:
- Retrospective analysis of medical records for febrile infants ≤60 days old.
- Comparison of outcomes (lumbar puncture rates, antibiotic use, antibiotic hours of therapy, length of stay) before and after CPG implementation in 2011.
- Specific analysis for low-risk infants with RSV infection and EV meningitis.
Main Results:
- For RSV-positive infants, no significant changes were observed in lumbar puncture rates, antibiotic exposure, or length of stay after CPG implementation.
- For EV meningitis, antibiotic hours of therapy decreased significantly (79 to 46 hours) post-CPG.
- Length of stay also decreased significantly for EV meningitis patients (47 to 43 hours) post-CPG.
Conclusions:
- CPG implementation effectively reduced antibiotic exposure and hospital length of stay for low-risk infants with EV meningitis.
- The CPG did not demonstrate similar benefits for low-risk infants with RSV infection.
- Further research is needed to understand barriers to integrating viral diagnostic testing into clinical decision-making for febrile infants.
Objectives:
To evaluate clinical practice patterns and patient outcomes among febrile low-risk infants with respiratory syncytial virus (RSV) infection or enterovirus (EV) meningitis after implementing a clinical practice guideline (CPG) that provides recommendations for managing febrile infants with RSV infection and EV meningitis.
Methods:
Our institution implemented a CPG for febrile infants, which gives explicit recommendations for managing both RSV-positive and EV-positive infants in 2011. We retrospectively analyzed medical records of febrile infants ≤60 days old from June 2008 to January 2013. Among 134 low-risk RSV-positive infants, we compared the proportion of infants who underwent lumbar puncture (LP), the proportion of infants who received antibiotics, antibiotic hours of therapy (HOT), and length of stay (LOS) pre- and post-CPG implementation. Among 274 low-risk infants with EV meningitis, we compared HOT and LOS pre- and post-CPG implementation.
Results:
Among low-risk RSV-positive patients, the proportion of infants undergoing LP, the proportion of infants receiving antibiotics, HOT, and LOS were unchanged post-CPG. Among low-risk infants with EV meningitis, HOT (79 hours pre-CPG implementation versus 46 hours post-CPG implementation, P < .001) and LOS (47 hours pre-CPG implementation versus 43 hours post-CPG implementation, P = .01) both decreased post-CPG.
Conclusions:
CPG implementation is associated with decreased antibiotic exposure and hospital LOS among low-risk infants with EV meningitis; however, there were no associated changes in the proportion of infants undergoing LP, antibiotic exposure, or LOS among low-risk infants with RSV. Further studies are needed to determine specific barriers and facilitators to effectively incorporate diagnostic viral testing into medical decision-making for these infants.
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