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

Elizabeth C Lloyd1, Emily T Martin2, Nicholas Dillman3

  • 1Division of Pediatric Infectious Diseases, University of Michigan, Ann Arbor, Michigan.

Journal of the Pediatric Infectious Diseases Society
|June 13, 2020
PubMed

Insights

An electronic medical record system improved antibiotic therapy for Staphylococcus aureus bacteremia in children. This system led to faster treatment, especially for methicillin-sensitive S. aureus infections.

Area of Science:

  • Pediatric Infectious Diseases
  • Health Informatics
  • Antimicrobial Stewardship

Background:

  • Staphylococcus aureus bacteremia (SAB) requires prompt Infectious Diseases (ID) consultation and appropriate antibiotic therapy for optimal patient outcomes.
  • Strategies to enhance adherence to these critical care pathways in pediatric populations remain under-explored.

Purpose of the Study:

  • To evaluate the effectiveness of an electronic medical record (EMR)-based best practice advisory (BPA) system designed to improve ID consultation and optimal antibiotic selection for pediatric SAB.
  • To assess the impact of the BPA on key clinical outcomes, including time to appropriate therapy and patient mortality.

Main Methods:

  • A quasi-experimental study design was employed, comparing pediatric patients with SAB before and after the implementation of an EMR-based BPA.
  • The BPA utilized rapid mecA gene detection to recommend ID consultation and optimal antibiotic therapy.
  • Interrupted time series (ITS) analysis and Cox regression were used to evaluate changes in consultation rates and time to optimal therapy.

Main Results:

  • The implementation of the EMR-based BPA was associated with a significant reduction in the median time to optimal antibiotic therapy, decreasing from 26.1 to 5.5 hours.
  • This acceleration in optimal therapy was particularly pronounced in patients with methicillin-sensitive S. aureus (MSSA), with a median time reduction from 42.2 to 10.8 hours.
  • While ID consultation rates increased throughout the study, the BPA did not demonstrate a statistically significant impact on consultation frequency due to pre-existing positive trends.

Conclusions:

  • An EMR-based BPA effectively expedited the delivery of optimal antibiotic therapy for pediatric patients diagnosed with SAB.
  • The system demonstrated particular efficacy in accelerating treatment for MSSA infections.
  • The BPA's impact on ID consultation rates was less pronounced, likely due to concurrent improvements in care practices.
Abstract

Keywords:
Staphylococcus aureus bacteremiaantimicrobial stewardshipbest practice advisorypediatricsrapid diagnostics

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