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Protocol-driven Antibiotic Treatment of Pediatric Empyema After Fibrinolysis
Wendy Jo Svetanoff1, Robert M Dorman1, Charlene Dekonenko1
1From the Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri.
Insights
A new protocol for antibiotic treatment duration after childhood empyema resolution reduced antibiotic use and complications. This approach safely decreased hospital stays without increasing empyema recurrence.
Area of Science:
- Pediatric infectious diseases
- Thoracic surgery
- Antibiotic stewardship
Background:
- Antibiotic treatment duration for pediatric empyema is highly variable.
- Fibrinolysis is a common treatment for pediatric empyema.
- Optimizing antibiotic duration post-treatment is crucial for patient outcomes and resource management.
Purpose of the Study:
- To evaluate the efficacy and safety of a protocol-driven antibiotic regimen.
- To decrease antibiotic duration following fibrinolysis for pediatric empyema.
- To assess the impact of a standardized protocol on antibiotic-related complications and treatment outcomes.
Main Methods:
- A prospective observational study was conducted from September 2014 to March 2019.
- A protocol mandated 7 additional days of antibiotics post-thoracostomy tube removal under specific clinical criteria.
- Empyema recurrence and antibiotic complications were recorded and compared to pre-protocol data.
Main Results:
- Mean total antibiotic duration decreased from 26.5 to 22 days (P=0.004).
- Hospital stay significantly reduced from 9.3 to 6.8 days (P=0.003).
- Protocol initiation led to fewer antibiotic-related complications without affecting empyema recurrence.
Conclusions:
- A protocol-driven approach can safely reduce antibiotic duration and associated complications in pediatric empyema.
- Standardized antibiotic regimens may improve clinical outcomes and reduce healthcare resource utilization.
- Further research could explore adherence optimization and long-term impacts.
Background:
The duration of antibiotic treatment after resolution of empyema in children is variable. We evaluated the efficacy and safety of a protocol-driven antibiotic regimen aimed to decrease antibiotic duration following treatment with fibrinolysis.
Methods:
Our institutional protocol consisted of 7 further days of antibiotics upon removal of the thoracostomy tube, with the patient being afebrile, off supplemental oxygen, and having negative cultures. A prospective observational study was then performed between September 2014 and March 2019. Empyema recurrence and antibiotic-related complications were recorded. Results were compared with previously published data from the preprotocol era.
Results:
A total of 37 patients were included. Mean total duration of antibiotics decreased from 26 ± 6.5 days in the preprotocol group to 22 ± 9.7 days in the postprotocol group (P = 0.004). This resulted in a significant decrease in hospital stay from the preprotocol cohort to the postprotocol cohort, respectively (9.3 ± 4.8 d versus 6.8 ± 3.1 d, P = 0.003). Sixty-two percentage of the patients were intended to treat according to the protocol, with a 50% adherence rate. Patients in which the protocol was followed had an average of 2.8 fewer days of antibiotics after discharge (P = 0.004), although overall duration was not statistically different. Significantly fewer antibiotic-related complications were noted after protocol initiation. There was no difference in empyema recurrence or readmissions.
Conclusions:
Institution of a protocol-driven approach to antibiotic duration following resolution of pleural space disease may reduce antibiotic duration and complications without reducing efficacy.
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