Aligning Provider Prescribing With Guidelines for Soft Tissue Infections.

Area of Science:

• Pediatric Infectious Diseases
• Antimicrobial Stewardship
• Dermatology

Background:

• Antibiotic prescribing for uncomplicated skin and soft tissue infections frequently deviates from evidence-based guidelines.
• Inappropriate microbial coverage can occur, impacting treatment efficacy and antimicrobial resistance.
• Mild nonpurulent cellulitis in pediatric patients warrants specific evaluation of prescribing practices.

Purpose of the Study:

• To assess the appropriateness of antibiotic prescribing for mild nonpurulent cellulitis in a pediatric tertiary academic medical center.
• To evaluate adherence to Infectious Diseases Society of America (IDSA) guidelines for antibiotic selection.
• To determine the rate of antibiotic reutilization within 14 days for these infections.

Main Methods:

• Retrospective review of 967 pediatric encounters for cellulitis from January to December 2017.
• Identification of patients using ICD-10 codes for cellulitis.
• Primary outcome: adherence to IDSA guidelines; Secondary outcome: 14-day revisit rate.

Main Results:

• 60.0% of encounters demonstrated guideline-adherent antibiotic care.
• Common nonadherence reasons included inappropriate methicillin-resistant Staphylococcus aureus (MRSA) coverage with clindamycin (56.1%) and single-agent sulfamethoxazole-trimethoprim use (33.3%).
• The 14-day revisit rate was 3.0% and not significantly associated with guideline adherence.

Conclusions:

• Antibiotic prescribing for pediatric nonpurulent cellulitis presents an opportunity for standardization and care optimization.
• Current practices indicate a need to improve adherence to established antimicrobial guidelines.
• Further efforts are required to ensure appropriate microbial coverage and reduce unnecessary antibiotic use.