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A Quality Improvement Initiative to Decrease Intravenous Antibiotic Use in Febrile Young Infants.

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This quality improvement project successfully reduced antibiotic use in febrile infants by implementing updated guidelines and inflammatory marker testing. Procalcitonin (PCT) testing increased significantly, leading to safer care for young children.

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Area of Science:

  • Pediatrics
  • Infectious Disease
  • Quality Improvement

Background:

  • 2021 AAP guidelines recommend inflammatory markers (IMs) like procalcitonin (PCT) to identify low-risk febrile infants eligible to forego antibiotics.
  • A quality improvement (QI) project targeted febrile infants aged 22-56 days in the emergency department.

Purpose of the Study:

  • To safely decrease antibiotic administration in febrile infants from a baseline of 46% to 36% within one year.
  • To ensure reductions in antibiotic use were equitable across different races, ethnicities, and preferred languages.

Main Methods:

  • A multidisciplinary team implemented interventions including clinical pathway updates, clinical decision support (CDS), and education.
  • Four Plan-Do-Study-Act cycles were used, with statistical process control analyzing antibiotic use and PCT results.
  • Missed bacteremia or bacterial meningitis served as the balancing measure.

Main Results:

  • Antibiotic use decreased from 46% to 33%, notably in infants aged 22-28 days (86% to 43%).
  • Procalcitonin (PCT) use increased from 4% to 97% with no disparities in IM testing.
  • Antibiotic use decreased in non-Hispanic white infants but not in non-Hispanic Black infants; no cases of missed bacteremia or meningitis occurred.

Conclusions:

  • A QI framework integrating clinical pathways, CDS, and education effectively reduced antibiotic exposure in febrile infants as young as 22 days, aligning with AAP guidelines.
  • Future efforts must address ensuring equitable reductions in antibiotic exposure across all infant populations.