Measuring the impact of an empiric antibiotic algorithm for pulmonary exacerbation in children and young adults with cystic fibrosis

Authors

Charles Kennedy, MD Program, George Washington University School of Medicine and Health Sciences (GWU SMHS), Washington, District of Columbia, USA.
Isabella Greenberg, Department of Medical Education, Children's National Hospital (CNH), Washington, District of Columbia, USA.
Geovanny F. Perez, Division of Pulmonary Medicine, Oishei Children's Hospital, Buffalo, New York, USA.
Hollis Chaney, Division of Pulmonary and Sleep Medicine, CNH, Washington, District of Columbia, USA.
Iman Sami, Division of Pulmonary and Sleep Medicine, CNH, Washington, District of Columbia, USA.
Folasade Ogunlesi, Division of Pulmonary and Sleep Medicine, CNH, Washington, District of Columbia, USA.
Anastassios C. Koumbourlis, Division of Pulmonary and Sleep Medicine, CNH, Washington, District of Columbia, USA.
Benjamin Hammer, Division of Pharmacy Services, CNH, Washington, District of Columbia, USA.
Rana F. Hamdy, Department of Pediatrics, GWU SMHS, Washington, District of Columbia, USA.
Jonathan D. Cogen, Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA.
Asha S. Payne, Department of Pediatrics, GWU SMHS, Washington, District of Columbia, USA.
Andrea Hahn, Department of Pediatrics, GWU SMHS, Washington, District of Columbia, USA.

Document Type

Journal Article

Publication Date

4-1-2022

Journal

Pediatric pulmonology

Volume

57

Issue

4

DOI

10.1002/ppul.25840

Keywords

antibacterial agents; cystic fibrosis; pediatrics; quality improvement

Abstract

BACKGROUND: Antimicrobial stewardship is a systematic effort to change prescribing attitudes that can provide benefit in the provision of care to persons with cystic fibrosis (CF). Our objective was to decrease the unwarranted use of broad-spectrum antibiotics and assess the impact of an empiric antibiotic algorithm using quality improvement methodology. METHODS: We assembled a multidisciplinary team with expertise in CF. We assessed baseline antibiotic use for treatment of pulmonary exacerbation (PEx) and developed an algorithm to guide empiric antibiotic therapy. We included persons with CF admitted to Children's National Hospital for treatment of PEx between January 2017 and March 2020. Our primary outcome measure was reducing unnecessary broad-spectrum antibiotic use, measured by use consistent with the empiric antibiotic algorithm. The primary intervention was the initiation of the algorithm. Secondary outcomes included documentation of justification for broad-spectrum antibiotic use and use of infectious disease (ID) consult. RESULTS: Data were collected from 56 persons with CF who had a total of 226 PEx events. The mean age at first PEx was 12 (SD 6.7) years; 55% were female, 80% were white, and 29% were Hispanic. After initiation of the algorithm, the proportion of PEx with antibiotic use consistent with the algorithm increased from 46.2% to 79.5%. Documentation of justification for broad-spectrum antibiotics increased from 56% to 85%. Use of ID consults increased from 17% to 54%. CONCLUSION: Antimicrobial stewardship initiatives are beneficial in standardizing care and fostering positive working relationships between CF pulmonologists, ID physicians, and pharmacists.

APA Citation

Kennedy, Charles; Greenberg, Isabella; Perez, Geovanny F.; Chaney, Hollis; Sami, Iman; Ogunlesi, Folasade; Koumbourlis, Anastassios C.; Hammer, Benjamin; Hamdy, Rana F.; Cogen, Jonathan D.; Payne, Asha S.; and Hahn, Andrea, "Measuring the impact of an empiric antibiotic algorithm for pulmonary exacerbation in children and young adults with cystic fibrosis" (2022). GW Authored Works. Paper 282.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/282

Department

Pediatrics