Clinical and Financial Impact of a Diagnostic Stewardship Program for Children with Suspected Central Nervous System Infection

Messacar, Kevin; Palmer, Claire; Gregoire, LiseAnne; Elliott, Audrey; Ackley, Elizabeth; Perraillon, Marcelo Coca; Tyler, Kenneth L.; Dominguez, Samuel R.

doi:10.1016/j.jpeds.2022.02.002

Cited by 13 publications

(15 citation statements)

References 39 publications

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“…These clinical guidelines or pathways as part of an antimicrobial stewardship team may help provide support to clinicians, especially with patient populations where management can be less straightforward, as is frequently encountered with infants < 2 months old and patients with positive viral targets of unclear significance, such as HHV-6. Studies evaluating such stewardship programs (including use of real-time decision support) indicate potentially positive effects on length of empiric antibiotic and ancillary test utilization [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Current state and practice variation in the use of Meningitis/Encephalitis (ME) FilmArray panel in children

et al. 2022

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Background The Meningitis/Encephalitis FilmArray® Panel (ME panel) was approved by the U.S. Food and Drug Administration in 2015 and provides rapid results when assessing patients with suspected meningitis or encephalitis. These patients are evaluated by various subspecialties including pediatric hospital medicine (PHM), pediatric emergency medicine (PEM), pediatric infectious diseases, and pediatric intensive care unit (PICU) physicians. The objective of this study was to evaluate the current use of the ME panel and describe the provider and subspecialty practice variation. Methods We conducted an online cross-sectional survey via the American Academy of Pediatrics Section of Hospital Medicine (AAP-SOHM) ListServe, Brown University PEM ListServe, and PICU Virtual pediatric system (VPS) Listserve. Results A total of 335 participants out of an estimated 6998 ListServe subscribers responded to the survey. 68% reported currently using the ME panel at their institutions. Among test users, most reported not having institutional guidelines on test indications (75%) or interpretation (76%). 58% of providers self-reported lack of knowledge of the test’s performance characteristics. Providers from institutions that have established guidelines reported higher knowledge compared to those that did not (51% vs. 38%; p = 0.01). More PHM providers reported awareness of ME panel performance characteristics compared to PEM physicians (48% vs. 27%; p = 0.004); confidence in test interpretation was similar between both groups (72 vs. 69%; p = 0.80). Conclusion Despite the widespread use of the ME panel, few providers report having institutional guidelines on test indications or interpretation. There is an opportunity to provide knowledge and guidance about the ME panel among various pediatric subspecialties.

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Section: Discussionmentioning

confidence: 99%

Current state and practice variation in the use of Meningitis/Encephalitis (ME) FilmArray panel in children

et al. 2022

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“… 13 As for inflammatory marker testing, pathogen-specific testing is more useful to avoid antimicrobial use rather than to prompt the initiation of antimicrobial therapy. 14 …”

Section: Discussionmentioning

confidence: 99%

“…13 As for inflammatory marker testing, pathogenspecific testing is more useful to avoid antimicrobial use rather than to prompt the ini tiation of antimicrobial therapy. 14 The microbiologic etiology of bacteremia varies around the world. In much of Africa and Asia, even with lower rates of immunization against Haemophilus and pneumococcus than in Europe and North America, Gram negative enteric bacteria and Staphylococcus aureus are more predominant than are other germs.…”

Section: Discussionmentioning

confidence: 99%

Opportunities for Antimicrobial Stewardship in Caring for Febrile Pediatric Inpatients in Abu Dhabi

Abass

Khan

Nsutebu

et al. 2022

Global Pediatric Health

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Antimicrobial stewardship programs seek to improve patient outcomes, reduce cost, and hinder development of antimicrobial resistance. Collection of inpatient antimicrobial use data is foundational to these programs, and decisions to initiate and discontinue antibiotics are potentially amenable to improvement. In order to better understand our current practices and with a view toward improved antimicrobial stewardship, we reviewed charts of previously healthy children to age 16 years hospitalized with fever (without an evident localized source) and/or other findings suggestive of serious bacterial infection. Of 105 patients (18% 0-2 months of age, 42% 3-12 months, 25% 2-5 years), 100 (95%) received antibiotics, 72% for more than 2 days. Of 98 patients with negative body fluid cultures, 23 received antibiotics for 2 days or less, and 70 received antimicrobial therapy for more than 2 days. Focusing on selective initiation and earlier discontinuation of antimicrobial therapy in hospitalized children might reduce unnecessary antibiotic use.

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“…Examples for each moment can be found in Table 2. Remove urinalysis from ED triage and admission orders sets (ie, order set "hygiene") 24 Remove urinalysis from standard pre-surgical evaluation order sets CDS to discourage testing asymptomatic patients and promote testing for appropriate indications for urinalysis and urine cultures 44,45 Education and guidance algorithm to reduce unnecessary blood culture orders 35,46,47 20,22 Moment 1: Does my patient have an infection that requires antibiotics?…”

Section: Examples Of Diagnostic Stewardship Interventions That Advanc...mentioning

confidence: 99%

“…This intervention resulted in significant improvements in antimicrobial use by providing faster results and shortening empiric therapy. 22 Similarly, interventions to stop unnecessary diagnostic testing in patients without symptoms of an infection (or symptoms attributable to another cause) also belong in Moment 1 (eg, order-set hygiene, and best-practice advisories advising against or declining C. difficile testing if the patient is on laxatives). For example, a CDS algorithm implemented in a pediatric intensive care unit at a major academic medical center was instrumental in reducing the frequency of endotracheal aspirate cultures performed monthly by 41% without any significant changes in in-hospital mortality, length of stay, and 7-day readmissions.…”

Section: Examples Of Diagnostic Stewardship Interventions That Advanc...mentioning

confidence: 99%

Improving antimicrobial use through better diagnosis: The relationship between diagnostic stewardship and antimicrobial stewardship

Ku,

Al Mohajer,

Newton

et al. 2023

Infect. Control Hosp. Epidemiol.

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Executive summary Antimicrobial stewardship programs (ASPs) exist to optimize antibiotic use, reduce selection for antimicrobial-resistant microorganisms, and improve patient outcomes. Rapid and accurate diagnosis is essential to optimal antibiotic use. Because diagnostic testing plays a significant role in diagnosing patients, it has one of the strongest influences on clinician antibiotic prescribing behaviors. Diagnostic stewardship, consequently, has emerged to improve clinician diagnostic testing and test result interpretation. Antimicrobial stewardship and diagnostic stewardship share common goals and are synergistic when used together. Although ASP requires a relationship with clinicians and focuses on person-to-person communication, diagnostic stewardship centers on a relationship with the laboratory and hardwiring testing changes into laboratory processes and the electronic health record. Here, we discuss how diagnostic stewardship can optimize the “Four Moments of Antibiotic Decision Making” created by the Agency for Healthcare Research and Quality and work synergistically with ASPs.

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Clinical and Financial Impact of a Diagnostic Stewardship Program for Children with Suspected Central Nervous System Infection

Cited by 13 publications

References 39 publications

Current state and practice variation in the use of Meningitis/Encephalitis (ME) FilmArray panel in children

Current state and practice variation in the use of Meningitis/Encephalitis (ME) FilmArray panel in children

Opportunities for Antimicrobial Stewardship in Caring for Febrile Pediatric Inpatients in Abu Dhabi

Improving antimicrobial use through better diagnosis: The relationship between diagnostic stewardship and antimicrobial stewardship

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