Impact of a Best Practice Advisory for Pediatric Patients With <i>Staphylococcus aureus</i> Bacteremia

Lloyd, Elizabeth C; Martin, Emily T.; Dillman, Nicholas O; Nagel, Jerod; Chang, Robert S.; Gandhi, Tejal; Tribble, Alison C.

doi:10.1093/jpids/piaa058

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…These formative steps and stakeholder engagement may have helped bring attention and acceptance of the advisory supporting IDC for SAB, as was recently described. 29 The primary clinical outcome, recurrence within the first 6 months, occurred in 8% of SAB events, none of the index events had received IDC, and all occurred before intervention. Recurrence occurred only among children dependent on central lines for total parenteral nutrition or dialysis.…”

Section: Discussionmentioning

confidence: 94%

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Increasing Pediatric Infectious Diseases Consultation Rates for Staphylococcus aureus Bacteremia

Gordon

Akindele

Schumacher³

et al. 2022

Pediatric Quality &Amp; Safety

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Introduction: Staphylococcus aureus bacteremia (SAB) in children is associated with significant mortality and morbidity, including recurrent bacteremia. Infectious disease consultation (IDC) improves SAB outcomes in adult patients. However, increasing IDC and impact for pediatric patients with SAB is not well described. Methods: This quality improvement project aimed to increase IDC for SAB events at a quaternary pediatric medical center. First, we evaluated the local practices regarding pediatric SAB and engaged stakeholders (July 2018–August 2020). We added an advisory comment supporting IDC for SAB to all blood culture results in September 2020. Using statistical process control charts, we monitored the number of SAB events with IDC before a SAB event without IDC. Finally, we evaluated SAB recurrences before and after initiating the advisory comment. Results: In the baseline period, 30 of 49 (61%) SAB events received an IDC with a mean of 1.4 SAB events with IDC before a SAB event without IDC. Postintervention, 22 of 23 (96%) SAB events received IDC with a mean of 14 events with IDC before 1 event without IDC. The SAB recurrence rate was 8%, with 6 events in 4 children; none of the index cases resulting in recurrence received an IDC ( P = 0.0002), and all occurred before any intervention. Conclusions: An electronic advisory comment supporting IDC for SAB significantly increased the rate of pediatric IDC with no further SAB recurrence episodes following intervention. This low-resource intervention may be considered in other pediatric centers to optimize SAB management.

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Section: Discussionmentioning

confidence: 94%

“…These formative steps and stakeholder engagement may have helped bring attention and acceptance of the advisory supporting IDC for SAB, as was recently described. 29 …”

Section: Discussionmentioning

confidence: 99%

Increasing Pediatric Infectious Diseases Consultation Rates for Staphylococcus aureus Bacteremia

Gordon

Akindele

Schumacher³

et al. 2022

Pediatric Quality &Amp; Safety

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“…al. conducted a quasi-experimental study to assess an electronic health record Best Practice Advisory (BPA) that recommended ID consultation and targeted antibiotic therapy (based on MRSA or MSSA) for all patients with S. aureus bacteremia 20 . One year following BPA implementation, 100% of patients with S. aureus bacteremia received ID consultation.…”

Section: Discussionmentioning

confidence: 99%

The impact of infectious diseases consultation for children with Staphylococcus aureus bacteremia

Whittington

Butler

et al. 2022

Pediatr Res

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Background: Despite clear benefit of improved outcomes in adults, the impact of Infectious Diseases (ID) consultation for Staphylococcus aureus bacteremia in children remains understudied. Methods: To assess the impact of Pediatric ID consultation on management and outcomes, we conducted a cohort study of children with S. aureus bacteremia at St. Louis Children’s Hospital from 2011–2018. We assessed adherence to six established quality-of-care indicators (QCIs). We applied propensity score methodology to examine the impact of ID consultation on risk of treatment failure, a composite of all-cause mortality or hospital readmission within 90 days. Results: Of 306 patients with S. aureus bacteremia, 193 (63%) received ID consultation. ID consultation was associated with increased adherence to all QCIs, including proof-of-cure blood cultures, indicated laboratory studies, echocardiography, source control, targeted antibiotic therapy, and antibiotic duration. Obtaining proof-of-cure blood cultures and all indicated laboratory studies were associated with improved outcomes. In propensity score-weighted analyses, risk of treatment failure was similar among patients who did and did not receive ID consultation. However, the number of events was small and risk estimates were imprecise. Conclusions: For children with S. aureus bacteremia, ID consultation improved adherence to QCIs, some of which were associated with improved clinical outcomes.

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Implementation of a Best Practice Advisory to Improve Infection Screening Prior to New Prescriptions of Biologics and Targeted Synthetic Drugs

Baker

Fine

Suter

et al. 2023

Arthritis Care & Research

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ObjectiveUse of biologic and targeted synthetic DMARDs (b/tsDMARDs) in patients with pre‐existing tuberculosis (TB), hepatitis B virus (HBV), or hepatitis C virus (HCV) infection can have serious consequences. Although various society guidelines recommend routine screening for these infections prior to initiating certain b/tsDMARDs adherence to these recommendations varies widely. This quality improvement initiative evaluated local compliance with screening and assessed if automated computerized decision support system (CDSS) in the form of a best practice advisory (BPA) in the electronic health record could improve patient screening.MethodsEstablished patients with autoimmune rheumatic disease (ARD) aged 18 years or older with at least one visit to our rheumatology practice between 10/1/2017 and 3/3/2022 were included. When prescribing a new b/tsDMARD, clinicians were alerted via a BPA that showed the most recent results for TB, HBV, and HCV. Screening proportions for TB, HBV, and HCV before BPA initiation were compared with those of eligible patients after the BPA implementation.ResultsA total of 711 patients pre‐BPA and 257 patients post‐BPA implementation were included in the study. The BPA implementation was associated with statistically significant improvement in screening for TB from 66% to 82% (p=<0.001), HCV from 60 to 79% (p=<0.001), hepatitis B core antibody (HBcAb) 32% to 51% (p=<0.001), and hepatitis B surface antigen (HBsAg) from 51% to 70% (p=<0.001).ConclusionImplementation of a BPA can improve infectious disease screening for patients with ARD who are started on b/tsDMARD and has potential to improve patient safety.This article is protected by copyright. All rights reserved.

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Impact of a Best Practice Advisory for Pediatric Patients With Staphylococcus aureus Bacteremia

Cited by 4 publications

References 28 publications

Increasing Pediatric Infectious Diseases Consultation Rates for Staphylococcus aureus Bacteremia

Increasing Pediatric Infectious Diseases Consultation Rates for Staphylococcus aureus Bacteremia

The impact of infectious diseases consultation for children with Staphylococcus aureus bacteremia

Implementation of a Best Practice Advisory to Improve Infection Screening Prior to New Prescriptions of Biologics and Targeted Synthetic Drugs

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