WIP 2 - Quality Initiative for Antimicrobial Stewardship in Pediatric Community Acquired Pneumonia on the Hospitalist Service

Poster Number: WIP 2
Publication Number: WIP 2.996

Background: Pediatric community-acquired pneumonia (CAP) is a common cause for healthcare utilization. Prior studies have found that the majority of CAP in hospitalized pediatric patients is caused by viral pathogens, yet the majority of hospitalized children with pneumonia receive antibiotics. Low procalcitonin has been found to have a negative predictive value of >90% for typical bacterial pathogens and severe outcomes in pediatric pneumonia. A procalcitonin < 0.25 has been used for antimicrobial stewardship initiatives to reduce antibiotic prescribing for viral pneumonia.

Objective: Using quality improvement methodology, our specific aim is to reduce the percentage of patients admitted to the PHM service for uncomplicated CAP who received >2 day of any antibiotics by 15% over 6 months.

Design/Methods: We included hospitalized children ages ≥2 months-≤18 years with an Emergency Department clinical impression or an admitting diagnosis of pneumonia between January 2023-Present. Through chart review, we excluded patients with complicated pneumonia (pleural effusion, empyema, necrotizing pneumonia, chest tube placement), an alternate respiratory diagnosis (such as asthma, pneumonitis, or bronchiolitis without pneumonia). Our primary outcome measure was the percentage of patients who received ≤2 days of antibiotics. We used procalcitonin being obtained as a process measure. Our first intervention in June 2023 included an update to the inpatient clinical practice guideline for uncomplicated pneumonia paired with educational sessions for faculty. We updated our admission order sets in parallel to reflect the updated guideline recommending only a procalcitonin if obtaining labs for decision support. Data will be presented and analyzed using statistical process control charts, as well as comparative statistics to evaluate differences between baseline population and intervention period. Our study was deemed exempt by our Institutional Review Board.