744 - Impact of formative lectures on reducing excessive duration of intravenous antibiotics in hospitalized pediatric patients.

Poster Number: 744
Publication Number: 744.414

Elena Granda, Río Hortega University Hospital, Valladolid, Castilla y Leon, Spain; Isabel Bullón González, Universidad Francisco de Vitoria, Valladolid, Castilla y Leon, Spain; Elena Pérez Gutiérrez, Clínico Universitario Hospital, Valladolid, Castilla y Leon, Spain; Ana M. Vegas, Hospital Universitario Río Hortega, Valladolid, Castilla y Leon, Spain; Roberto Velasco, Hosp. Univ. Río Hortega, Laguna de Duero, Castilla y Leon, Spain

Background: Reduction of intravenous antibiotics (IVAtb) is a key action to prevent antibiotic resistance, as well as to improve patient-centered care and efficiency. We detected that in our tertiary university hospital almost 80% of children who were hospitalized receiving longer IVAtb treatments than recommended by current guidelines. To address that, a series of formative lectures were given to medical staff on the most frequent bacterial infections in pediatrics.

Objective:

To analyze the impact of a series of formative lectures on the proportion of patients who received an excessive duration of IVAtb. 

Design/Methods: retrospective observational study of patients < 14 years old hospitalized in a terciary university hospital who received IVAtb. Patients who received IVAtb for a suspected bacterial infection which was ruled out were excluded. Main outcome was the percentage of patients with excessive IVAtb. ‘Excessive IVAtb’ was consider if patients received longer IVAtb treatment than recommended by the guidelines published by McMullan et al (Lancet Infectious Diseases, 2016). For infections not included in those guidelines, a review of literature and consultation with a pediatric infectious diseases expert were made to establish the standard duration. As secondary outcomes mean days of excessive IVAtb per patient, percentage change in excessive IVAtb per diagnosis and mean length of stay (LOS) were analyzed. We compared the results in the baseline period (2013-2018) with those following the formative lessons (2019-2021).

Results:

499 patients were included, 310 (61.1%) from the pre and 189 (37.9%) from the postintervention period. P-chart (Figure1) shows the reduction in the percentage of patients with excessive IVAtb, from 74.2% to 51.6% (p < 0.01). The mean days of excessive IVAtb also decreased (2.4 [SD 3.2] vs 1.2 [SD 3], p< 0.01). The greatest impact was seen in non-complicated pneumonia (-83.3%) and pneumonia with pleural effusion (-63.1%). LOS did not change (5.4 [SD 3.8] vs 5.4 [SD 3.5]).

Conclusion(s): Formative lectures reduced the proportion of hospitalized patients who received an excessive duration of IVAtb treatment as well as the mean days of excessive IVAtb per patient.