1510. Improving the Management of Pediatric Complicated Pneumonia

Abstract

BackgroundPneumonia is a leading cause of pediatric hospitalization in the United States. Our Antimicrobial Stewardship Program (ASP) recognized significant variation in the management of pediatric complicated pneumonia. We developed and implemented a quality improvement (QI) intervention to align the management of complicated pneumonia with national guidelines and compared the medical care and clinical outcomes between a pre-intervention period and two post-intervention periods.MethodsWe queried Webi Universe for all ICD-9 and ICD-10-related admissions for pneumonia at our facility from November 15, 2015 to February 28, 2019. Manual chart review was done to extract clinical points of interest and to ensure that all included patients met inclusion criteria. Our first intervention (period 1) consisted of education to providers to increase use of chest tubes instilled with fibrinolytics and to decrease empiric antistaphylococcal therapy. Our second intervention (period 2) consisted of a care process model which codified the standardized management made by the first intervention, followed by several didactic sessions.Results29 patients were identified in the pre-intervention period, 11 in post-intervention period 1, and 27 in post-intervention period 2. Streptococcal species were the most common pathogens recovered in all periods. Following our interventions the number of video-assisted thorascopic procedures to drain complicated parapneumonic effusions decreased three-fold in favor of chest tubes instilled with fibrinolytics (P < 0.01). Our interventions also reduced empiric antistaphylococcal therapy within the first 48 hours of admission (P = 0.02) and decreased the use of empiric vancomycin three-fold (P = 0.01). Our interventions did not affect the median length of stay, frequency of pulmonary complications, number of 30-day readmissions, or duration of antimicrobial therapy.ConclusionOur ASP’s QI intervention decreased surgical drainage of complicated parapneumonic effusions and decreased the use of empiric antistaphylococcal agents without an increase in complications or readmissions. Opportunities remain to decrease the use of multiple antimicrobial agents within the first 48 hours of admission and to decrease the empiric use of antistaphylococcal therapy.Disclosures All authors: No reported disclosures.