Improving Institutional Management of MSSA Infections in Children: A Quality Improvement Initiative

Abstract

Background S. aureus is a common cause of skin/soft tissue, musculoskeletal, and bloodstream infections in children, with methicillin susceptible S. aureus (MSSA) accounting for most cases in the U.S. Antibiotic treatment of MSSA with anti-staphylococcal penicillins, or first-generation cephalosporins is associated with improved outcomes compared with treatment with broader spectrum antibiotics. The objective of our study was to analyze current treatment of MSSA infections in our institution, and to implement and assess the effect of interventions to improve appropriate prescribing.MethodsRetrospective analysis of all children with MSSA positive skin, wound, and blood cultures obtained from the Emergency Department and the inpatient setting between January 1, 2015 to June 30, 2017. Patients undergoing therapy for additional infections and poly-microbial cultures were excluded. A spaced multifaceted quality improvement intervention included medical staff education, modification of notation to MSSA culture results with therapeutic suggestions, and an institutional pathway for skin/soft-tissue infections (SSTIs). Outcomes measured included proportion of patients prescribed appropriate antibiotic therapy both with and without infectious diseases consultation.ResultsA total of 464 episodes of MSSA infection met our case criterion. Overall during the study period, 33% of patients were switched to appropriate therapy, 62% remained on clindamycin, and 5% were kept on other nonspecific therapy. Prior to intervention, appropriate therapy over the 7 pre-intervention quarters measured ranged between 18 and 43%. Post-intervention, appropriate therapy was 45–50% over the next 2 quarters. For inpatient episodes, 92% of cases with ID consultion were switched appropriately, whereas 18% of cases without ID consultion were switched appropriately.ConclusionUnder current practice habits, a majority of MSSA isolates are treated inappropriately in the absence of ID consultation. Medical staff education can be a beneficial quality improvement focus to improve antimicrobial prescribing for MSSA infections. Antimicrobial suggestions built into laboratory culture reporting and clinical pathways may also be beneficial to improve prescribing.Disclosures All authors: No reported disclosures.