Optimizing Antibiotic Treatment of Skin Infections in Pediatric Emergency and Urgent Care Centers

• DOI: 10.1542/peds.2021-053197
• Publication Date: 2022-09-08T08:12:47Z
• Authors: Susan May Wiltrakis; Preeti Jaggi; Lydia Lu; Shabnam Jain
• Keywords: Lymphangitis; Erysipelas; Impetigo

The objective was to optimize antibiotic choice and duration for uncomplicated skin/soft tissue infections (SSTIs) discharged from pediatric emergency departments (EDs) urgent cares (UCs).Pediatric patients aged 0 18 years 3 EDs 8 UCs with a diagnosis of SSTIs were included. Optimal treatment defined as 5 days cephalexin nonpurulent 7 clindamycin or trimethoprim/sulfamethoxazole purulent SSTIs. Exclusion criteria included erysipelas, folliculitis, felon, impetigo, lymphangitis, paronychia, perianal abscess, phlegmon, preseptal orbital cellulitis, cephalosporin allergy. Baseline data collected January 2018 June 2019. Quality improvement (QI) interventions began July 2019 revised SSTI guideline, discharge order set, maintenance certification (MOC) QI project. MOC participants received education sessions, monthly group feedback, individual scorecards. Balancing measures return visits within 10 requiring escalation care. Data monitored through March 2021.In total, 9306 project 50 ED UC physicians (27% eligible physicians). For SSTI, optimal choice, plus duration, increased baseline median 28% 64%. 2% 43%. had greater than non-MOC providers (P < .010). Return did not significantly change pre- postintervention, remaining <2%.We improved reduced outpatient participation associated sustained after the intervention period.