37 Reducing the inappropriate use of ceftriaxone in the ambulatory paediatric setting: A quality-improvement initiative
Notice bibliographique
Résumé
Abstract Background Ceftriaxone has many features which make it an attractive choice in the ambulatory paediatric setting. However, the ramifications of a broad-spectrum intravenous antibiotic, including the promotion of antibiotic resistance and daily visits to a Medical Day Hospital (MDH) should not be ignored. A prior analysis at our tertiary care center revealed a 57% rate of inappropriate ceftriaxone use among patients referred from the Emergency Department (ED) to the MDH. Following a brainstorming session with ED physicians, we identified the drivers of ceftriaxone overuse and developed interventions to reduce inappropriate prescribing. Interventions included: education sessions with physicians; revision of MDH inclusion criteria; and implementation of a standardized referral form to the MDH. Objectives Our objective was to reduce the inappropriate use of ceftriaxone according to centre-specific first-line indications in children ages 3 months to 18 years in the MDH. Design/Methods Data were collected retrospectively in each of the pre- and post-intervention periods for one summer and one winter season to capture diagnostic variations. The pre-intervention period was from November 2019 to January 2020 and June to September 2020; the post-intervention period was from November 2023 to January 2024 and May to July 2024. Included patients were between the ages of 3 months to 18 years and had received ceftriaxone in the MDH after referral from ED. Immunocompromised patients were excluded. We calculated the proportion of inappropriate ceftriaxone use pre-intervention and post-intervention as well as the frequency of MDH referral form use post-intervention. Ceftriaxone appropriateness was assessed based on our institution’s empiric antimicrobial guide. When the indications for ceftriaxone were unclear, a detailed chart review was performed by two parties including a staff trained in paediatric infectious diseases. Results There were 196 eligible patients in the pre-intervention and 107 in the post-intervention periods. Ceftriaxone use was inappropriate in 113 (58%) patients pre-intervention compared to 24 (22%) post-intervention (p<0.001). Inappropriate use was more common in the summer than the winter. The most frequent inappropriate indications were pneumonia (33%) and skin and soft tissue infections (29%). The use of the standardized MDH referral form was over 90% in both post-intervention seasons. Conclusion Team brainstorming, educational sessions, guideline review and referral standardization were effective in our institution at reducing the rate of inappropriate ceftriaxone use in the MDH. This highlights the positive impact that antibiotic stewardship initiatives can have in the outpatient setting and further initiatives may include direct audit-and-feedback to physicians; however, this is more challenging in the ED setting.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,011 | 0,027 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».