Patterns of Empiric Antimicrobial Usage for Febrile Infants Between the Emergency Department and Inpatient Settings Vijit Chouhan1, Russell McCulloh2, Angela Myers1,2

1UMKC School of Medicine, 2Children’s Mercy Hospital

INTRODUCTION

• Variation in empiric antimicrobial regimens exists for febrile infants seen in the emergency department and inpatient setting. This applies for infants who have a suspected serious bacterial infection (SBI) and those who do not have an SBI.

• However, variation in empiric antimicrobial regimens between the ED and inpatient settings is not well described in the literature.

• Our study consists of 3 main objectives: 1) describe the patterns of empiric antimicrobial use for

febrile infants in the ED and the inpatient settings2) determine if there is a change in empiric antimicrobial

regimens from the ED to inpatient settings for the selected population

3) determine the concordance rates of empiric ED versus empiric inpatient antimicrobial regimens with microbiology susceptibility results

METHODS

Medical records of febrile infants <90 days of age without chronic co-morbid conditions were reviewed

Infants were divided into two categories: those with a serious bacterial infection (SBI) and those without an SBI based on microbiology testing results and treatment strategies.

Data collected included empiric antimicrobial usage in the ED and inpatient settings and treatment duration in the inpatient setting.

All data was entered into a secure Redcap database. Descriptive statistics and parametric tests including Chi square

analysis and Fisher’s exact tests were performed in the statistics program SPSS

RESULTS

CONCLUSIONS

We found no significant difference between the empiric antimicrobial regimens utilized in the two healthcare settings

We found no significant change in antimicrobial regimens for pediatric patients in their transition from the ED to inpatient setting. If a specific antibiotic was started in the ED, it was very likely to have been continued in the inpatient setting, and vice versa.

We found no significant difference in concordance rates between ED and inpatient empiric antibiotic regimens

Our results suggest there likely is ample communication between the ED and inpatient settings regarding each patient case and the determination of which empiric antimicrobials are appropriate given the patient’s condition.

ID specialists are frequently consulted for children with suspected serious bacterial infections and help ED physicians form appropriate antimicrobial regimens for such patients

Additionally, national guidelines regarding empiric antimicrobials for serious bacterial infections have been established and these may contribute to our findings regarding empiric antibiotic use.

CREDITS/DISCLOSURE/REFERENCES

1 Association of clinical practice guidelines with emergency department management of febrile infants ≤56 days of age. Aronson PL, Thurm C, Williams DJ, Nigrovic LE, Alpern ER, Tieder JS, Shah SS, McCulloh RJ, Balamuth F, Schondelmeyer AC, Alessandrini EA, Browning WL, Myers AL, Neuman MI; for the Febrile Young Infant Research Collaborative. J Hosp Med. 2015 Feb 13

2 Variation in care of the febrile young infant &lt;90 days in US pediatric emergency departments. Aronson PL, Thurm C, Alpern ER, Alessandrini EA, Williams DJ, Shah SS, Nigrovic LE, McCulloh RJ, Schondelmeyer A, Tieder JS, Neuman MI; Febrile Young Infant Research Collaborative. Pediatrics. 2014 Oct 13 4(4):667-77.

28%

63%

2%6%1%

ED Empiric Antimicrobials

Ampicillin + Cefotaxime/GentamicinCeftriaxoneCefepime +/- other*Acyclovir + antibioticsAmpicillin

26%

64%

3%7%1%

Inpatient Empiric Antimicrobials

Ampicillin + Cefotaxime/GentamicinCeftriaxoneCefepime +/- other*Acyclovir + antibioticsAmpicillin

• There was no significant change in antimicrobial therapy when patients were transitioned from the ED to the inpatient setting

*other: includes vancomycin and clindamycin