Pediatric Bone and Joint Infection Guidelines

Abstract

Problem & Purpose: Antimicrobial stewardship guidelines are a Joint Commission requirement to address the Centers for Disease Control and Prevention’s call to reduce unnecessary and potentially harmful antibiotics. Pediatric bone and joint infections are traditionally treated with lengthy intravenous antibiotic courses, but evidence shows earlier transition to oral therapy is safe and reduces antibiotic exposure. In the absence of hospital-wide clinical guidelines at an urban academic institution, provider guidance is needed to minimize antibiotic exposure in this population. The purpose of this project is to implement two institution-specific pediatric guidelines for osteomyelitis and septic arthritis with a diagnostic order set and targeted provider education. Methods: The project lead wrote guidelines and order sets based on evidence review, the institution’s protocols and resources, and input from infectious disease, orthopedics, radiology, emergency medicine, microbiology, pharmacy, and advanced nursing. Guideline virtual education for all pediatric providers was provided synchronously and asynchronously. The project was implemented over a 15-week period. Inclusion criteria are acute hematogenous infections in ages one month to 18 years. NICU patients or those with major trauma or other medical history that increases risk for infection such as bone disease, open fractures, existing hardware, or previous surgeries are excluded. Prospective chart reviews and real-time provider education were conducted for all eligible patients. Data collected includes guideline compliance, order set use, and safety outcomes. Results: The guidelines were published on the institution’s stewardship website and mobile application. Two eligible patients have been identified. Management of one patient followed the guidelines. The other transferred from another hospital and empiric antibiotic choices were not consistent with the guidelines; subsequent care has been. Conclusions: A team and multidisciplinary approach successfully implemented new stewardship guidelines. Findings suggest an institution-wide guideline with targeted education is an effective way to ensure more streamlined care for pediatric patients with bone or joint infections and may reduce antibiotic exposure.