Implementing antibiotic stewardship to improve the care of children hospitalized with pneumonia

PROJECT SUMMARY/ABSTRACT The way antibiotics are delivered to hospitalized children matters. When intravenous (IV) and oral antibiotics are equally effective, the use of oral antibiotics may avoid IV-related harms, improve patient experience, and decrease resource utilization, hospital length of stay, and cost. Pneumonia is the ideal infection to study the overuse of IV antibiotics as it is one of the most common reasons for hospitalization and there is emerging evidence that initial oral antibiotics are likely as effective as IV antibiotics. Despite existing evidence, most children hospitalized with pneumonia still receive IV therapy. This gap in translating evidence into practice highlights the critical need for strategies to increase oral (and reduce IV) antibiotic use. The overall hypothesis is that clinician-focused strategies that target initial antibiotic route in the Emergency Department are feasible, increase oral antibiotic use, and improve patient outcomes. The PI will evaluate these strategies in a pilot hybrid trial that will evaluate both effectiveness and implementation outcomes. Through this, the PI will simultaneously gather data on the effectiveness of IV vs. oral therapy and investigate ways to translate evidence into practice. Specifically, the PI, Jillian Cotter, MD, MSCS, in collaboration with her mentoring team will pursue the following aims: (1) Identify barriers and facilitators to increasing initial oral antibiotics for children hospitalized with pneumonia; (2) Develop a set of implementation strategies to increase initial oral antibiotics; and (3) Conduct a pilot hybrid trial to determine the feasibility and acceptability of the implementation strategies. This will prepare her to submit an R01 grant for a multisite hybrid trial to definitively evaluate implementation and effectiveness outcomes. This proposal focuses on children, an AHRQ priority population, and aligns with AHRQ’s goals to implement studies to accelerate the spread of evidence-based practices. As a pediatric hospital medicine physician and clinical researcher with growing expertise in pneumonia and antibiotic stewardship, Dr. Cotter is uniquely positioned to accomplish the proposed research and training aims. Her career goal is to become an independently funded investigator and national leader in the implementation of antibiotic stewardship practices. Dr. Cotter has developed a detailed career development plan that builds on her research skillset and fills key knowledge gaps that are critical to advancing her career. Through coursework, experiential learning, and guided mentorship, she will gain experience in the: (1) design and conduct of qualitative research, (2) development of evidence-based interventions using implementation science, and (3) conduct and evaluation of pragmatic trials. Dr. Cotter has assembled a strong multidisciplinary mentorship team with expertise in pneumonia, qualitative methods, implementation science, and pragmatic trials, which will ensure her success in achieving her stated aims and training goals. This line of inquiry will prepare Dr. Cotter for future R01 funding and her transition to independence.