Pediatria e Terapêutica
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Hospitalist Impact in Antibiotic Selection in Pediatric Community Acquired Staphylococcus aureus Skin Infection

Janie Robles, Denise I Pinal and Charles F Seifert

Background: Pediatric hospitalist systems continue to increase due to the adoption of these programs within pediatric centers. Pediatric hospitalists provide patient care to hospitalized children for a wide range of conditions with an associated decrease in hospitalization cost and in length of stay. In this study, we aimed to assess empiric antibiotic selection of community acquired Staphylococcus aureus (S. aureus) skin and soft tissue infections in pediatric patients and the impact on prescribing patterns following the introduction of the pediatric hospitalist service to our institution.

Methods: We conducted a five-year retrospective chart review study from January 2001 to December 2006. One hundred children with positive S. aureus cultures, aged 1-18 years were enrolled in the study. Patients who were discharged with the International Classification of Disease, Ninth Revision, Clinical Modification codes for S. aureus skin and soft tissue infections were included. Trends in antibiotic selection, infection outcomes, and percent oxacillin resistance S. aureus (ORSA)/oxacillin sensitive S. aureus (OSSA) were recorded. Results: One hundred children (5%) of the 1860 patients evaluated, predominately-Hispanic patients, met inclusion criteria. Seventy-seven ORSA and 23 OSSA cultures were identified. Study participants included 55 males and 45 females. Sixty-eight percent of ORSA patients with S. aureus strains were susceptible to initial empiric therapy (p=0.0018) vs. 100% of patients with S. aureus strains in the OSSA group. No differences were identified in length of stay in the patients that received appropriate treatment vs those that did not (p=0.5511). Among patients with ORSA infections, incidence increased significantly from 2001 to 2006 while susceptible empiric antibiotic regimens reached a low in 2003 and were over 90% in 2006 following the initiation of the hospitalist service. Conclusion: Pediatric hospitalists improve quality of patient care. In this study, participants had an increase in susceptible empiric antibiotic regimens following the implementation of the pediatric hospitalist service to our facility.