Impact of a statewide sepsis pathway on quality of antibiotic use in children in the Emergency Department

Abstract Background and objectives Sepsis is a leading cause of preventable harm in children. Sepsis pathways reduce time to antibiotics in suspected sepsis but risk unnecessary antibiotics in children with non-bacterial infections. We estimate the impact of a statewide paediatric sepsis pathway implementation on antibiotic appropriateness and consumption in Queensland, Australia. Methods ‘Before-and-after’ comparison of antibiotic appropriateness and consumption in children with suspected sepsis in three dedicated paediatric Emergency Departments (EDs). Children suspected of sepsis presenting to EDs between April 1st and December 31st 2019 were compared with a sample attending the EDs in 2017, before pathway implementation. Outcome measures included the proportion of children receiving appropriate empiric antibiotic choice and dose. We additionally performed time series analysis of all antibiotic prescriptions in the tertiary children’s ED. Results 1852 children underwent sepsis evaluation following pathway implementation and were compared with 523 historical controls. The proportion with appropriate empiric antibiotic choice and dosing increased after pathway introduction (adjusted relative risk [aRR] 1.33; 95% confidence interval [CI] 1.20 to 1.48 and aRR 1.25; 95%CI 1.17 to 1.35 respectively). Pathway introduction was associated with increased 3rd generation cephalosporin consumption in the ED (relative change 32.0%; 95%CI 2.1 to 70.5), but not amongst inpatients (8.8%; 95%CI -10.1 to 31.7). Conclusions The sepsis pathway was associated with improved empiric antibiotic choice and dosing in children suspected of sepsis. Consumption of 3rd generation cephalosporins in ED increased, but this did not spillover into inpatients. Sepsis Quality Improvement initiatives should include antimicrobial stewardship as key performance indicators.