OBJECTIVES The objective was to optimize antibiotic choice and duration for uncomplicated skin/soft tissue infections (SSTIs) discharged from pediatric emergency departments (EDs) and urgent cares (UCs). METHODS Pediatric patients aged 0 to 18 years discharged from 3 pediatric EDs and 8 UCs with a diagnosis of uncomplicated SSTIs were included. Optimal treatment was defined as 5 days of cephalexin for nonpurulent SSTIs and 7 days of clindamycin or trimethoprim/sulfamethoxazole for purulent SSTIs. Exclusion criteria included erysipelas, folliculitis, felon, impetigo, lymphangitis, paronychia, perianal abscess, phlegmon, preseptal or orbital cellulitis, and cephalosporin allergy. Baseline data were collected from January 2018 to June 2019. Quality improvement (QI) interventions began July 2019 with a revised SSTI guideline, discharge order set, and maintenance of certification (MOC) QI project. MOC participants received 3 education sessions, monthly group feedback, and individual scorecards. Balancing measures included return visits within 10 days requiring escalation of care. Data were monitored through March 2021. RESULTS In total, 9306 SSTIs were included. The MOC QI project included 50 ED and UC physicians (27% of eligible physicians). For purulent SSTI, optimal antibiotic choice, plus duration, increased from a baseline median of 28% to 64%. For nonpurulent SSTI, optimal antibiotic choice, plus duration, increased from a median of 2% to 43%. MOC participants had greater improvement than non-MOC providers (P < .010). Return visits did not significantly change pre- to postintervention, remaining <2%. CONCLUSIONS We improved optimal choice and reduced duration of antibiotic treatment of outpatient SSTIs. MOC participation was associated with greater improvement and was sustained after the intervention period.

中文翻译：

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优化儿科急诊和紧急护理中心皮肤感染的抗生素治疗。

目标 目标是优化从儿科急诊 (ED) 和紧急护理 (UC) 出院的单纯性皮肤/软组织感染 (SSTI) 的抗生素选择和持续时间。方法 包括从 3 个儿科 ED 和 8 个 UC 出院且诊断为单纯性 SSTI 的 0 至 18 岁的儿科患者。最佳治疗定义为非化脓性 SSTI 使用头孢氨苄 5 天，化脓性 SSTI 使用克林霉素或甲氧苄啶/磺胺甲恶唑 7 天。排除标准包括丹毒、毛囊炎、重罪犯、脓疱疮、淋巴管炎、甲沟炎、肛周脓肿、痰、中隔或眼眶蜂窝织炎和头孢菌素过敏。从 2018 年 1 月到 2019 年 6 月收集了基线数据。质量改进 (QI) 干预措施于 2019 年 7 月开始，修订了 SSTI 指南、出院令集、和维护认证 (MOC) QI 项目。MOC 参与者接受了 3 次教育课程、每月小组反馈和个人记分卡。平衡措施包括需要升级护理的 10 天内回访。数据监测到 2021 年 3 月。结果总共包括 9306 个 SSTI。MOC QI 项目包括 50 名 ED 和 UC 医生（占合格医生的 27%）。对于化脓性 SSTI，最佳抗生素选择加上持续时间从基线中位数 28% 增加到 64%。对于非化脓性 SSTI，最佳抗生素选择加上持续时间从 2% 的中位数增加到 43%。MOC 参与者比非 MOC 提供者有更大的改善 (P < .010)。回访在干预前后没有显着变化，保持在<2%。结论 我们改进了门诊 SSTI 的最佳选择并缩短了抗生素治疗的持续时间。MOC 参与与更大的改善相关，并在干预期后持续。