This is a monocentric, retrospective, observational, pre-post, quasi-experimental study, set at the Department of Women's and Children's health in Padua, Northern Italy.
Between the end of 2015 and the beginning of 2016, OM/SA internal guidelines were developed by the Division of Pediatric Infectious Diseases and the Pediatric Rheumatology Unit of Padua University Hospital, summarizing international literature evidence. In addition, three training sessions with an overview of the guidelines and treatment rationale were offered to attending physicians and residents.
The impact of the intervention was assessed by comparing the four-year period before OM/SA guidelines implementation (pre-intervention: January 1st, 2012, through December 31st, 2015) to the six years and ten months after intervention (post-intervention: January 1st, 2016, through October 31st, 2022).
According to the implemented guidelines, in fully vaccinated patients older than 3 months, an IV empirical antibiotic therapy is started with a first-generation cephalosporin (cefazolin 150–200 mg/kg/day) for 5–7 days in uncomplicated forms, as the prevalence of MSSA is above 90% in the considered area (7 (link), 8 (link)). The subsequent shift in case of identification of the causative microorganism is to targeted oral therapy, otherwise to an oral antibiotic with the same spectrum activity as the IV therapy (shift from cefazolin to cefalexin or cefuroxime axetil). The total suggested duration of OM treatment is three-four weeks in case of clinical improvement with a normalized C-reactive protein (CRP) before the twentieth day of therapy. The total duration of SA is two-three weeks if isolated, or four weeks in case of associated OM (7 (link)).
Broad-spectrum antimicrobials were defined as: β-lactam and β-lactamase inhibitor combinations, third-generation cephalosporins, clindamycin, glycopeptides, fluoroquinolones, and macrolides. Therapeutic regimens including at least one broad-spectrum prescription, despite the association with amoxicillin or oxacillin, were considered broad-spectrum.
Between the end of 2015 and the beginning of 2016, OM/SA internal guidelines were developed by the Division of Pediatric Infectious Diseases and the Pediatric Rheumatology Unit of Padua University Hospital, summarizing international literature evidence. In addition, three training sessions with an overview of the guidelines and treatment rationale were offered to attending physicians and residents.
The impact of the intervention was assessed by comparing the four-year period before OM/SA guidelines implementation (pre-intervention: January 1st, 2012, through December 31st, 2015) to the six years and ten months after intervention (post-intervention: January 1st, 2016, through October 31st, 2022).
According to the implemented guidelines, in fully vaccinated patients older than 3 months, an IV empirical antibiotic therapy is started with a first-generation cephalosporin (cefazolin 150–200 mg/kg/day) for 5–7 days in uncomplicated forms, as the prevalence of MSSA is above 90% in the considered area (7 (link), 8 (link)). The subsequent shift in case of identification of the causative microorganism is to targeted oral therapy, otherwise to an oral antibiotic with the same spectrum activity as the IV therapy (shift from cefazolin to cefalexin or cefuroxime axetil). The total suggested duration of OM treatment is three-four weeks in case of clinical improvement with a normalized C-reactive protein (CRP) before the twentieth day of therapy. The total duration of SA is two-three weeks if isolated, or four weeks in case of associated OM (7 (link)).
Broad-spectrum antimicrobials were defined as: β-lactam and β-lactamase inhibitor combinations, third-generation cephalosporins, clindamycin, glycopeptides, fluoroquinolones, and macrolides. Therapeutic regimens including at least one broad-spectrum prescription, despite the association with amoxicillin or oxacillin, were considered broad-spectrum.
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