{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:46:00Z","timestamp":1791935160757,"version":"4.3.4"},"reference-count":10,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background Outpatient antibiotic prescribing often deviates from local guidelines despite the availability of institutional pathways and antibiograms. Limited integration of these resources into clinical workflow may reduce their effect on point-of-care decision-making.<\/jats:p>\n                  <jats:p>Objective This study aimed to evaluate whether a multicomponent intervention integrating electronic health record (EHR)-embedded clinical decision support (CDS), provider education, and practice-level prescribing analytics could increase use of the recommended first-line empiric antibiotic selection for pediatric urinary tract infections (UTIs).<\/jats:p>\n                  <jats:p>Methods We conducted a 12-month quality improvement initiative across pediatric outpatient clinics within a large academic health system using iterative Plan\u2013Do\u2013Study\u2013Act cycles. Empiric therapy was defined as antibiotic prescribing at the initial visit before culture results. Encounters were identified using the International Classification of Diseases, Tenth Revision (ICD-10) codes with concurrent antibiotic prescribing. The intervention combined sequential components: provider education, passive CDS embedded within urinalysis results linking to institutional guidance, practice-level prescribing reports with audit and feedback, and targeted case-based emails discouraging broader-spectrum cephalosporin use. Prescribing trends were evaluated using run charts.<\/jats:p>\n                  <jats:p>Results Among 3312 eligible encounters, empiric prescribing of the recommended first-line increased from 13.9% at baseline to 41.9% within 12 months. A shift in prescribing patterns followed the deployment of the EHR-embedded CDS and dissemination of practice-level prescribing reports. Concurrently, the use of broad-spectrum second- and third-generation cephalosporins declined.<\/jats:p>\n                  <jats:p>Conclusion This initiative brought stewardship guidance into the EHR workflow and reinforced it with provider education, prescribing analytics, and audit and feedback. We observed improved empiric antibiotic selection for outpatient pediatric UTIs after implementation. These findings suggest that informatics strategies may support outpatient antimicrobial stewardship when they fit naturally into clinical decision-making and make prescribing patterns visible over time.<\/jats:p>","DOI":"10.1055\/a-2976-8504","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:08:04Z","timestamp":1791932884000},"page":"945-949","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Decision Support and Prescribing Analytics to Improve Empiric Antibiotic Selection for Pediatric Urinary Tract Infections"],"prefix":"10.1055","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3763-9612","authenticated-orcid":false,"given":"Hani Abou","family":"Hatab","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, Texas, United States","place":["Houston"],"department":["Department of Pediatrics, Division of Infectious Diseases"]},{"name":"Texas Children\u2019s Hospital, Texas, United States","place":["Houston"],"department":["Department of Pediatrics, Division of Infectious Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Smith","sequence":"additional","affiliation":[{"name":"Duke University Medical Center, North Carolina, United States","place":["Durham"],"department":["Department of Pediatrics, Division of Infectious Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Yarrington","sequence":"additional","affiliation":[{"name":"Duke University Medical Center, North Carolina, United States","place":["Durham"],"department":["Department of Medicine, Division of Infectious Diseases"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1542\/peds.2010-3465","article-title":"National ambulatory antibiotic prescribing patterns for pediatric urinary tract infection, 1998\u20132007","volume":"127","author":"H L Copp","year":"2011","journal-title":"Pediatrics"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"e1224","DOI":"10.1093\/cid\/ciac504","article-title":"Patterns, predictors, and intercenter variability in empiric gram-negative antibiotic use across 928 United States hospitals","volume":"76","author":"K E Goodman","year":"2023","journal-title":"Clin Infect Dis"},{"issue":"9","key":"ref3","doi-asserted-by":"crossref","first-page":"ofy198","DOI":"10.1093\/ofid\/ofy198","article-title":"An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections","volume":"5","author":"M J Durkin","year":"2018","journal-title":"Open Forum Infect Dis"},{"issue":"15","key":"ref4","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1001\/jama.282.15.1458","article-title":"Why don\u2019t physicians follow clinical practice guidelines? A framework for improvement","volume":"282","author":"M D Cabana","year":"1999","journal-title":"JAMA"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1055\/a-2054-0270","article-title":"Digital antimicrobial stewardship decision support to improve antimicrobial management","volume":"14","author":"J KW Yarahuan","year":"2023","journal-title":"Appl Clin Inform"},{"issue":"11","key":"ref6","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1017\/ice.2020.357","article-title":"Improved empiric antibiotic prescribing for acute cystitis with use of local urinary antibiogram and clinical decision support system","volume":"41","author":"C J Shoff","year":"2020","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1055\/s-0042-1760082","article-title":"Evaluation of an antimicrobial stewardship decision support for pediatric infections","volume":"14","author":"E A McGonagle","year":"2023","journal-title":"Appl Clin Inform"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"e2313011","DOI":"10.1001\/jamanetworkopen.2023.13011","article-title":"Implementation of an antibiotic stewardship initiative in a large urgent care network","volume":"6","author":"E Stenehjem","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1177\/00185787231159578","article-title":"Impact of a multifaceted intervention on antibiotic prescribing for cystitis and asymptomatic bacteriuria in 23 community hospital emergency departments","volume":"58","author":"E M Ingalls","year":"2023","journal-title":"Hosp Pharm"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1093\/cid\/ciae604","article-title":"Audit and feedback interventions for antibiotic prescribing in primary care: a systematic review and meta-analysis","volume":"80","author":"A XT Xu","year":"2025","journal-title":"Clin Infect Dis"}],"container-title":["Applied Clinical Informatics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2976-8504.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:08:05Z","timestamp":1791932885000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2976-8504"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":10,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2026,8,14]]},"published-print":{"date-parts":[[2026,8]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2976-8504","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1869-0327"],"issn-type":[{"value":"1869-0327","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}