{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T18:24:01Z","timestamp":1789064641096,"version":"build-2803163510"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"\n Background:<\/jats:title>\n Children with pediatric intestinal failure (PIF) on parenteral nutrition through central venous catheters are at high risk for central line-associated bloodstream infections (CLABSI), a major cause of morbidity and mortality. Current guidelines recommend prompt empiric antibiotic therapy, yet limited data exist on quality improvement initiatives in this population.<\/jats:p>\n <\/jats:sec>\n \n Objective:<\/jats:title>\n To increase appropriate antibiotics ordered in the emergency department (ED) for febrile PIF patients by 50% and increase antibiotics administered within 60 minutes by 50% within 2 years.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n This single-center quality improvement project included PIF patients on home parenteral nutrition presenting to the ED with fever from February 2020 through August 2023. Interventions included electronic health record alerts, provider education, standardized CLABSI cards for families, antibiotic order sets, and ensuring cefepime availability in the ED.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Ninety-five encounters were analyzed (43 preprotocol, 52 postprotocol). Postintervention, cefepime orders increased from 2.3% to 90.4% (\n P<\/jats:italic>\n <0.0001), while ceftriaxone orders decreased from 88.4% to 23.1% (\n P<\/jats:italic>\n <0.0001). Vancomycin orders increased from 76.7% to 98.1% (\n P<\/jats:italic>\n <0.001). Both recommended antibiotics were ordered in 55.8% preintervention versus 80.8% postintervention (\n P<\/jats:italic>\n <0.01). Median time to cephalosporin administration decreased 58%, from 94.5 to 39.5 minutes (\n P<\/jats:italic>\n <0.05); vancomycin administration time decreased 56%, from 178 to 78 minutes (\n P<\/jats:italic>\n <0.05). Cephalosporins were administered within 60 minutes in 30.2% preintervention versus 72.6% postintervention (\n P<\/jats:italic>\n <0.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n This quality improvement initiative significantly improved appropriateness and timeliness of antibiotic delivery in children with PIF presenting with suspected CLABSI through multidisciplinary interventions targeting provider awareness, process standardization, and system-level barriers.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/pec.0000000000003605","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T08:00:29Z","timestamp":1778486429000},"page":"596-601","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Improving Appropriateness and Timeliness of Antibiotic Delivery in Pediatric Intestinal Failure"],"prefix":"10.1097","volume":"42","author":[{"given":"Christina","family":"Meenan","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Dell Medical School at UT Austin, Austin, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deidre","family":"Graham","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Oklahoma Health Science Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0317-6493","authenticated-orcid":false,"given":"Saurabh","family":"Talathi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, University of Oklahoma Health Science Center \u2013 College of Medicine, Oklahoma City, OK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"R1-20260909","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1002\/jpen.2232","article-title":"ASPEN definitions in pediatric intestinal failure","volume":"46","author":"Modi","year":"2022","journal-title":"J Parenter Enteral Nutr"},{"key":"R2-20260909","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1097\/MPG.0000000000003036","article-title":"Management of central venous access in children with intestinal failure: a position paper from the NASPGHAN intestinal rehabilitation special interest group","volume":"72","author":"Wendel","year":"2021","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"R3-20260909","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1093\/ajcn\/nqz110","article-title":"Clinical outcomes in pediatric intestinal failure: a meta-analysis and meta-regression","volume":"110","author":"Pierret","year":"2019","journal-title":"Am J Clin Nutr"},{"key":"R4-20260909","doi-asserted-by":"crossref","first-page":"e140","DOI":"10.1097\/PEC.0000000000000812","article-title":"Bloodstream infections in patients with intestinal failure presenting to a pediatric emergency department with fever and a central line","volume":"33","author":"Szydlowski","year":"2017","journal-title":"Pediatr Emerg Care"},{"key":"R5-20260909","doi-asserted-by":"crossref","first-page":"e77","DOI":"10.1097\/MPG.0000000000002058","article-title":"Analysis of healthcare institutional costs of pediatric home parenteral nutrition central line infections","volume":"67","author":"Raphael","year":"2018","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"R6-20260909","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1097\/CCM.0b013e3181cc4824","article-title":"Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department","volume":"38","author":"Gaieski","year":"2010","journal-title":"Crit Care Med"},{"key":"R7-20260909","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1002\/pbc.25435","article-title":"Pediatric patients who receive antibiotics for fever and neutropenia in less than 60 min have decreased intensive care needs","volume":"62","author":"Salstrom","year":"2015","journal-title":"Pediatr Blood Cancer"},{"key":"R8-20260909","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1200\/JOP.2014.002733","article-title":"Reducing time to antibiotic administration for febrile neutropenia in the emergency department","volume":"11","author":"Keng","year":"2015","journal-title":"J Oncol Pract"},{"key":"R9-20260909","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1200\/OP.23.00314","article-title":"Improving time to antibiotic administration for pediatric oncology patients with new-onset fever","volume":"20","author":"Smith","year":"2024","journal-title":"JCO Oncol Pract"},{"key":"R10-20260909","doi-asserted-by":"crossref","first-page":"e201","DOI":"10.1542\/peds.2012-0153","article-title":"Improving timeliness of antibiotic delivery for patients with fever and suspected neutropenia in a pediatric emergency department","volume":"130","author":"Volpe","year":"2012","journal-title":"Pediatrics"},{"issue":"5","key":"R11-20260909","doi-asserted-by":"crossref","first-page":"e201712071","DOI":"10.1542\/peds.2017-1201","article-title":"Reducing Time to Antibiotics in Children With Intestinal Failure, Central Venous Line, and Fever.","volume":"140","author":"Hudgins","year":"2017","journal-title":"Pediatrics"},{"key":"R12-20260909","doi-asserted-by":"crossref","first-page":"16","DOI":"10.4103\/2153-3539.153916","article-title":"Default settings of computerized physician order entry system order sets drive ordering habits","volume":"6","author":"Olson","year":"2015","journal-title":"J Pathol Inform"},{"key":"R13-20260909","doi-asserted-by":"crossref","first-page":"e689","DOI":"10.1542\/peds.2010-3587","article-title":"Quality-improvement initiative sustains improvement in pediatric health care worker hand hygiene","volume":"128","author":"Linam","year":"2011","journal-title":"Pediatrics"},{"key":"R14-20260909","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1093\/jpids\/piu079","article-title":"Epidemiologic associations between short-bowel syndrome and bloodstream infection among hospitalized children","volume":"4","author":"Miko","year":"2015","journal-title":"J Pediatric Infect Dis Soc"}],"updated-by":[{"DOI":"10.1097\/pec.0000000000003711","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000}}],"container-title":["Pediatric Emergency 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