{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:52:54Z","timestamp":1791204774431,"version":"4.2.0"},"reference-count":15,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"\n BACKGROUND<\/jats:title>\n Projects employing performance feedback with education have been used to improve antimicrobial prescribing practices, but improvements may not be sustainable after the active intervention. We sought to determine whether ongoing clinical decision support (CDS) could sustain improvements achieved through initial feedback and education in prescribing shorter durations of treatment for skin and soft tissue infections (SSTI).<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n As a follow-up to a site-randomized trial, we provided performance feedback and education for 3\u00a0months along with an ongoing CDS alert operating at the point of care within a large statewide cohort of pediatricians. Following the initial period of feedback and education, we continued to deploy the alert and monitored outcomes over a 24-month period.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The proportion of skin and soft tissue infection cases treated for 7 days or fewer rose from 62.5% (3299\/5275) to 88.5% (14\u2009740\/16\u2009662), with an immediate change in the level of performance at the outset of the intervention (P\u2009&lt;\u2009.001). After the 3-month active phase of feedback and education ceased, there was no degradation in the effect over the ensuing 21-month period (slope +0.2% per month).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n In this follow-up to a site-randomized trial that encouraged shorter duration of antibiotic treatment for SSTI in children, the use of initial feedback with education accompanied by an ongoing alert operating at the point of care resulted in long-term maintenance of improvements over 24\u00a0months. This approach provides a framework strategy for achieving and maintaining gains that could be applied to other improvement projects.<\/jats:p>\n <\/jats:sec>","DOI":"10.1542\/peds.2026-076331","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:02:31Z","timestamp":1789603351000},"source":"Crossref","is-referenced-by-count":0,"title":["Spread and Sustainability of an Antimicrobial Stewardship Initiative Within a Pediatric Network"],"prefix":"10.1542","volume":"158","author":[{"given":"Louis","family":"Vernacchio","sequence":"first","affiliation":[{"name":"1Pediatric Physicians\u2019 Organization at Children\u2019s, Wellesley Hills, Massachusetts"},{"name":"2Department of Pediatrics, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura Burckett","family":"Patane","sequence":"additional","affiliation":[{"name":"1Pediatric Physicians\u2019 Organization at Children\u2019s, Wellesley Hills, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveed","family":"Rabbani","sequence":"additional","affiliation":[{"name":"1Pediatric Physicians\u2019 Organization at Children\u2019s, Wellesley Hills, Massachusetts"},{"name":"2Department of Pediatrics, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Hatoun","sequence":"additional","affiliation":[{"name":"1Pediatric Physicians\u2019 Organization at Children\u2019s, Wellesley Hills, Massachusetts"},{"name":"2Department of Pediatrics, Boston Children\u2019s Hospital, Boston, Massachusetts"},{"name":"3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"issue":"5","key":"2026100508120836700_r1","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1093\/jpids\/piab002","article-title":"Policy statement: antibiotic stewardship in pediatrics","volume":"10","author":"Gerber","year":"2021","journal-title":"J Pediatric Infect Dis Soc."},{"issue":"1","key":"2026100508120836700_r2","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/s13012-023-01312-0","article-title":"Sustainability, spread, and scale in trials using audit and feedback: a theory-informed, secondary analysis of a systematic review","volume":"18","author":"Laur","year":"2023","journal-title":"Implement Sci."},{"issue":"23","key":"2026100508120836700_r3","doi-asserted-by":"crossref","first-page":"2569","DOI":"10.1001\/jama.2014.14042","article-title":"Durability of benefits of an outpatient antimicrobial stewardship intervention after discontinuation of audit and feedback","volume":"312","author":"Gerber","year":"2014","journal-title":"JAMA."},{"issue":"4","key":"2026100508120836700_r4","first-page":"250","article-title":"Intermittent education and audit and feedback reduce inappropriate prescribing of oral third-generation cephalosporins for pediatric upper respiratory tract infections","volume":"47","author":"Taylor","year":"2021","journal-title":"Jt Comm J Qual Patient Saf."},{"key":"2026100508120836700_r5","doi-asserted-by":"crossref","DOI":"10.1542\/9781610025225","volume-title":"Red Book: 2021\u20132024 Report of the Committee on Infectious Diseases","author":"Kimberlin","year":"2021"},{"issue":"4","key":"2026100508120836700_r6","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.jinf.2020.07.030","article-title":"Route and duration of antibiotic therapy in acute cellulitis: a systematic review and meta-analysis of the effectiveness and harms of antibiotic treatment","volume":"81","author":"Cross","year":"2020","journal-title":"J Infect."},{"issue":"3","key":"2026100508120836700_r7","doi-asserted-by":"crossref","first-page":"106076","DOI":"10.1016\/j.ijantimicag.2020.106076","article-title":"Antibiotic route and duration of therapy for cellulitis: data extracted from a multi-center clinical trial","volume":"56","author":"Williams","year":"2020","journal-title":"Int J Antimicrob Agents."},{"issue":"2","key":"2026100508120836700_r8","doi-asserted-by":"crossref","first-page":"e2023063691","DOI":"10.1542\/peds.2023-063691","article-title":"Improving short course treatment of pediatric infections: a randomized quality improvement trial","volume":"153","author":"Vernacchio","year":"2024","journal-title":"Pediatrics."},{"issue":"23","key":"2026100508120836700_r9","doi-asserted-by":"crossref","first-page":"394","DOI":"10.15585\/mmwr.mm7423a1","article-title":"Mycoplasma pneumoniae infections in hospitalized children - United States, 2018-2024","volume":"74","author":"Diaz","year":"2025","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"3","key":"2026100508120836700_r10","first-page":"CD000259","article-title":"Audit and feedback: effects on professional practice","volume":"3","author":"Ivers","year":"2025","journal-title":"Cochrane Database Syst Rev."},{"issue":"1","key":"2026100508120836700_r11","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1186\/s12913-019-4327-3","article-title":"Clinician dashboard views and improvement in preventative health outcome measures: a retrospective analysis","volume":"19","author":"Twohig","year":"2019","journal-title":"BMC Health Serv Res."},{"issue":"10","key":"2026100508120836700_r12","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1093\/jamia\/ocac094","article-title":"Effectiveness of clinical dashboards as audit and feedback or clinical decision support tools on medication use and test ordering: a systematic review of randomized controlled trials","volume":"29","author":"Xie","year":"2022","journal-title":"J Am Med Inform Assoc."},{"issue":"3","key":"2026100508120836700_r13","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1136\/amiajnl-2011-000185","article-title":"A framework for evaluating the appropriateness of clinical decision support alerts and responses","volume":"19","author":"McCoy","year":"2012","journal-title":"J Am Med Inform Assoc."},{"issue":"1","key":"2026100508120836700_r14","first-page":"1","article-title":"Reducing alert burden in electronic health records: state of the art recommendations from four health systems","volume":"11","author":"McGreevey","year":"2020","journal-title":"Appl Clin Inform."},{"issue":"1","key":"2026100508120836700_r15","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1038\/s41746-020-0221-y","article-title":"An overview of clinical decision support systems: benefits, risks, and strategies for success","volume":"3","author":"Sutton","year":"2020","journal-title":"NPJ Digit Med."}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2026-076331\/1961291\/pediatrics.2026076331.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2026-076331\/1961291\/pediatrics.2026076331.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:12:12Z","timestamp":1791202332000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/158\/4\/e2026076331\/209443\/Spread-and-Sustainability-of-an-Antimicrobial"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":15,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,9,17]]},"published-print":{"date-parts":[[2026,10,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2026-076331","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]},"article-number":"e2026076331"}}