Implementing antibiotic stewardship to improve the care of children hospitalized with pneumonia - PROJECT SUMMARY/ABSTRACT
The way antibiotics are delivered to hospitalized children matters. When intravenous (IV) and oral antibiotics
are equally effective, the use of oral antibiotics may avoid IV-related harms, improve patient experience, and
decrease resource utilization, hospital length of stay, and cost. Pneumonia is the ideal infection to study the
overuse of IV antibiotics as it is one of the most common reasons for hospitalization and there is emerging
evidence that initial oral antibiotics are likely as effective as IV antibiotics. Despite existing evidence, most
children hospitalized with pneumonia still receive IV therapy. This gap in translating evidence into practice
highlights the critical need for strategies to increase oral (and reduce IV) antibiotic use. The overall hypothesis
is that clinician-focused strategies that target initial antibiotic route in the Emergency Department are feasible,
increase oral antibiotic use, and improve patient outcomes. The PI will evaluate these strategies in a pilot
hybrid trial that will evaluate both effectiveness and implementation outcomes. Through this, the PI will
simultaneously gather data on the effectiveness of IV vs. oral therapy and investigate ways to translate
evidence into practice. Specifically, the PI, Jillian Cotter, MD, MSCS, in collaboration with her mentoring team
will pursue the following aims: (1) Identify barriers and facilitators to increasing initial oral antibiotics for children
hospitalized with pneumonia; (2) Develop a set of implementation strategies to increase initial oral antibiotics;
and (3) Conduct a pilot hybrid trial to determine the feasibility and acceptability of the implementation
strategies. This will prepare her to submit an R01 grant for a multisite hybrid trial to definitively evaluate
implementation and effectiveness outcomes. This proposal focuses on children, an AHRQ priority population,
and aligns with AHRQ’s goals to implement studies to accelerate the spread of evidence-based practices.
As a pediatric hospital medicine physician and clinical researcher with growing expertise in pneumonia and
antibiotic stewardship, Dr. Cotter is uniquely positioned to accomplish the proposed research and training
aims. Her career goal is to become an independently funded investigator and national leader in the
implementation of antibiotic stewardship practices. Dr. Cotter has developed a detailed career development
plan that builds on her research skillset and fills key knowledge gaps that are critical to advancing her career.
Through coursework, experiential learning, and guided mentorship, she will gain experience in the: (1) design
and conduct of qualitative research, (2) development of evidence-based interventions using implementation
science, and (3) conduct and evaluation of pragmatic trials. Dr. Cotter has assembled a strong multidisciplinary
mentorship team with expertise in pneumonia, qualitative methods, implementation science, and pragmatic
trials, which will ensure her success in achieving her stated aims and training goals. This line of inquiry will
prepare Dr. Cotter for future R01 funding and her transition to independence.
