299 - Evaluation of Group A Streptococcus Screening and Antibiotic Prescription in a Pediatric Emergency Department

Poster Number: 299
Publication Number: 299.114

Sara E. Brown, Children's Health, Jacksonville, FL, United States; Jamie Tweedle, Children's Health, Murphy, TX, United States; Michael C. Cooper, University of Texas Southwestern Medical School, Dallas, TX, United States; Kara Quaney, Children's Health, Forth Worth, TX, United States; Rong Huang, Children's Medical Center Dallas, Dallas, TX, United States; Jo-ann Nesiama, University of Texas Southwestern Medical School, Coppell, TX, United States

Background: Previous studies have demonstrated that in many institutions Group A Streptococcus (GAS) pharyngitis testing is inconsistent with recommendations made by the Infectious Diseases Society of America (IDSA), leading to inappropriate use of antimicrobials.

Objective: The objectives were to assess adherence of screening practices GAS pharyngitis in a tertiary care Pediatric Emergency Department (ED) to IDSA guidelines, compare antibiotic prescribing trends with current IDSA recommendations, and evaluate which symptoms significantly correlated with a positive GAS test.

Design/Methods: Retrospective review of charts was done of patients who had an ICD-10 code indicative of pharyngitis in our institution’s EDs from September 1, 2018, to August 31, 2019. Baseline characteristics, demographics, clinical symptoms, and laboratory data used to screen for GAS were collected. Information regarding antimicrobial treatment and ED readmissions were also collected. Multivariate logistic regression was done on all patients who had GAS testing to determine symptoms highly associated with a positive diagnosis.

Results: A total of 5,554 patients were included in the study. There were equal proportions of females and males (p=0.57), with a median age of 7 years (range 0-19.72). Of these, 89.4% were ≥ 3 years of age. Caucasian children accounted for more than half of all patients (59.96%). Most patients 4,673/5,554 (84.13%) were screened for GAS. Of these, 2,551/4,673 (54.59%) were screened according to IDSA guidelines. The symptoms most associated with positive GAS result were rash (OR 2.87, 95% CI: 2.37-3.47:p < 0.0001) and adenopathy (OR 1.34, 95% CI:1.14-1.56:p < 0.0001). The presence of sore throat was negatively associated with positive GAS result (OR 0.67, 95% CI:0.58-0.77:P < 0.0001). Amoxicillin was prescribed most frequently (87.3%), followed by cephalexin (3.97%).Conclusion(s): Providers adhered to IDSA screening guidelines for GAS infection more than half the time. Rash and adenopathy were positively associated with positive GAS results, while sore throat was not. In concordance with IDSA recommendations, amoxicillin was used most often to treat patients with GAS positive results, followed by cephalexin.