Standardization of Evaluation to Treatment of pediatric perianal Crohn’s disease and improving Outcomes through Networking (SETON)

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ABSTRACT Antibiotics are given universally to treat Crohn’s disease, especially with perianal fistulizing complications (PFC), which occur in about 1/3 of children. Decreasing the utilization is challenging, yet significant, as many guidelines support the use of antibiotics as first-line despite a lack of research showing benefit. Furthermore, there is such variation in treatment not only regarding antibiotic use but also around use of other medications, interventions such as drainage, and timing of each of these. In this innovative proposal, the investigators evaluate the current practices for management of PFC in Crohn’s disease at seven large pediatric institutions, develop a protocol to guide antibiotic stewardship, and improve care through a multidisciplinary approach (pediatric gastroenterology, surgery, infectious disease, radiology, and nursing) and prospective implementation arm for data collection and evaluation of barriers and facilitators. Our central hypothesis is that antibiotic use for PFC in Crohn’s disease can be reduced, and outcomes improved through standardization of multidisciplinary care of children. The rationale for this project is that reduction in antibiotic use and providing higher quality care will reduce the risk of developing healthcare-associated infections such as clostridioides difficile, acquiring resistant organisms, and improved care will also reduce the risk of perianal abscess development or fistula recurrence among pediatric patients with Crohn’s disease. We will test our hypothesis through the specific aims: 1) describe variation in antibiotic use and treatment of PFCs among pediatric patients with Crohn’s disease at seven children’s hospitals; 2) develop evidence-based protocols through multidisciplinary, multicenter collaboration aimed at antibiotic reduction and standardization of PFC care; and 3) implement the protocols for antibiotic stewardship and prospectively evaluate the barriers and facilitators with shared insight of best practices for pediatric Crohn’s disease. This approach will create an evidence-base for antibiotic utilization while standardizing the care for pediatric Crohn’s disease at several institutions with prospective evaluation of outcomes. The proposed research is innovative because it brings together multidisciplinary teams from multiple institutions to develop a shared approach to improving care, that is currently not standardized, or evidence-based. The proposed study is significant because it has the potential to change the paradigm for pediatric multidisciplinary care of complex conditions beyond pediatric Crohn’s disease.