scholarly journals Considerable variability in antibiotic use among US children’s hospitals in 2017–2018

2020 ◽  
Vol 41 (5) ◽  
pp. 571-578
Author(s):  
Hannah G. Griffith ◽  
Keerti Dantuluri ◽  
Cary Thurm ◽  
Derek J. Williams ◽  
Ritu Banerjee ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Health Information System ◽  
Antibiotic Use ◽  
Hospitalized Children ◽  
Medical Patients ◽  
Broad Spectrum Antibiotic ◽  
Children's Hospitals ◽  
Cross Sectional ◽  
National Network ◽  
Children’S Hospitals

AbstractObjective:To characterize the prevalence of and seasonal and regional variation in inpatient antibiotic use among hospitalized US children in 2017–2018.Design:We conducted a cross-sectional examination of hospitalized children. The assessments were conducted on a single day in spring (May 3, 2017), summer (August 2, 2017), fall (October 25, 2017), and winter (January 31, 2018). The main outcome of interest was receipt of an antibiotic on the study day.Setting:The study included 51 freestanding US children’s hospitals that participate in the Pediatric Health Information System (PHIS).Patients:This study included all patients <18 years old who were admitted to a participating PHIS hospital, excluding patients who were admitted solely for research purposes.Results:Of 52,769 total hospitalized children, 19,174 (36.3%) received antibiotics on the study day and 6,575 of these (12.5%) received broad-spectrum antibiotics. The overall prevalence of antibiotic use varied across hospitals from 22.3% to 51.9%. Antibiotic use prevalence was 29.2% among medical patients and 47.7% among surgical patients. Although there was no significant seasonal variation in antibiotic use prevalence, regional prevalence varied, ranging from 32.7% in the Midwest to 40.2% in the West (P < .001). Among units, pediatric intensive care unit patients had the highest prevalence of both overall and broad-spectrum antibiotic use at 58.3% and 26.6%, respectively (P < .001).Conclusions:On any given day in a national network of children’s hospitals, more than one-third of hospitalized children received an antibiotic, and 1 in 8 received a broad-spectrum antibiotic. Variation across hospitals, setting and regions identifies potential opportunities for enhanced antibiotic stewardship activities.

scholarly journals 1126. Variability in Antibiotic Use in Children’s Hospitals in the United States

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S400-S401
Author(s):  
Hannah Griffith ◽  
Keerti Dantuluri ◽  
Cary Thurm ◽  
Derek Williams ◽  
Ritu Banerjee ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Use ◽  
Surgical Patients ◽  
Hospitalized Children ◽  
Medical Patients ◽  
Broad Spectrum Antibiotic ◽  
Children's Hospitals ◽  
Children’S Hospitals ◽  
Median Hospital ◽  
Research Grant

Abstract Background Understanding patterns of inpatient antibiotic use is necessary to enhance appropriate use and minimize preventable harm at hospitals. Few studies have characterized antibiotic use in the inpatient setting in children. Methods We conducted a cross-sectional study in children admitted to 51 freestanding US children’s hospitals included in the Pediatric Health Information System (PHIS). Overall and broad-spectrum antibiotic use (see Table) were measured using charge data, and prevalence of use was assessed on a single day of each 2017–2018 season over one year. Comparisons were made based on clinical setting (medical vs. surgical), clinical unit (PICU, NICU, and all others), hospital, and region. We assessed the relationship between antibiotic use and median hospital case-mix index (CMI), a surrogate for clinical complexity. Results Of 52769 hospitalized children assessed on a study day, 19174 (36%) received antibiotics, and 6575 (12%) received broad-spectrum antibiotics (table). Overall antibiotic use prevalence varied across hospitals from 22% to 52% (Figure 1). Median hospital CMI had no significant relationship with overall antibiotic use and only a weak correlation (ρ=0.29) with broad-spectrum antibiotic use (Figure 2). Antibiotic use prevalence varied minimally by season, ranging from 36% in fall to 37% in summer. Antibiotic use prevalence was 29% (9470/32436) among medical patients and 48% (9704/20333) among surgical patients. The antibiotics most commonly administered in medical patients were ceftriaxone and ampicillin, while surgical patients most commonly received cefazolin and vancomycin. Regional prevalence ranged from 33% (Midwest) to 40% (West). By unit, PICU patients had the highest prevalence of overall [58% (4006/6874)] and broad-spectrum [27% (1830/6874)] antibiotic use. Children with complex chronic conditions accounted for 63% of hospitalized children but represented 72% of children receiving any antibiotic and 85% of those receiving broad-spectrum antibiotics. Conclusion We observed large and apparently unexplained variability in antibiotic use prevalence among children’s hospitals, clinical settings, and regions. This indicates potential opportunities for enhanced antibiotic stewardship activities. Disclosures Ritu Banerjee, MD, PhD, Accelerate Diagnostics: Grant/Research Support; BioFire: Research Grant; Biomerieux: Research Grant; Roche: Research Grant

Quantifying Empiric Antibiotic Use in US Children’s Hospitals

2021 ◽  
Author(s):  
Kathleen Chiotos ◽  
Lauren D’Arinzo ◽  
Eimear Kitt ◽  
Rachael Ross ◽  
Jeffrey S. Gerber
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Use ◽  
Level Variation ◽  
Hospital Level ◽  
Broad Spectrum Antibiotic ◽  
Children's Hospitals ◽  
Broad Spectrum Antibiotics ◽  
Children’S Hospitals ◽  
Days Of Therapy ◽  
Rule Out

OBJECTIVES Empirical broad-spectrum antibiotics are routinely administered for short durations to children with suspected bacteremia while awaiting blood culture results. Our aim for this study was to estimate the proportion of broad-spectrum antibiotic use accounted for by these “rule-outs.” METHODS The Pediatric Health Information System was used to identify children aged 3 months to 20 years hospitalized between July 2016 and June 2017 who received broad-spectrum antibiotics for suspected bacteremia. Using an electronic definition for a rule-out, we estimated the proportion of all broad-spectrum antibiotic days of therapy accounted for by this indication. Clinical and demographic characteristics, as well as antibiotic choice, are reported descriptively. RESULTS A total of 67 032 episodes of suspected bacteremia across 42 hospitals were identified. From these, 34 909 (52%) patients were classified as having received an antibiotic treatment course, and 32 123 patients (48%) underwent an antibiotic rule-out without a subsequent treatment course. Antibiotics prescribed for rule-outs accounted for 12% of all broad-spectrum antibiotic days of therapy. Third-generation cephalosporins and vancomycin were the most commonly prescribed antibiotics, and substantial hospital-level variation in vancomycin use was identified (range: 16%–58% of suspected bacteremia episodes). CONCLUSIONS Broad-spectrum intravenous antibiotic use for rule-out infections appears common across children’s hospitals, with substantial hospital-level variation in the use of vancomycin in particular. Antibiotic stewardship programs focused on intervening on antibiotics prescribed for longer durations may consider this novel opportunity to further standardize antibiotic regimens and reduce antibiotic exposure.

Vancomycin Use: Room for Improvement Among Hospitalized Children

2016 ◽  
Vol 30 (3) ◽  
pp. 296-299 ◽  
Author(s):  
Jessica Gillon ◽  
Meng Xu ◽  
James Slaughter ◽  
M. Cecilia Di Pentima
Keyword(s):  
Real Time ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Hospitalized Children ◽  
Interrupted Time Series Analysis ◽  
Prospective Audit ◽  
Children's Hospitals ◽  
Children’S Hospitals ◽  
Before And After ◽  
The Impact

Introduction: The use of vancomycin is common among hospitalized children. We sought to evaluate the impact of prospective audit with real-time feedback on vancomycin use and pharmacy costs. Methods: Vancomycin use was evaluated at Monroe Carell Jr Children’s Hospital at Vanderbilt (MCJCHV) before and after the implementation of prospective audit with intervention and feedback to providers in 2012. Antibiotic use was compared to academic children’s hospitals with established antimicrobial stewardship programs (ASPs). Two similar pediatric academic institutions without an ASP were used as nonintervention controls. Analysis of monthly days of antibiotic therapy (DoT) per 1000 patient-days was performed by interrupted time series analysis. Results: Monthly vancomycin use decreased from 114 DoTs/1000 patient-days to 89 DoTs/1000 patient-days ( P < .0001). We did not find significant differences in the slope of change in vancomycin use between MCJCHV and institutions with ASPs either before or after the intervention ( P = .86 and P = .71, respectively). When compared to children’s hospitals without ASPs, the use of vancomycin was significantly lower at MCJCHV ( P < .001). Conclusion: The use of vancomycin at academic children’s hospitals with an ASP is declining. In our experience, prospective audit with real-time intervention and feedback to providers significantly reduced the use and costs associated with vancomycin.

Community antibiotic prescribing for children in France from 2015 to 2017: a cross-sectional national study

2020 ◽  
Author(s):  
Nhung T H Trinh ◽  
Robert Cohen ◽  
Magali Lemaitre ◽  
Pierre Chahwakilian ◽  
Gregory Coulthard ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
National Study ◽  
Antibiotic Prescribing ◽  
Broad Spectrum Antibiotic ◽  
Duration Of Treatment ◽  
Cross Sectional ◽  
Prescription Rates ◽  
Tract Infections

Abstract Objectives To assess recent community antibiotic prescribing for French children and identify areas of potential improvement. Methods We analysed 221 768 paediatric (&lt;15 years) visits in a national sample of 680 French GPs and 70 community paediatricians (IQVIA’s EPPM database), from March 2015 to February 2017, excluding well-child visits. We calculated antibiotic prescription rates per 100 visits, separately for GPs and paediatricians. For respiratory tract infections (RTIs), we described broad-spectrum antibiotic use and duration of treatment. We used Poisson regression to identify factors associated with antibiotic prescribing. Results GPs prescribed more antibiotics than paediatricians [prescription rate 26.1 (95% CI 25.9–26.3) versus 21.6 (95% CI 21.0–22.2) per 100 visits, respectively; P &lt; 0.0001]. RTIs accounted for more than 80% of antibiotic prescriptions, with presumed viral RTIs being responsible for 40.8% and 23.6% of all antibiotic prescriptions by GPs and paediatricians, respectively. For RTIs, antibiotic prescription rates per 100 visits were: otitis, 68.1 and 79.8; pharyngitis, 67.3 and 53.3; sinusitis, 67.9 and 77.3; pneumonia, 80.0 and 99.2; bronchitis, 65.2 and 47.3; common cold, 21.7 and 11.6; bronchiolitis 31.6 and 20.1; and other presumed viral RTIs, 24.1 and 11.0, for GPs and paediatricians, respectively. For RTIs, GPs prescribed more broad-spectrum antibiotics [49.8% (95% CI 49.3–50.3) versus 35.6% (95% CI 34.1–37.1), P &lt; 0.0001] and antibiotic courses of similar duration (P = 0.21). After adjustment for diagnosis, antibiotic prescription rates were not associated with season and patient age, but were significantly higher among GPs aged ≥50 years. Conclusions Future antibiotic stewardship campaigns should target presumed viral RTIs, broad-spectrum antibiotic use and GPs aged ≥50 years.

Prothrombin Complex Concentrate Utilization in Children's Hospitals

2021 ◽  
Author(s):  
Jeffrey E. Lutmer ◽  
Christian Mpody ◽  
Eric A. Sribnick ◽  
Takaharu Karube ◽  
Joseph D. Tobias
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Health Information System ◽  
Bleeding Risk ◽  
Cross Sectional Study ◽  
Critically Ill Children ◽  
Children's Hospitals ◽  
Cross Sectional ◽  
Medical Coding ◽  
Children’S Hospitals

AbstractProthrombin complex concentrates (PCCs) are used to manage bleeding in critically ill children. We performed a repeat cross-sectional study using the Pediatric Health Information System registry to describe PCC utilization in the U.S. children's hospitals over time and determine the relationship between PCC use and specific risk factors for bleeding. We included children < 18 years who received three-factor or four-factor PCC during hospital admission between January 2015 and December 2020 to describe the association between PCC therapy, anticoagulation therapies, and inherited or acquired bleeding diatheses. PCC use steadily increased over the 6-year study period (from 1.3 to 4.6 per 10,000 encounters). Patients exhibited a high degree of critical illness, with 85.0% requiring intensive care unit admission and a mortality rate of 25.8%. PCCs were used in a primarily emergent or urgent fashion (32.6 and 39.3%, respectively) and more frequently in surgical cases (79.0% surgical vs. 21.0% medical). Coding analysis suggested a low rate of chronic anticoagulant use which was supported by review of concomitant anticoagulant medications. PCC use is increasing in critically ill children and does not correlate with specific anticoagulant therapy use or other bleeding risk factors. These findings suggest PCC use is not limited to vitamin K antagonist reversal. Indications, efficacy, and safety of PCC therapy in children require further study.

Pediatric antibiotic stewardship: successful interventions to reduce broad-spectrum antibiotic use on general pediatric wards

Infection ◽  
2017 ◽  
Vol 45 (4) ◽  
pp. 493-504 ◽  
Author(s):  
Katharina Kreitmeyr ◽  
Ulrich von Both ◽  
Alenka Pecar ◽  
Johannes P. Borde ◽  
Rafael Mikolajczyk ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Broad Spectrum Antibiotic

scholarly journals A study on antibiotic prescription among the hospitalized pediatric patients at a referral center in Puducherry, India

2017 ◽  
Vol 4 (3) ◽  
pp. 700
Author(s):  
M. Bala Gopal ◽  
P. Thiyagarajan ◽  
Vinayagamoorthy Venugopal ◽  
Venkata Naveen Kumar
Keyword(s):  
Infectious Disease ◽  
Developing Countries ◽  
Antimicrobial Resistance ◽  
Significant Proportion ◽  
Antibiotic Use ◽  
Hospitalized Children ◽  
Referral Centre ◽  
Cross Sectional ◽  
Microbial Resistance ◽  
The Cost

Background: Antimicrobial resistance has reached to a significant proportion globally. This antimicrobial resistance increases the cost of health care in addition to the existing burden of the prevalence of infectious disease in developing countries. We need to have institutional protocols based on the standard guidelines. It is important for the clinician to use antibiotics only when it is necessary. The aim of the study was to analyze the rationality of the antibiotics used among the hospitalized children in the referral centre located in the rural area, to evaluate the pattern of antibiotics prescribed among the hospitalized children and to find out the factors associated with the usage of antibiotics among them.  Methods: Analytical, cross sectional study was performed on all patients admitted to the inpatient pediatric medical service at a referral centre situated in the rural part of the Puducherry, India during the period from July 2015 to June 2016. Results: 959 children were included in our study.607 children belong to less than 5 years of age group. Overall 60% of the children have received either oral or parenteral antibiotics. Based on the categorization of children as per the final clinical diagnosis children requiring antibiotic, can be used and not required are 13% (125), 38.6% (370) and 48.4% (464) respectively. Respiratory, gastrointestinal and systemic infectious diseases were the major group of cases admitted in our centre. Antibiotic use in respiratory and systemic infectious disease were maximum with 248 (70.1%) and 179 (71.6%) respectively. Among the antibiotics cephalosporin, penicillin group and azithromycin constitute more than 90% of the antibiotics prescribed cases.Conclusions: Overuse of antibiotic is universal and seen in both developed and developing countries. This increases the cost of treatment and increases the chances of microbial resistance. As per the W.H.O. recommendations surveillance system is required in all the hospitals to assess the antibiotic use and to monitor the prevalence of microbial resistance. 

Impact of Order-Set Modifications and Provider Education Following Guideline Updates on Broad-Spectrum Antibiotic Use in Patients Admitted With Community Acquired Pneumonia

2021 ◽  
pp. 001857872110557
Author(s):  
Jessica L. Colmerauer ◽  
Kristin E. Linder ◽  
Casey J. Dempsey ◽  
Joseph L. Kuti ◽  
David P. Nicolau ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Intervention Period ◽  
Provider Education ◽  
Broad Spectrum Antibiotic ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Days Of Therapy ◽  
Order Set

Purpose: Following updates to the Infectious Diseases Society of America (IDSA) practice guidelines for the Diagnosis and Treatment of Adults with Community-acquired Pneumonia in 2019, Hartford HealthCare implemented changes to the community acquired pneumonia (CAP) order-set in August 2020 to reflect criteria for the prescribing of broad-spectrum antimicrobial therapy. The objective of the study was to evaluate changes in broad-spectrum antibiotic days of therapy (DOT) following these order-set updates with accompanying provider education. Methods: This was a multi-center, quasi-experimental, retrospective study of patients with a diagnosis of CAP from September 1, 2019 to October 31, 2019 (pre-intervention) and September 1, 2020 to October 31, 2020 (post-intervention). Patients were identified using ICD-10 codes (A48.1, J10.00-J18.9) indicating lower respiratory tract infection. Data collected included demographics, labs and vitals, radiographic, microbiological, and antibiotic data. The primary outcome was change in broad-spectrum antibiotic DOT, specifically anti-pseudomonal β-lactams and anti-MRSA antibiotics. Secondary outcomes included guideline-concordance of initial antibiotics, utilization of an order-set to prescribe antibiotics, and length of stay (LOS). Results: A total of 331 and 352 patients were included in the pre- and post-intervention cohorts, respectively. There were no differences in order-set usage (10% vs 11.3%, P = .642) between the pre- and post-intervention cohort, respectively. The overall duration of broad-spectrum therapy was a median of 2 days (IQR 0-8 days) in the pre-intervention period and 0 days (IQR 0-4 days) in the post-intervention period ( P < .001). Patients in whom the order-set was used in the post-intervention period were more likely to have guideline-concordant regimens ([36/40] 90% vs [190/312] 60.9%; P = .003). Hospital LOS was shorter in the post-intervention cohort (4.8 days [2.9-7.2 days] vs 5.3 days [IQR 3.5-8.5 days], P = .002). Conclusion: Implementation of an updated CAP order-set with accompanying provider education was associated with reduced use of broad-spectrum antibiotics. Opportunities to improve compliance and thus further increase guideline-concordant therapy require investigation.

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