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

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

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

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.373 ◽

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.

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Quantifying Empiric Antibiotic Use in US Children’s Hospitals

Hospital Pediatrics ◽

10.1542/hpeds.2021-005950 ◽

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.

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Vancomycin Use: Room for Improvement Among Hospitalized Children

Journal of Pharmacy Practice ◽

10.1177/0897190016635478 ◽

2016 ◽

Vol 30 (3) ◽

pp. 296-299 ◽

Cited By ~ 8

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.

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1137. Variability of Antibiotic Use in Neonatal Intensive Care Units in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1001 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S404-S405

Author(s):

Keerti Dantuluri ◽

Hannah Griffith ◽

Cary Thurm ◽

Ritu Banerjee ◽

...

Keyword(s):

United States ◽

Intensive Care ◽

Broad Spectrum ◽

Neonatal Intensive Care ◽

Antibiotic Use ◽

The United States ◽

Neonatal Intensive Care Units ◽

Case Mix ◽

Broad Spectrum Antibiotic ◽

Research Grant

Abstract Background Although antibiotics are often indicated to treat early-life infections, such exposure may lead to serious adverse outcomes. Few studies have characterized patterns of antibiotic use among neonatal intensive care units (NICUs). Methods We performed a cross-sectional study of antibiotic use in 51 NICUs participating in the Pediatric Health Information System (PHIS), a database that includes clinical and resource utilization data for standalone children’s hospitals in the United States. Assessments were conducted on a single mid-week day of 2017. We examined the use of any antibiotic and broad-spectrum antibiotics using charge data in children admitted in each NICU on the study day. We compared antibiotic use among NICUs and geographical regions, and assessed its association with the NICU median case mix index (CMI) (as a surrogate for clinical complexity). Results 2813 infants were hospitalized in NICUs on the study day; the median number of patients at each study site was 47 (IQR = 34 – 62). 90% were <1 month old, 56% were male, 46% were white, and 62% were extremely/very preterm. Overall, 23% received at least one antibiotic and 6% received broad-spectrum antibiotics. Broad-spectrum antibiotic use was twice as prevalent in surgical compared with medical patients. Antibiotic use prevalence varied by region, ranging from 19% in the Midwest to 26% in the West (table). Ampicillin, gentamicin and vancomycin were the most common antibiotics used (25.2%, 18.8% and 9.9%, respectively). Antibiotic use prevalence varied substantially across NICUs (Figure 1). There was a moderate but significant positive correlation between overall or broad-spectrum antibiotic use and median NICU CMI (Figure 2). Conclusion There is substantial variability in antibiotic use among US NICUs, which seems partially explained by patient case-mix. Additional studies are needed to identify drivers of unwarranted variability in antibiotic use among NICUs. Disclosures Ritu Banerjee, MD, PhD, Accelerate Diagnostics: Grant/Research Support; BioFire: Research Grant; Biomerieux: Research Grant; Roche: Research Grant.

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Variability in Antibiotic Use at Children's Hospitals

PEDIATRICS ◽

10.1542/peds.2010-1275d ◽

2010 ◽

Vol 127 (2) ◽

pp. peds.2010-1275d-peds.2010-1275d

Keyword(s):

Antibiotic Use ◽

Children's Hospitals ◽

Children’S Hospitals

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

Infection ◽

10.1007/s15010-017-1009-0 ◽

2017 ◽

Vol 45 (4) ◽

pp. 493-504 ◽

Cited By ~ 25

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

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Association of broad-spectrum antibiotic use with faecal carriage of oxyiminocephalosporin-resistant enterobacteriaceae in an intensive care unit

Journal of Hospital Infection ◽

10.1016/j.jhin.2005.12.017 ◽

2006 ◽

Vol 63 (3) ◽

pp. 306-315 ◽

Cited By ~ 11

Author(s):

R. Vignoli ◽

E. Calvelo ◽

N.F. Cordeiro ◽

R. Lucero ◽

E. Ingold ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Broad Spectrum ◽

Antibiotic Use ◽

Broad Spectrum Antibiotic ◽

Faecal Carriage

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

Hospital Pharmacy ◽

10.1177/00185787211055797 ◽

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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