Variability in Antibiotic Use at Children's Hospitals

PEDIATRICS ◽  
2010 ◽  
Vol 127 (2) ◽  
pp. peds.2010-1275d-peds.2010-1275d
Keyword(s):  
Antibiotic Use ◽  
Children's Hospitals ◽  
Children’S Hospitals

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.

scholarly journals Antibiotic Use for Children with Pneumonia: Sustained Adoption of National Guidelines at United States Children's Hospitals

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Derek J. Williams ◽  
Matthew Hall ◽  
Jeffrey S. Gerber ◽  
Mark Neuman ◽  
Adam L. Hersh ◽  
...  
Keyword(s):  
United States ◽  
Antibiotic Use ◽  
National Guidelines ◽  
Children's Hospitals ◽  
Children’S Hospitals

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.

Outpatient antibiotic use and assessment of antibiotic guidelines in Chinese children’s hospitals

2008 ◽  
Vol 64 (8) ◽  
pp. 821-828 ◽  
Author(s):  
Wenshuang Zhang ◽  
Xuzhuang Shen ◽  
Yi Wang ◽  
Yuan Chen ◽  
Min Huang ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Children's Hospitals ◽  
Children’S Hospitals

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

Antibiotic use in pulmonology wards of Chinese children’s hospitals: 2002-2006

2009 ◽  
Vol 34 (1) ◽  
pp. 61-65 ◽  
Author(s):  
W. Zhang ◽  
X. Liu ◽  
Y. Wang ◽  
Y. Chen ◽  
M. Huang ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Children's Hospitals ◽  
Children’S Hospitals

scholarly journals Variability in Antibiotic Use at Children's Hospitals

PEDIATRICS ◽  
2010 ◽  
Vol 126 (6) ◽  
pp. 1067-1073 ◽  
Author(s):  
J. S. Gerber ◽  
J. G. Newland ◽  
S. E. Coffin ◽  
M. Hall ◽  
C. Thurm ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Children's Hospitals ◽  
Children’S Hospitals

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.

Identifying Targets for Antimicrobial Stewardship in Children's Hospitals

2013 ◽  
Vol 34 (12) ◽  
pp. 1252-1258 ◽  
Author(s):  
Jeffrey S. Gerber ◽  
Matthew P. Kronman ◽  
Rachael K. Ross ◽  
Adam L. Hersh ◽  
Jason G. Newland ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antimicrobial Stewardship ◽  
Severity Of Illness ◽  
Antibiotic Use ◽  
The United States ◽  
High Impact ◽  
Antimicrobial Use ◽  
Children's Hospitals ◽  
Children’S Hospitals ◽  
Days Of Therapy

Objective.Antimicrobial stewardship programs (ASPs) are recommended to optimize antimicrobial use for hospitalized patients. Although mechanisms for the implementation of ASPs have been described, data-driven approaches to prioritize specific conditions and antimicrobials for intervention have not been established. We aimed to develop a strategy for identifying high-impact targets for antimicrobial stewardship efforts.Design.Retrospective cross-sectional study.Setting and Patients.Children admitted to 32 freestanding children's hospitals in the United States in 2010.Methods.We identified the conditions with the largest proportional contribution to the total days of antibiotic therapy prescribed to all hospitalized children. For the 4 highest-using conditions, we examined variability between hospitals in antibiotic selection patterns for use of either first- or second-line therapies depending on the condition. Antibiotic use was determined using standardized probability of exposure to selected agents and standardized days of therapy per 1,000 patient-days, adjusting for patient demographics and severity of illness.Results.In 2010, 524,364 children received 2,082,929 days of antibiotic therapy. Surgical patients received 43% of all antibiotics. The 4 highest-using conditions—pneumonia, appendicitis, cystic fibrosis, and skin and soft-tissue infection—represent 1% of all conditions yet accounted for more than 10% of all antibiotic use. Wide variability in antibiotic use occurred for 3 of these 4 conditions.Conclusions.Antibiotic use in children's hospitals varied broadly across institutions when examining diagnoses individually and adjusting for severity of illness. Identifying conditions with both frequent and variable antimicrobial use informs the prioritization of high-impact targets for future antimicrobial stewardship interventions.

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