Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-10T08:29:12.819Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  06 March 2020

Hannah G. Griffith Open the ORCID record for Hannah G. Griffith [Opens in a new window] ,
Keerti Dantuluri Open the ORCID record for Keerti Dantuluri [Opens in a new window] ,
Cary Thurm ,
Derek J. Williams ,
Ritu Banerjee ,
Leigh M. Howard  and
Carlos G. Grijalva
Hannah G. Griffith*
Affiliation:
Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
Keerti Dantuluri
Affiliation:
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
Cary Thurm
Affiliation:
Children’s Hospital Association, Overland Park, Kansas City, Kansas
Derek J. Williams
Affiliation:
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
Ritu Banerjee
Affiliation:
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
Leigh M. Howard
Affiliation:
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
Carlos G. Grijalva
Affiliation:
Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
*
Author for correspondence: Hannah G. Griffith, E-mail: hannah.griffith.1@vumc.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 5 , May 2020 , pp. 571 - 578
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

Authors of equal contribution.

PREVIOUS PRESENTATION: An abstract for this research was presented as a poster at IDWeek 2019 on October 4, 2019, in Washington, DC.

References

Hales, CM, Kit, BK, Gu, Q, et al. Trends in prescription medication use among children and adolescents–United States, 1999–2014. JAMA 2018;319:2009–2020.CrossRefGoogle ScholarPubMed
Dellit, TH, Owens, RC, McGowan, JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159–177.CrossRefGoogle Scholar
Ingram, PR, Seet, JM, Budgeon, CA, Murray, R. Point-prevalence study of inappropriate antibiotic use at a tertiary Australian hospital. Intern Med J 2012;42:719–721.CrossRefGoogle Scholar
Camins, BC, King, MD, Wells, JB, et al. Impact of an antimicrobial utilization program on antimicrobial use at a large teaching hospital: a randomized controlled trial. Infect Control Hosp Epidemiol 2009;30:931–938.CrossRefGoogle Scholar
Levin, PD, Idrees, S, Sprung, CL, et al, Antimicrobial use in the ICU: indications and accuracy–an observational trial. J Hosp Med 2012;7:672–678.CrossRefGoogle Scholar
Fridkin, SK, Baggs, J, Fagan, R, et al. Vital signs: improving antibiotic use among hospitalized patients. Morbid Mortal Wkly Rept 2014;63:194–200.Google ScholarPubMed
Josefsdottir, KS, Baldridge, MT, Kadmon, CS, et al. Antibiotics impair murine hematopoiesis by depleting the intestinal microbiota. Blood 2017;129:729–739.CrossRefGoogle ScholarPubMed
Westphal, JF, Vetter, D, Brogard, JM. Hepatic side-effects of antibiotics. J Antimicrob Chemother 1994;33:387–401.CrossRefGoogle ScholarPubMed
Hersh, AL, De Lurgio, SA, Thurm, C, et al. Antimicrobial stewardship programs in freestanding children’s hospitals. Pediatrics 2015;135:33–39.CrossRefGoogle ScholarPubMed
Gerber, JS, Kronman, MP, Ross, RK, et al. Identifying targets for antimicrobial stewardship in children’s hospitals. Infect Control Hosp Epidemiol 2013;34:1252–1258.CrossRefGoogle ScholarPubMed
Magill, SS, Edwards, JR, Beldavs, ZG, et al. Prevalence of antimicrobial use in US acute care hospitals, May–September 2011. JAMA 2014;312:1438–1446.CrossRefGoogle ScholarPubMed
Bundy, DG, Richardson, TE, Hall, M, et al. Association of guideline-adherent antibiotic treatment with readmission of children with sickle cell disease hospitalized with acute chest syndrome JAMA Pediatr 2017;171:1090–1099.CrossRefGoogle ScholarPubMed
Feudtner, C, Feinstein, JA, Wenjun Zhong, Hall M, Dai, Dingwei. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr 2014;14:199.CrossRefGoogle ScholarPubMed
Richardson, T, Rodean, J, Harris, M, Berry, J, Gay, JC, Hall, M. Development of Hospitalization Resource Intensity Scores for Kids (H-RISK) and comparison across pediatric populations. J Hosp Med 2018;13:602–608.Google ScholarPubMed
Gerber, JS, Newland, JG, Coffin, SE, et al. Variability in antibiotic use at children’s hospitals. Pediatr 2010;126:1067–1073.CrossRefGoogle ScholarPubMed
Hufnagel, M, Versporten, A, Bielicki, J, et al. High rates of prescribing antimicrobials for prophylaxis in children and neonates: results from the antibiotic resistance and prescribing in European children point prevalence survey. J Pediatric Infect Dis Soc 2019;8:143–151.CrossRefGoogle ScholarPubMed
Brogan, TV, Thurm, C, Hersh, AL, et al. Variability in antibiotic use across PICUs. Pediatr Crit Care Med 2018;19:519–527.CrossRefGoogle ScholarPubMed
Yu, KC, Moisan, E, Tartof, SY, et al. Benchmarking inpatient antimicrobial use: a comparison of risk-adjusted observed-to-expected ratios. Clin Infect Dis 2018;67:1677–1685.CrossRefGoogle ScholarPubMed
Fleming-Dutra, KE, Hersh, AL, Shapiro, DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US Ambulatory Care Visits, 2010-2011. JAMA 2016;315:1864–1873.CrossRefGoogle ScholarPubMed
Tribble, AC, Ross, RK, Gerber, JS. Comparison of antibiotic prescribing for pediatric community-acquired pneumonia in children’s and non-children’s hospitals—comparison of antibiotic prescribing for community-acquired pneumonia by hospital typeletters. JAMA Pediatr 2019;173:190–192.CrossRefGoogle Scholar
Supplementary material: File

Griffith et al. supplementary material

Griffith et al. supplementary material

Download Griffith et al. supplementary material(File)
File 2 MB