Variability in Antibiotic Use at Children's Hospitals

Division of Infectious Diseases, Children's Hospital of Philadelphia, CHOP North, Suite 1518, Philadelphia, PA 19104, USA.
PEDIATRICS (Impact Factor: 5.47). 11/2010; 126(6):1067-73. DOI: 10.1542/peds.2010-1275
Source: PubMed


Variation in medical practice has identified opportunities for quality improvement in patient care. The degree of variation in the use of antibiotics in children's hospitals is unknown.
We conducted a retrospective cohort study of 556,692 consecutive pediatric inpatient discharges from 40 freestanding children's hospitals between January 1, 2008, and December 31, 2008. We used the Pediatric Health Information System to acquire data on antibiotic use and clinical diagnoses.
Overall, 60% of the children received at least 1 antibiotic agent during their hospitalization, including >90% of patients who had surgery, underwent central venous catheter placement, had prolonged ventilation, or remained in the hospital for >14 days. Even after adjustment for both hospital- and patient-level demographic and clinical characteristics, antibiotic use varied substantially across hospitals, including both the proportion of children exposed to antibiotics (38%-72%) and the number of days children received antibiotics (368-601 antibiotic-days per 1000 patient-days). In general, hospitals that used more antibiotics also used a higher proportion of broad-spectrum antibiotics.
Children's hospitals vary substantially in their use of antibiotics to a degree unexplained by patient- or hospital-level factors typically associated with the need for antibiotic therapy, which reveals an opportunity to improve the use of these drugs.

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    • "Antibiotics are among the most common medicines given to children [1] [2]. According to some studies, 60% of the children receive at least one antibiotic during their hospital stay [3]. There is been a lot of discussion about the rational use of antibiotics because wrongly used they can become a risk factor for the development of resistant bacteria and extra costs for both hospitals and patients [4] [5] [6]. "
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    ABSTRACT: Background and objective The point prevalence survey was conducted as part of the Antibiotic Resistance and Prescribing in European Children (ARPEC) Project. The study aimed at analyzing pediatric and neonatal antimicrobial prescribing patterns in Latvian hospitals, to identify targets for quality improvement. Materials and methods A one day cross-sectional point prevalence survey on antibiotic use in hospitalized children was conducted in November 2012 in 10 Latvian hospitals, using a previously validated and standardized method. The survey included all inpatient pediatric and neonatal beds and identified all children receiving an anti microbial treatment on the day of survey. Results Overall 549 patients were included in the study; 167 (39%) patients admitted to pediatric wards and 25 (21%) patients admitted to neonatal wards received at least one antimicrobial. Pediatric top three antibiotic groups were third-generation cephalosporins (55 prescriptions, 28%), extended spectrum penicillins (n = 32, 16%) and first-generation cephalosporins (n = 26, 13%). Eleven pediatric patients (85%) received surgical prophylaxis more than 1 day; 143 pediatric patients (86%) received antibiotics intravenously. Lower respiratory tract infections were the most common indications for antibiotic use both in pediatric (n = 60, 35.9%) and neonatal patients (n = 9, 36%). The most used antibiotics for neonatal patients were benzylpenicillin (n = 12, 32%), and gentamicin (9, 24%). Conclusions We identified a few problematic areas, which need improvement: the high use of third-generation cephalosporins for pediatric patients, prolonged surgical prophylaxis, predominant use of parenteral antibiotics and an urgent need for local antibiotic guidelines.
    Medicina (Kaunas, Lithuania) 08/2014; 50(3). DOI:10.1016/j.medici.2014.08.005 · 0.49 Impact Factor
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    • "As examples, susceptibility rates of P. aeruginosa to meropenem and piperacillin/tazobactam remained largely unchanged, despite increases in use of 70 and 92%, respectively, over the 7-year period of observation. Although no apparent cause-and-effect relationships seemed operative, these results might not pertain to other hospitals especially in light of the variation in antibiotic use from one pediatric hospital to the next [8]. The current study must be viewed in light of being a single-center experience with a limited number of tested isolates. "
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    ABSTRACT: Introduction: It is assumed that a direct relationship exists between the extent of use of any given antibiotic or antibiotic class and the degree of susceptibility or resistance on the part of various bacteria to that antibiotic or class. Methods: Pseudomonas aeruginosa susceptibility rates and utilization of key antipseudomonal antibiotics in a pediatric hospital, reflected as grams/1,000 patient days, were studied over a 7-year period. Results: While the volume of use of a number of antibiotics changed dramatically over this time period, susceptibility of Pseudomonas to these same agents remained relatively stable. The use of aminoglycosides decreased 14.5% while that of piperacillin/tazobactam increased 92% over the period of observation while susceptibility generally varied by <10%. Conclusion: Contrary to popular belief, changes in antibiotic utilization patterns do not always result in changes in susceptibility thus emphasizing the importance of continual institutional monitoring of antibiotic use and susceptibility patterns.
    06/2014; 3(1):55-9. DOI:10.1007/s40121-014-0028-8
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    • "Despite its importance, no national clinical guidelines currently exist for the management of pediatric CAP. Recent evidence indicates that overall antibiotic utilization for hospitalized children varies widely across hospitals [2], although the extent to which this variation exists for individual conditions, such as CAP, remains unknown. "
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    ABSTRACT: Community-acquired pneumonia (CAP) is a common childhood infection. CAP complications, such as parapneumonic empyema (PPE), are increasing and are frequently caused by antibiotic-resistant organisms. No clinical guidelines currently exist for management of pediatric CAP and no published data exist about variations in antibiotic prescribing patterns. Our objectives were to describe variation in CAP clinical management for hospitalized children by pediatric infectious disease consultants and to examine associations between recommended antibiotic regimens and local antibiotic resistance levels. We surveyed pediatric members of the Emerging Infections Network, which consists of 259 pediatric infectious disease physicians. Participants responded regarding their recommended empiric antibiotic regimens for hospitalized children with CAP with and without PPE and their recommendations for duration of therapy. Participants also provided information about the prevalence of penicillin non-susceptible S. pneumoniae and methicillin-resistant S. aureus (MRSA) in their community. We received 148 responses (57%). For uncomplicated CAP, respondents were divided between recommending beta-lactams alone (55%) versus beta-lactams in combination with another class (40%). For PPE, most recommended a combination of a beta-lactam plus an anti-MRSA agent, however, they were divided between clindamycin (44%) and vancomycin (57%). The relationship between reported antibiotic resistance and empiric regimen was mixed. We found no relationship between aminopenicillin use and prevalence of penicillin non-suscepetible S. pneumoniae or clindamycin use and clindamycin resistance, however, respondents were more likely to recommend an anti-MRSA agent when MRSA prevalence increased. Substantial variability exists in recommendations for CAP management. Development of clinical guidelines via antimicrobial stewardship programs and dissemination of data about local antibiotic resistance patterns represent opportunities to improve care.
    PLoS ONE 05/2011; 6(5):e20325. DOI:10.1371/journal.pone.0020325 · 3.23 Impact Factor
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