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Appropriateness of Antibiotic Prescribing in U.S. Children's Hospitals: A National Point Prevalence Survey.

Tribble, AC; Lee, BR; Flett, KB; Handy, LK; Gerber, JS; Hersh, AL; Kronman, MP; Terrill, CM; Sharland, M; Newland, JG (2020) Appropriateness of Antibiotic Prescribing in U.S. Children's Hospitals: A National Point Prevalence Survey. Clin Infect Dis. ISSN 1537-6591 https://doi.org/10.1093/cid/ciaa036
SGUL Authors: Sharland, Michael Roy

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Abstract

BACKGROUND: Studies estimate that 30-50% of antibiotics prescribed for hospitalized patients are inappropriate, but pediatric data are limited. Characterization of inappropriate prescribing practices for children are needed to guide pediatric antimicrobial stewardship. METHODS: Cross-sectional analysis of antibiotic prescribing at 32 US children's hospitals. Subjects included hospitalized children with ≥1 antibiotic order at 0800 on one day per calendar quarter, over six quarters (Quarter 3 2016 - Quarter 4 2017). Antimicrobial stewardship program (ASP) physicians and/or pharmacists used a standardized survey to collect data on antibiotic orders and evaluate appropriateness. The primary outcome was the percentage of antibiotics prescribed for infectious use that were classified as suboptimal, defined as inappropriate or needing modification. RESULTS: Of 34 927 children hospitalized on survey days, 12 213 (35.0%) had ≥1 active antibiotic order. Among 11 784 patients receiving antibiotics for infectious use, 25.9% were prescribed ≥1 suboptimal antibiotic. Of the 17 110 antibiotic orders prescribed for infectious use, 21.0% were considered suboptimal. Most common reasons for inappropriate use were bug-drug mismatch (27.7%), surgical prophylaxis >24 hours (17.7%), overly broad empiric therapy (11.2%), and unnecessary treatment (11.0%). The majority of recommended modifications were to stop (44.7%) or narrow (19.7%) the drug. ASPs would not have routinely reviewed 46.1% of suboptimal orders. CONCLUSIONS: Across 32 children's hospitals, approximately 1 in 3 hospitalized children are receiving one or more antibiotics at any given time. One quarter of these children are receiving suboptimal therapy, and nearly half of suboptimal use is not captured by current ASP practices.

Item Type: Article
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Appropriateness of Antibiotic Prescribing in U.S. Children’s Hospitals: A National Point Prevalence Survey following peer review. The version of record Alison C Tribble, Brian R Lee, Kelly B Flett, Lori K Handy, Jeffrey S Gerber, Adam L Hersh, Matthew P Kronman, Cindy M Terrill, Mike Sharland, Jason G Newland, on behalf of the SHARPS Collaborative, Appropriateness of Antibiotic Prescribing in U.S. Children’s Hospitals: A National Point Prevalence Survey, Clinical Infectious Diseases, , ciaa036 is available online at: https://doi.org/10.1093/cid/ciaa036
Keywords: antibiotic prevalence, antimicrobial stewardship, appropriate antibiotic use, hospitalized children, 06 Biological Sciences, 11 Medical and Health Sciences, Microbiology
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Clin Infect Dis
ISSN: 1537-6591
Language: eng
Dates:
DateEvent
16 January 2020Published Online
13 January 2020Accepted
Publisher License: Publisher's own licence
PubMed ID: 31942952
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/111642
Publisher's version: https://doi.org/10.1093/cid/ciaa036

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