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Using risk adjustment to improve the interpretation of global inpatient pediatric antibiotic prescribing.

Bielicki, JA; Sharland, M; Versporten, A; Goossens, H; Cromwell, DA (2018) Using risk adjustment to improve the interpretation of global inpatient pediatric antibiotic prescribing. PLoS One, 13 (7). e0199878. ISSN 1932-6203 https://doi.org/10.1371/journal.pone.0199878
SGUL Authors: Sharland, Michael Roy Bielicki, Julia Anna

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Abstract

Objectives Assessment of regional pediatric last-resort antibiotic utilization patterns is hampered by potential confounding from population differences. We developed a risk-adjustment model from readily available, internationally used survey data and a simple patient classification to aid such comparisons. Design We investigated the association between pediatric conserve antibiotic (pCA) exposure and patient / treatment characteristics derived from global point prevalence surveys of antibiotic prescribing, and developed a risk-adjustment model using multivariable logistic regression. The performance of a simple patient classification of groups with different expected pCA exposure levels was compared to the risk model. Setting 226 centers in 41 countries across 5 continents. Participants Neonatal and pediatric inpatient antibiotic prescriptions for sepsis/bloodstream infection for 1281 patients. Results Overall pCA exposure was high (35%), strongly associated with each variable (patient age, ward, underlying disease, community acquisition or nosocomial infection and empiric or targeted treatment), and all were included in the final risk-adjustment model. The model demonstrated good discrimination (c-statistic = 0.83) and calibration (p = 0.38). The simple classification model demonstrated similar discrimination and calibration to the risk model. The crude regional pCA exposure rates ranged from 10.3% (Africa) to 67.4% (Latin America). Risk adjustment substantially reduced the regional variation, the adjusted rates ranging from 17.1% (Africa) to 42.8% (Latin America). Conclusions Greater comparability of pCA exposure rates can be achieved by using a few easily collected variables to produce risk-adjusted rates.

Item Type: Article
Additional Information: © 2018 Bielicki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: General Science & Technology, MD Multidisciplinary
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: PLoS One
ISSN: 1932-6203
Language: eng
Dates:
DateEvent
6 July 2018Published
15 June 2018Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
ARPEC Project A 2009-11-01Executive Agency for Health and Consumershttp://dx.doi.org/10.13039/501100000810
PubMed ID: 29979795
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/109987
Publisher's version: https://doi.org/10.1371/journal.pone.0199878

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