TY - JOUR
T1 - Appropriateness of antibiotic prescribing varies by clinical services at United States children's hospitals
AU - and on behalf of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative
AU - Diggs, Devin T.
AU - Tribble, Alison C.
AU - Same, Rebecca G.
AU - Newland, Jason G.
AU - Lee, Brian R.
AU - Al-Sayyad, Ban
AU - Banerjee, Ritu
AU - Bio, Laura
AU - Bridger, Kathryn E.
AU - Burns, Alaina
AU - Carpenter, Melinda
AU - Crawford, Michelle
AU - Daniels, Robert
AU - Feja, Kristina
AU - Fernandez, Alfred J.
AU - Fernandez, Marisol
AU - Flett, Kelly
AU - Gainey, Andrew
AU - Gertz, Shira J.
AU - Gillon, Jessica
AU - Girotto, Jennifer
AU - Hamdy, Rana F.
AU - Heger, Margaret
AU - Henderson, Sheryl L.
AU - Hines, Andrea Green
AU - Islam, Shamim
AU - Jaggi, Preeti
AU - Kussin, Michelle
AU - Kuzmic, Brenik
AU - Lloyd, Elizabeth C.
AU - Manaloor, John
AU - Mazade, Marc
AU - Mongkolrattanothai, Kanokporn
AU - Moorthy, Ganga
AU - Morris, Lee
AU - Naeem, Fouzia
AU - Nakamura, Mari
AU - Nelson, Miranda
AU - Ogrin, Sara
AU - Olivero, Rosemary
AU - Pak, Daniel
AU - Patel, Rupal
AU - Patel, Sameer
AU - Polischuk, Emily
AU - Ray, Katie
AU - Sadler, Eleanor
AU - Sapozhnikov, Julia
AU - Scala, Judy
AU - Scardina, Tonya L.
AU - Schmit, Kathryn M.
AU - Schwenk, Hayden
AU - Smith, Michael J.
AU - Wirtz, Annie
AU - Yu, Diana
AU - Zembles, Tracy
AU - Zwiener, Jennifer
N1 - Publisher Copyright:
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
PY - 2023/11/12
Y1 - 2023/11/12
N2 - Objective: To describe patterns of inappropriate antibiotic prescribing at US children's hospitals and how these patterns vary by clinical service. Design: Serial, cross-sectional study using quarterly surveys. Setting: Surveys were completed in quarter 1 2019-quarter 3 2020 across 28 children's hospitals in the United States. Participants: Patients at children's hospitals with ≥1 antibiotic order at 8:00 A.M. on institution-selected quarterly survey days. Methods: Antimicrobial stewardship physicians and pharmacists collected data on antibiotic orders and evaluated appropriateness of prescribing. The primary outcome was percentage of inappropriate antibiotics, stratified by clinical service and antibiotic class. Secondary outcomes included reasons for inappropriate use and association of infectious diseases (ID) consultation with appropriateness. Results: Of 13,344 orders, 1,847 (13.8%) were inappropriate; 17.5% of patients receiving antibiotics had ≥1 inappropriate order. Pediatric intensive care units (PICU) and hospitalists contributed the most inappropriate orders (n = 384 and n = 314, respectively). Surgical subspecialists had the highest percentage of inappropriate orders (22.5%), and 56.8% of these were for prolonged or unnecessary surgical prophylaxis. ID consultation in the previous 7 days was associated with fewer inappropriate orders (15% vs 10%; P < .001); this association was most pronounced for hospitalist, PICU, and surgical and medical subspecialty services. Conclusions: Inappropriate antibiotic use for hospitalized children persists and varies by clinical service. Across 28 children's hospitals, PICUs and hospitalists contributed the most inappropriate antibiotic orders, and surgical subspecialists' orders were most often judged inappropriate. Understanding service-specific prescribing patterns will enable antimicrobial stewardship programs to better design interventions to optimize antibiotic use.
AB - Objective: To describe patterns of inappropriate antibiotic prescribing at US children's hospitals and how these patterns vary by clinical service. Design: Serial, cross-sectional study using quarterly surveys. Setting: Surveys were completed in quarter 1 2019-quarter 3 2020 across 28 children's hospitals in the United States. Participants: Patients at children's hospitals with ≥1 antibiotic order at 8:00 A.M. on institution-selected quarterly survey days. Methods: Antimicrobial stewardship physicians and pharmacists collected data on antibiotic orders and evaluated appropriateness of prescribing. The primary outcome was percentage of inappropriate antibiotics, stratified by clinical service and antibiotic class. Secondary outcomes included reasons for inappropriate use and association of infectious diseases (ID) consultation with appropriateness. Results: Of 13,344 orders, 1,847 (13.8%) were inappropriate; 17.5% of patients receiving antibiotics had ≥1 inappropriate order. Pediatric intensive care units (PICU) and hospitalists contributed the most inappropriate orders (n = 384 and n = 314, respectively). Surgical subspecialists had the highest percentage of inappropriate orders (22.5%), and 56.8% of these were for prolonged or unnecessary surgical prophylaxis. ID consultation in the previous 7 days was associated with fewer inappropriate orders (15% vs 10%; P < .001); this association was most pronounced for hospitalist, PICU, and surgical and medical subspecialty services. Conclusions: Inappropriate antibiotic use for hospitalized children persists and varies by clinical service. Across 28 children's hospitals, PICUs and hospitalists contributed the most inappropriate antibiotic orders, and surgical subspecialists' orders were most often judged inappropriate. Understanding service-specific prescribing patterns will enable antimicrobial stewardship programs to better design interventions to optimize antibiotic use.
UR - http://www.scopus.com/inward/record.url?scp=85178535876&partnerID=8YFLogxK
U2 - 10.1017/ice.2023.56
DO - 10.1017/ice.2023.56
M3 - Article
C2 - 37905378
AN - SCOPUS:85178535876
SN - 0899-823X
VL - 44
SP - 1711
EP - 1717
JO - Infection Control and Hospital Epidemiology
JF - Infection Control and Hospital Epidemiology
IS - 11
ER -