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Appropriateness of Antibiotic Prescribing in United States Children’s Hospitals: A National Point Prevalence Survey

2020; Oxford University Press; Volume: 71; Issue: 8 Linguagem: Inglês

10.1093/cid/ciaa036

1537-6591

Alison C. Tribble, Brian Lee, Kelly B. Flett, Lori Handy, Jeffrey S. Gerber, Adam L. Hersh, Matthew P. Kronman, Cindy Terrill, Mike Sharland, Jason G. Newland, Holly Maples, Hoang Huynh, Kanokporn Mongkolrattanothai, Hayden T. Schwenk, Betty Lee, Fouzia Naeem, Brenik Kuzmic, Amanda L. Hurst, Sarah J. Parker, Jennifer E Girotto, Nicholas Bennett, Rana F. Hamdy, B Hammer, Shannon Melissa Chan, Katie Namtu, David M. Berman, Preeti Jaggi, Ariel José Romero Fernández, Craig Shapiro, Margaret Heger, George Johnson, Sameer Patel, Leslie Stach, Tony Scardina, Kristen R. Nichols, John J. Manaloor, Sarah Bruyn Jones, Rosemary Olivero, Sara Ogrin, Terri Stillwell, Elizabeth C Lloyd, Jennifer Goldman, Karisma Patel, Diana Yu, Miranda Nelson, David S. Rosen, Andrea Green, Jennifer Zweiner, Joshua Courter, David Haslam, Saul Hymes, Preeti Jaggi, Jessica Tansmore, Talene A. Metjian, Kelly C. Lee, Sandra R. Arnold, Luis A. Castagnini, Sarah Kubes, Marc Mazade, Michelle Crawford, Kathryn Merkel, Marisol Fernández, Michael Chang, Hillary Orr, Jared Olsen, Scott J. Weissman, Adam Brothers, Ritu Banerjee, Jessica Gillon, Sheryl L. Henderson, Erin K McCreary, Holly Maples, Hoang Huynh, Kanokporn Mongkolrattanothai, Hayden T. Schwenk, Betty Lee, Fouzia Naeem, Brenik Kuzmic, Amanda L. Hurst, Sarah J. Parker, Jennifer E Girotto, Nicholas Bennett, Rana F. Hamdy, B Hammer, Shannon Melissa Chan, Katie Namtu, David M. Berman, Preeti Jaggi, Ariel José Romero Fernández, Craig Shapiro, Margaret Heger, George Johnson, Sameer Patel, Leslie Stach, Tony Scardina, Kristen R. Nichols, John J. Manaloor, Sarah Bruyn Jones, Rosemary Olivero, Sara Ogrin, Terri Stillwell, Elizabeth C Lloyd, Jennifer Goldman, Karisma Patel, Diana Yu, Miranda Nelson, David S. Rosen, Andrea Green, Jennifer Zweiner, Joshua Courter, David Haslam, Saul Hymes, Preeti Jaggi, Jessica Tansmore, Talene A. Metjian, Kelly C. Lee, Sandra R. Arnold, Luis A. Castagnini, Sarah Kubes, Marc Mazade, Michelle Crawford, Kathryn Merkel, Marisol Fernández, Michael Chang, Hillary Orr, Jared Olsen, Scott J. Weissman, Adam Brothers, Ritu Banerjee, Jessica Gillon, Sheryl L. Henderson, Erin K McCreary,

Pneumonia and Respiratory Infections

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 is needed to guide pediatric antimicrobial stewardship. Methods Cross-sectional analysis of antibiotic prescribing at 32 children’s hospitals in the United States. Subjects included hospitalized children with ≥ 1 antibiotic order at 8:00 am on 1 day per calendar quarter, over 6 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 1 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.