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

TitleAppropriateness of Antibiotic Prescribing in U.S. Children's Hospitals: A National Point Prevalence Survey.
Publication TypeJournal Article
Year of Publication2020
AuthorsTribble AC, Lee BR, Flett KB, Handy LK, Gerber JS, Hersh AL, Kronman MP, Terrill CM, Sharland M, Newland JG
JournalClin Infect Dis
Date Published2020 Jan 16
ISSN1537-6591
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.

DOI10.1093/cid/ciaa036
Alternate JournalClin. Infect. Dis.
PubMed ID31942952