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Identifying Targets for Antimicrobial Stewardship in Children's Hospitals

Published online by Cambridge University Press:  02 January 2015

Jeffrey S. Gerber ,
Matthew P. Kronman ,
Rachael K. Ross ,
Adam L. Hersh ,
Jason G. Newland ,
Talene A. Metjian  and
Theoklis E. Zaoutis
Jeffrey S. Gerber*
Affiliation:
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Antimicrobial Stewardship, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Matthew P. Kronman
Affiliation:
Division of Infectious Diseases, Seattle Children's Hospital, Seattle, Washington
Rachael K. Ross
Affiliation:
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Adam L. Hersh
Affiliation:
Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah
Jason G. Newland
Affiliation:
Division of Infectious Diseases, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
Talene A. Metjian
Affiliation:
Department of Antimicrobial Stewardship, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Theoklis E. Zaoutis
Affiliation:
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
*
Division of Infectious Diseases, Children's Hospital of Philadelphia, CHOP North, Suite 1518, Philadelphia, PA 19104 (gerberj@email.chop.edu)
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Abstract

Objective.

Antimicrobial stewardship programs (ASPs) are recommended to optimize antimicrobial use for hospitalized patients. Although mechanisms for the implementation of ASPs have been described, data-driven approaches to prioritize specific conditions and antimicrobials for intervention have not been established. We aimed to develop a strategy for identifying high-impact targets for antimicrobial stewardship efforts.

Design.

Retrospective cross-sectional study.

Setting and Patients.

Children admitted to 32 freestanding children's hospitals in the United States in 2010.

Methods.

We identified the conditions with the largest proportional contribution to the total days of antibiotic therapy prescribed to all hospitalized children. For the 4 highest-using conditions, we examined variability between hospitals in antibiotic selection patterns for use of either first- or second-line therapies depending on the condition. Antibiotic use was determined using standardized probability of exposure to selected agents and standardized days of therapy per 1,000 patient-days, adjusting for patient demographics and severity of illness.

Results.

In 2010, 524,364 children received 2,082,929 days of antibiotic therapy. Surgical patients received 43% of all antibiotics. The 4 highest-using conditions—pneumonia, appendicitis, cystic fibrosis, and skin and soft-tissue infection—represent 1% of all conditions yet accounted for more than 10% of all antibiotic use. Wide variability in antibiotic use occurred for 3 of these 4 conditions.

Conclusions.

Antibiotic use in children's hospitals varied broadly across institutions when examining diagnoses individually and adjusting for severity of illness. Identifying conditions with both frequent and variable antimicrobial use informs the prioritization of high-impact targets for future antimicrobial stewardship interventions.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 12 , December 2013 , pp. 1252 - 1258
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1.Gerber, JS, Newland, JG, Coffin, SE, et al. Variability in antibiotic use at children's hospitals. Pediatrics 2010;126(6):1067–1073.Google Scholar
2.Cosgrove, SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis 2006;42(suppl 2):S82–S89.CrossRefGoogle ScholarPubMed
3.Forum on Emerging Infections, Institute of Medicine. Antimicrobial Resistance: Issues and Options. Washington, DC: National Academies Press, 1998.Google Scholar
4.Shlaes, DM, Gerding, DN, John, JF Jr, et al. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Clin Infect Dis 1997;25(3):584–599.CrossRefGoogle Scholar
5.Dellit, TH, Owens, RC, McGowan, JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44(2):159–177.CrossRefGoogle Scholar
6.Spellberg, B, Guidos, R, Gilbert, D, et al. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis 2008;46(2):155–164.Google Scholar
7.Dubois, RW, Graff, JS. Setting priorities for comparative effectiveness research: from assessing public health benefits to being open with the public. Health Aff (Millwood) 2011;30(12):2235–2242.Google Scholar
8.Institute of Medicine. National Priorities for the Assessment of Clinical Conditions and Medical Technologies: Report of a Pilot Study. Washington, DC: National Academies Press, 1990.Google Scholar
9.Institute of Medicine. Initial National Priorities for Comparative Effectiveness Research. Washington, DC: National Academies Press, 2009.Google Scholar
10.Federal Coordinating Council for Comparative Effectiveness Research. Report to the President and the Congress. Washington, DC: Department of Health and Human Services, 2009.Google Scholar
11.Keren, R, Luan, X, Localio, R, et al. Prioritization of comparative effectiveness research topics in hospital pediatrics. Arch Pediatr Adolesc Med 2012;166(12):1155–1164.Google Scholar
12.James, BC, Savitz, LA. How Intermountain trimmed health care costs through robust quality improvement efforts. Health Aff (Millwood) 2011;30(6):1185–1191.Google Scholar
13.Averill, RF, Goldfield, N, Hughes, J, et al. All Patient Refined Diagnosis Related Groups (APR-DRGs) Version 20.0: Methodology Overview. Wallingford, CT: 3M Health Information Systems, 2003.Google Scholar
14.Bradley, JS, Byington, CL, Shah, SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011;53(7):e25–e76.CrossRefGoogle Scholar
15.Nadler, EP, Gaines, BA. The Surgical Infection Society guidelines on antimicrobial therapy for children with appendicitis. Surg Infect (Larchmt) 2008;9(1):75–83.Google Scholar
16.Solomkin, JS, Mazuski, JE, Bradley, JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010;50(2):133–164.CrossRefGoogle ScholarPubMed
17.Feudtner, C, Christakis, DA, Connell, FA. Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980-1997. Pediatrics 2000;106(1 pt2):205–209.Google Scholar
18.Pakyz, AL, Gurgle, HE, Ibrahim, OM, Oinonen, MJ, Polk, RE. Trends in antibacterial use in hospitalized pediatric patients in United States academic health centers. Infect Control Hosp Epidemiol 2009;30(6):600–603.CrossRefGoogle ScholarPubMed
19.Pakyz, AL, MacDougall, C, Oinonen, M, Polk, RE. Trends in antibacterial use in US academic health centers: 2002 to 2006. Arch Intern Med 2008;168(20):2254–2260.Google Scholar
20.Polk, RE, Hohmann, SF, Medvedev, S, Ibrahim, O. Benchmarking risk-adjusted adult antibacterial drug use in 70 US academic medical center hospitals. Clin Infect Dis 2011;53(11):1100–1110.CrossRefGoogle ScholarPubMed
21.Grohskopf, LA, Huskins, WC, Sinkowitz-Cochran, RL, Levine, GL, Goldmann, DA, Jarvis, WR. Use of antimicrobial agents in United States neonatal and pediatric intensive care patients. Pediatr Infect Dis J 2005;24(9):766–773.CrossRefGoogle ScholarPubMed
22.Bratzler, DW, Houck, PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Am J Surg 2005;189(4):395–404.CrossRefGoogle ScholarPubMed