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Published on: August 30, 2018
Variability in antibiotic use at children's hospitals
Jeffrey S Gerber1, Jason G Newland, Susan E Coffin
1Division of Infectious Diseases, Children's Hospital of Philadelphia, CHOP North, Suite 1518, Philadelphia, PA 19104, USA. gerberj@email.chop.edu
Insights
Antibiotic use varies significantly among children
Area of Science:
- Pediatric Healthcare
- Infectious Disease Management
- Clinical Quality Improvement
Background:
- Significant variation exists in medical practices, highlighting potential areas for patient care enhancement.
- The extent of variation in antibiotic prescribing patterns within pediatric hospitals remains largely uncharacterized.
Purpose of the Study:
- To investigate the degree of variation in antibiotic utilization across children's hospitals.
- To identify factors contributing to antibiotic use disparities in pediatric inpatient settings.
Main Methods:
- A retrospective cohort study analyzed data from 556,692 pediatric inpatient discharges across 40 children's hospitals between 2008 and 2008.
- The Pediatric Health Information System (PHIS) was utilized to extract comprehensive data on antibiotic administration and patient diagnoses.
Main Results:
- Overall, 60% of pediatric patients received at least one antibiotic during hospitalization.
- Substantial inter-hospital variation in antibiotic exposure (38%-72%) and duration (368-601 antibiotic-days per 1000 patient-days) was observed, even after adjusting for patient and hospital characteristics.
- Hospitals with higher overall antibiotic use also tended to prescribe a greater proportion of broad-spectrum antibiotics.
Conclusions:
- Children's hospitals exhibit considerable unexplained variation in antibiotic prescribing practices.
- This variability presents a significant opportunity for optimizing antibiotic stewardship and improving patient outcomes in pediatric care.
Background:
Variation in medical practice has identified opportunities for quality improvement in patient care. The degree of variation in the use of antibiotics in children's hospitals is unknown.
Methods:
We conducted a retrospective cohort study of 556,692 consecutive pediatric inpatient discharges from 40 freestanding children's hospitals between January 1, 2008, and December 31, 2008. We used the Pediatric Health Information System to acquire data on antibiotic use and clinical diagnoses.
Results:
Overall, 60% of the children received at least 1 antibiotic agent during their hospitalization, including >90% of patients who had surgery, underwent central venous catheter placement, had prolonged ventilation, or remained in the hospital for >14 days. Even after adjustment for both hospital- and patient-level demographic and clinical characteristics, antibiotic use varied substantially across hospitals, including both the proportion of children exposed to antibiotics (38%-72%) and the number of days children received antibiotics (368-601 antibiotic-days per 1000 patient-days). In general, hospitals that used more antibiotics also used a higher proportion of broad-spectrum antibiotics.
Conclusions:
Children's hospitals vary substantially in their use of antibiotics to a degree unexplained by patient- or hospital-level factors typically associated with the need for antibiotic therapy, which reveals an opportunity to improve the use of these drugs.
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