Related Experiment Video
Updated: May 24, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Rates and appropriateness of antimicrobial prescribing at an academic children's hospital, 2007-2010
E R Levy1, S Swami, S G Dubois
1Department of Pediatrics, University of California, San Francisco, California 94143, USA. emily.levy@ucsf.edu
Insights
Pediatric antimicrobial use increased from 2007-2010. Inappropriate vancomycin and cefepime use was highest in pediatric intensive care and surgical units, indicating a need for antimicrobial stewardship interventions.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Hospital Epidemiology
Background:
- Antimicrobial use patterns in hospitalized children are not well-documented.
- Understanding these patterns is crucial for developing effective antimicrobial stewardship programs.
Purpose of the Study:
- To analyze pediatric antimicrobial utilization rates from 2007 to 2010.
- To evaluate the appropriateness of vancomycin and cefepime use in hospitalized children in 2010.
Main Methods:
- Retrospective chart review of 17,242 children hospitalized between 2007 and 2010.
- Calculation of antimicrobial utilization in days of therapy per 1,000 patient-days.
- Independent assessment of vancomycin and cefepime use appropriateness by pediatric infectious disease specialists.
Main Results:
- Over 57% of hospitalized children received antimicrobials.
- Utilization of 10 antimicrobials, including vancomycin and cefepime, increased significantly from 2007 to 2010.
- Inappropriate vancomycin and cefepime use was higher in pediatric intensive care and surgical units compared to wards and medical services, primarily due to failure to de-escalate therapy.
Conclusions:
- Antimicrobial use in hospitalized children shows an increasing trend.
- Targeted interventions are needed to address inappropriate vancomycin and cefepime prescribing, especially in critical care and surgical settings.
- Failure to de-escalate antimicrobial therapy is a key area for stewardship efforts.
Objective And Design:
Antimicrobial use in hospitalized children has not been well described. To identify targets for antimicrobial stewardship interventions, we retrospectively examined pediatric utilization rates for 48 antimicrobials from 2007 to 2010 as well as appropriateness of vancomycin and cefepime use in 2010.
Patients And Setting:
All children hospitalized between 2007 and 2010 at the Mayo Clinic Children's Hospital, a 120-bed facility within a larger adult hospital in Rochester, Minnesota.
Methods:
We calculated antimicrobial utilization rates in days of therapy per 1,000 patient-days. Details of vancomycin and cefepime use in 2010 were abstracted by chart review. Two pediatric infectious disease physicians independently assessed appropriateness of antibiotic use.
Results:
From 2007 to 2010, 9,880 of 17,242 (57%) hospitalized children received 1 or more antimicrobials. Antimicrobials (days of therapy per 1,000 patient-days) used most frequently in 2010 were cefazolin (97.8), vancomycin (97.1), fluconazole (76.4), piperacillin-tazobactam (70.7), and cefepime (67.6). Utilization rates increased significantly from 2007 to 2010 for 10 antimicrobials, including vancomycin, fluconazole, piperacillin-tazobactam, cefepime, trimethoprim-sulfamethoxazole, caspofungin, and cefotaxime. In 2010, inappropriate use of vancomycin and cefepime was greater in the pediatric intensive care unit than ward (vancomycin: 17.8% vs 6.4%, P = .001; cefepime: 9.2% vs 3.9%, P = .142) and on surgical versus medical services (vancomycin: 20.5% vs 8.0%, P = .001; cefepime: 19.4% vs 3.4%, P ≤ .001). The most common reason for inappropriate antibiotic use was failure to discontinue or de-escalate therapy.
Conclusions:
In our children's hospital, use of 10 antimicrobials increased during the study period. Inappropriate use of vancomycin and cefepime was greatest on the critical care and surgical services, largely as a result of failure to de-escalate therapy, suggesting targets for future antimicrobial stewardship interventions.
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:29Drug Dosing: Infants and Children
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:25Mechanism of Antibiotic Resistance in MRSA
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution