Quantifying Empiric Antibiotic Use in US Children's Hospitals

Area of Science:

• Pediatric Infectious Diseases
• Antimicrobial Stewardship
• Hospital Epidemiology

Background:

• Empirical broad-spectrum antibiotics are standard for suspected pediatric bacteremia pending culture results.
• Current practice involves short-duration antibiotic administration for "rule-out" indications.

Purpose of the Study:

• To quantify the proportion of broad-spectrum antibiotic use attributed to "rule-out" indications in children.
• To identify variations in antibiotic prescribing for suspected bacteremia.

Main Methods:

• Utilized the Pediatric Health Information System (PHIS) for data from July 2016 to June 2017.
• Identified pediatric patients (3 months–20 years) hospitalized with suspected bacteremia.
• Estimated the percentage of broad-spectrum antibiotic days of therapy for rule-out cases.

Main Results:

• Over 67,000 episodes of suspected bacteremia were analyzed across 42 hospitals.
• Antibiotic rule-outs constituted 48% of cases, accounting for 12% of total broad-spectrum antibiotic days.
• Third-generation cephalosporins and vancomycin were most frequent; vancomycin use varied significantly (16%-58%) between hospitals.

Conclusions:

• Broad-spectrum antibiotic use for rule-out infections is prevalent in pediatric hospitals.
• Significant hospital-level variability exists, particularly in vancomycin prescribing.
• Antibiotic stewardship programs can target longer-duration rule-out antibiotic courses to standardize regimens and minimize exposure.