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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Quantifying Empiric Antibiotic Use in US Children's Hospitals

Kathleen Chiotos1,2,3, Lauren D'Arinzo3,4, Eimear Kitt2

  • 1Departments of Anesthesiology and Critical Care.

Hospital Pediatrics
|November 22, 2021
PubMed

Insights

Broad-spectrum antibiotics for suspected bacteremia rule-outs in children are common, accounting for 12% of antibiotic use. This highlights a key area for antibiotic stewardship programs to standardize treatment and reduce exposure.

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.
Abstract

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