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Characteristics of antifungal utilization for hospitalized children in the United States
Lourdes Eguiguren1, Brian R Lee2, Jason G Newland3
1Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska.
Insights
Systemic antifungal use in hospitalized children is common, primarily for prophylaxis. Prescribing rates varied significantly across hospitals, suggesting targets for antifungal stewardship programs in high-risk pediatric populations.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Clinical Pharmacy
Background:
- Systemic antifungal prescribing patterns in pediatric hospital settings are not well-characterized.
- Understanding these patterns is crucial for optimizing antifungal use and combating resistance.
Purpose of the Study:
- To characterize antifungal prescribing patterns, including indications, in hospitalized children across the United States.
- To identify variations in antifungal prescribing rates among different hospitals.
Main Methods:
- Analysis of antifungal prescribing data from 32 hospitals participating in the SHARPS Antibiotic Resistance, Prescribing, and Efficacy among Children (SHARPEC) study.
- Inclusion of inpatients under 18 years with active systemic antifungal orders, classifying use by prophylaxis, empiric, or targeted indications.
Main Results:
- 6% of 34,927 surveyed patients received systemic antifungals (2,207 prescriptions).
- Prophylaxis was the most common indication (64%), with fluconazole being the most prescribed agent (48%).
- Antifungal prescribing rates varied widely across hospitals (13.6 to 131.2 per 1,000 patients).
Conclusions:
- Most systemic antifungal use in hospitalized children is for prophylaxis.
- Significant hospital-level variation in prescribing rates highlights opportunities for stewardship.
- Oncology/bone marrow transplant patients and prophylactic/combination therapy represent key targets for antifungal stewardship efforts.
Objective:
To characterize antifungal prescribing patterns, including the indication for antifungal use, in hospitalized children across the United States.
Design:
We analyzed antifungal prescribing data from 32 hospitals that participated in the SHARPS Antibiotic Resistance, Prescribing, and Efficacy among Children (SHARPEC) study, a cross-sectional point-prevalence survey conducted between June 2016 and December 2017.
Methods:
Inpatients aged <18 years with an active systemic antifungal order were included in the analysis. We classified antifungal prescribing by indication (ie, prophylaxis, empiric, targeted), and we compared the proportion of patients in each category based on patient and antifungal characteristics.
Results:
Among 34,927 surveyed patients, 2,095 (6%) received at least 1 systemic antifungal and there were 2,207 antifungal prescriptions. Most patients had an underlying oncology or bone marrow transplant diagnosis (57%) or were premature (13%). The most prescribed antifungal was fluconazole (48%) and the most common indication for antifungal use was prophylaxis (64%). Of 2,095 patients receiving antifungals, 79 (4%) were prescribed >1 antifungal, most often as targeted therapy (48%). The antifungal prescribing rate ranged from 13.6 to 131.2 antifungals per 1,000 patients across hospitals (P < .001).
Conclusions:
Most antifungal use in hospitalized children was for prophylaxis, and the rate of antifungal prescribing varied significantly across hospitals. Potential targets for antifungal stewardship efforts include high-risk, high-utilization populations, such as oncology and bone marrow transplant patients, and specific patterns of utilization, including prophylactic and combination antifungal therapy.
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