Antibiotic Diversity Index: A novel metric to assess antibiotic variation among hospitalized children
Jessica L Markham1,2, Matt Hall1,3, Samir S Shah4
1Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
Insights
A new metric quantifies antibiotic prescribing diversity in pediatric hospitals. This tool helps identify areas for antibiotic stewardship interventions, though it did not link diversity to patient length of stay or costs.
Area of Science:
- Pediatric Infectious Diseases
- Health Services Research
- Pharmacoeconomics
Background:
- Antibiotic prescribing variability deviates from guidelines, leading to overuse and adverse events.
- Existing measures of antibiotic prescribing variability are inadequate for comprehensive assessment.
- Standardized metrics are needed to quantify and address antibiotic prescribing inconsistencies.
Purpose of the Study:
- To develop a standardized metric for quantifying antibiotic prescribing diversity within and across children's hospitals.
- To assess the association between this novel diversity metric and patient outcomes, including length of stay and costs.
Main Methods:
- Cross-sectional study of 79,515 pediatric hospitalizations for common infections (2017-2019).
- Used the Shannon-Weiner entropy index (d-measure) to quantify antibiotic diversity per infection type.
- Generalized linear mixed-effects models analyzed the link between hospital-level diversity and risk-adjusted length of stay/costs.
Main Results:
- Significant variation in antibiotic diversity was observed within and across hospitals.
- Infections like pneumonia and septicemia/bacteremia exhibited higher antibiotic diversity compared to appendicitis or deep neck space infections.
- No statistically significant association was found between hospital-level antibiotic diversity and risk-adjusted length of stay or costs.
Conclusions:
- A novel metric effectively quantifies antibiotic prescribing diversity, enabling cross-hospital comparisons.
- This metric can guide targeted local and national antibiotic stewardship interventions.
- Further research may explore the clinical implications of antibiotic diversity beyond length of stay and costs.
Background:
Despite nationally endorsed treatment guidelines and stewardship programs, variation and deviation from evidence-based antibiotic prescribing occur, contributing to inappropriate use and medication-related adverse events. Measures of antibiotic prescribing variability can aid in quantifying this problem but are not adequate.
Objective:
The objective of this study is to develop a standardized metric to quantify antibiotic prescribing variability (diversity) within and across children's hospitals, and to examine its association with outcomes.
Methods:
We performed a cross-sectional study of empiric antibiotic exposure among children hospitalized during 2017-2019 with one of 15 common pediatric infections using the Pediatric Health Information System database. Encounters for children with complex chronic conditions, transfers in, and birth hospitalizations were excluded. Using the Shannon-Weiner entropy index, we quantified antibiotic diversity for each infection type using the d-measure of diversity. Generalized linear mixed-effects models were used to examine the association between hospital-level antibiotic diversity and risk-adjusted length of stay and costs.
Results:
A total of 79,515 hospitalizations for common pediatric infections were included. Antibiotic diversity varied within and across hospitals. Infections with low mean antibiotic diversity included appendicitis (mean diversity [mDiv] = 4.9, SD = 2.5) and deep neck space infections (mDiv = 5.9, SD = 1.9). Infections with high mean antibiotic diversity included pneumonia (mDiv = 23.4, SD = 5.6) and septicemia/bacteremia (mDiv = 28.5, SD = 12.1). There was no statistically significant association between hospital-level antibiotic diversity and risk-adjusted LOS or costs.
Conclusions:
We developed and applied a novel metric to quantify diversity in antibiotic prescribing that permits comparisons across hospitals and can be leveraged to identify high-priority areas for local and national stewardship interventions.
More Related Videos
11:17Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
12:03Antimicrobial Synergy Testing by the Inkjet Printer-assisted Automated Checkerboard Array and the Manual Time-kill Method
Published on: April 18, 2019
