Antibiotic susceptibility patterns in US children's hospitals

Antibiograms are important tools to guide empirical antibiotic selection. Aggregate antibiograms for children can provide guidance when local data are scarce (e.g., unavailable, insufficient isolates) and support regional and national comparisons; however, aggregate reporting is limited.

To examine antibiotic susceptibility patterns for children and to compare patterns of resistance by isolate source and geographic region.

A request for submission of the most recent institutional antibiogram was sent to 51 US children's hospitals in April 2023. Data elements were transcribed and standardized to facilitate aggregate analysis. Aggregate antibiograms were generated, and logistic regression was performed to examine regional differences in susceptibilities.

We received 46 institutional antibiograms. Antibiograms varied in presentation including the number and types of bacteria and antibiotics, reporting by specimen source (e.g., urine) and location (i.e., hospital unit). Staphylococcus spp. were the most frequently reported Gram-positive bacteria. Of the more than 35,000 Staphylococcus aureus isolates, 35.4% were identified as methicillin resistant and nearly 80% were susceptible to clindamycin. Escherichia coli and Klebsiella spp. were the most frequently reported Gram-negative bacteria with 85.4% and 84.1% of isolates, respectively, demonstrating susceptibility to cefazolin. Regional differences in susceptibilities were observed. For example, S. aureus isolates from hospitals located in the Southern region of the United States had the lowest susceptibility to oxacillin.

This study provides regional and national data on pediatric antibiotic susceptibilities at US children's hospitals. Many opportunities exist for the use and reporting of aggregate antibiograms to enhance antimicrobial stewardship processes and monitor changes in antimicrobial resistance.