Appropriateness of Antibiotic Prescribing in United States Children’s Hospitals: A National Point Prevalence Survey
Alison C. Tribble, Brian Lee, Kelly B. Flett, Lori Handy, Jeffrey S. Gerber, Adam L. Hersh, Matthew P. Kronman, Cindy Terrill, Mike Sharland, Jason G. Newland, for the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative, Holly Maples, Hoang Huynh, Kanokporn Mongkolrattanothai, Hayden T. Schwenk, Betty Lee, Fouzia Naeem, Brenik Kuzmic, Amanda Hurst, Sarah J. Parker, Jennifer E Girotto, Nicholas Bennett, Rana F. Hamdy, B Hammer, Shannon M. Chan, Katie Namtu, David M. Berman, Preeti Jaggi, Ariel José Romero Fernández, Craig Shapiro, Margaret Heger, George Johnson, Sameer J Patel, Leslie Stach, Tony Scardina, Kristen Nichols, John J. Manaloor, Sarah Bruyn Jones, Rosemary Olivero, Sara Ogrin, Terri Stillwell, Elizabeth C Lloyd, Jennifer L. Goldman, Karisma Patel, Diana Yu, Miranda Nelson, David S. Rosen, Andrea Green, Jennifer Zweiner, Joshua Courter, David Haslam, Saul Hymes, Preeti Jaggi, Jessica Tansmore, Talene A. Metjian, Kelly C. Lee, Sandra Arnold, Luis A. Castagnini, Sarah Kubes, Marc Mazade, Michelle Crawford, Kathryn Merkel, Marisol Fernández, Michael Chang, Hillary Orr, Jared Olsen, Scott J. Weissman, Adam Brothers, Ritu Banerjee, Jessica Gillon, Sheryl L. Henderson, Erin K McCreary, Holly Maples, Hoang Huynh, Kanokporn Mongkolrattanothai, Hayden T. Schwenk, Betty Lee, Fouzia Naeem, Brenik Kuzmic, Amanda Hurst, Sarah J. Parker, Jennifer E Girotto, Nicholas Bennett, Rana F. Hamdy, B Hammer, Shannon M. Chan, Katie Namtu, David M. Berman, Preeti Jaggi, Ariel José Romero Fernández, Craig Shapiro, Margaret Heger, George Johnson, Sameer J Patel, Leslie Stach, Tony Scardina, Kristen Nichols, John J. Manaloor, Sarah Bruyn Jones, Rosemary Olivero
Abstract
BACKGROUND: Studies estimate that 30%-50% of antibiotics prescribed for hospitalized patients are inappropriate, but pediatric data are limited. Characterization of inappropriate prescribing practices for children is needed to guide pediatric antimicrobial stewardship. METHODS: Cross-sectional analysis of antibiotic prescribing at 32 children's hospitals in the United States. Subjects included hospitalized children with ≥ 1 antibiotic order at 8:00 am on 1 day per calendar quarter, over 6 quarters (quarter 3 2016-quarter 4 2017). Antimicrobial stewardship program (ASP) physicians and/or pharmacists used a standardized survey to collect data on antibiotic orders and evaluate appropriateness. The primary outcome was the percentage of antibiotics prescribed for infectious use that were classified as suboptimal, defined as inappropriate or needing modification. RESULTS: Of 34 927 children hospitalized on survey days, 12 213 (35.0%) had ≥ 1 active antibiotic order. Among 11 784 patients receiving antibiotics for infectious use, 25.9% were prescribed ≥ 1 suboptimal antibiotic. Of the 17 110 antibiotic orders prescribed for infectious use, 21.0% were considered suboptimal. Most common reasons for inappropriate use were bug-drug mismatch (27.7%), surgical prophylaxis > 24 hours (17.7%), overly broad empiric therapy (11.2%), and unnecessary treatment (11.0%). The majority of recommended modifications were to stop (44.7%) or narrow (19.7%) the drug. ASPs would not have routinely reviewed 46.1% of suboptimal orders. CONCLUSIONS: Across 32 children's hospitals, approximately 1 in 3 hospitalized children are receiving 1 or more antibiotics at any given time. One-quarter of these children are receiving suboptimal therapy, and nearly half of suboptimal use is not captured by current ASP practices.