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. 2020 May;41(5):571-578.
doi: 10.1017/ice.2019.373. Epub 2020 Mar 6.

Considerable variability in antibiotic use among US children's hospitals in 2017-2018

Hannah G Griffith  1 , Keerti Dantuluri  2 , Cary Thurm  3 , Derek J Williams  2 , Ritu Banerjee  2 , Leigh M Howard #  2 , Carlos G Grijalva #  1
Affiliations

Considerable variability in antibiotic use among US children's hospitals in 2017-2018

Hannah G Griffith et al. Infect Control Hosp Epidemiol. 2020 May.

Abstract

Objective: To characterize the prevalence of and seasonal and regional variation in inpatient antibiotic use among hospitalized US children in 2017-2018.

Design: We conducted a cross-sectional examination of hospitalized children. The assessments were conducted on a single day in spring (May 3, 2017), summer (August 2, 2017), fall (October 25, 2017), and winter (January 31, 2018). The main outcome of interest was receipt of an antibiotic on the study day.

Setting: The study included 51 freestanding US children's hospitals that participate in the Pediatric Health Information System (PHIS).

Patients: This study included all patients <18 years old who were admitted to a participating PHIS hospital, excluding patients who were admitted solely for research purposes.

Results: Of 52,769 total hospitalized children, 19,174 (36.3%) received antibiotics on the study day and 6,575 of these (12.5%) received broad-spectrum antibiotics. The overall prevalence of antibiotic use varied across hospitals from 22.3% to 51.9%. Antibiotic use prevalence was 29.2% among medical patients and 47.7% among surgical patients. Although there was no significant seasonal variation in antibiotic use prevalence, regional prevalence varied, ranging from 32.7% in the Midwest to 40.2% in the West (P < .001). Among units, pediatric intensive care unit patients had the highest prevalence of both overall and broad-spectrum antibiotic use at 58.3% and 26.6%, respectively (P < .001).

Conclusions: On any given day in a national network of children's hospitals, more than one-third of hospitalized children received an antibiotic, and 1 in 8 received a broad-spectrum antibiotic. Variation across hospitals, setting and regions identifies potential opportunities for enhanced antibiotic stewardship activities.

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Figures

Figure 1.
Figure 1.
Flow diagram describing number and distribution of inpatient encounters in 51 PHIS hospitals on a study date, 2017–2018, by clinical unit and service line.
Figure 2.
Figure 2.
Distribution of overall and broad-spectrum antibiotic use among children admitted to a PHIS hospital on a study date, 2017–2018, by US census region, clinical unit, and service line. Blue represents overall antibiotic use is represented. Red represents broad-spectrum antibiotic use. Asterisks (*) indicate significant variation in prevalence among groups.
Figure 3.
Figure 3.
Prevalence of overall and broad-spectrum antibiotic use by hospital among US children’s hospitals on a study date, 2017–2018. Diamonds represent prevalence of antibiotic use. Vertical lines represent 95% confidence intervals. Blue represents overall antibiotic use, and red represents broad-spectrum antibiotic use. Asterisk (*) indicates significant variation in prevalence among hospitals.
Figure 4.
Figure 4.
Correlation between prevalence of antibiotic use and median hospital case-mix index (CMI). CMI is calculated using all patient-refined diagnosis-related group (AP-DRG) categories and severity levels. A higher CMI indicates a higher level of clinical severity. Blue circles represent prevalence of any antibiotic. Red circles represent prevalence of broad-spectrum antibiotic use.
Figure 5
Figure 5
Most frequently used antibiotics among PHIS hospitals, 2017–2018 by service line (A), and by clinical unit (B). Purple dots represent medical use, and orange dots represent surgical use. Blue dots represent use in PICU. Red dots represent use in NICU. Yellow dots represent use in all other units and wards.
See this image and copyright information in PMC

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