Variability in Antibiotic Use Across PICUs.

Document Type

Article

Publication Date

6-2018

Identifier

DOI: 10.1097/PCC.0000000000001535

Abstract

OBJECTIVES: To characterize and compare antibiotic prescribing across PICUs to evaluate the degree of variability.

DESIGN: Retrospective analysis from 2010 through 2014 of the Pediatric Health Information System.

SETTING: Forty-one freestanding children's hospital.

SUBJECTS: Children aged 30 days to 18 years admitted to a PICU in children's hospitals contributing data to Pediatric Health Information System.

INTERVENTIONS: To normalize for potential differences in disease severity and case mix across centers, a subanalysis was performed of children admitted with one of the 20 All Patient Refined-Diagnosis Related Groups and the seven All Patient Refined-Diagnosis Related Groups shared by all PICUs with the highest antibiotic use.

RESULTS: The study included 3,101,201 hospital discharges from 41 institutions with 386,914 PICU patients. All antibiotic use declined during the study period. The median-adjusted antibiotic use among PICU patients was 1,043 days of therapy/1,000 patient-days (interquartile range, 977-1,147 days of therapy/1,000 patient-days) compared with 893 among non-ICU children (interquartile range, 805-968 days of therapy/1,000 patient-days). For PICU patients, the median adjusted use of broad-spectrum antibiotics was 176 days of therapy/1,000 patient-days (interquartile range, 152-217 days of therapy/1,000 patient-days) and was 302 days of therapy/1,000 patient-days (interquartile range, 220-351 days of therapy/1,000 patient-days) for antimethicillin-resistant Staphylococcus aureus agents, compared with 153 days of therapy/1,000 patient-days (interquartile range, 130-182 days of therapy/1,000 patient-days) and 244 days of therapy/1,000 patient-days (interquartile range, 203-270 days of therapy/1,000 patient-days) for non-ICU children. After adjusting for potential confounders, significant institutional variability existed in antibiotic use in PICU patients, in the 20 All Patient Refined-Diagnosis Related Groups with the highest antibiotic usage and in the seven All Patient Refined-Diagnosis Related Groups shared by all 41 PICUs.

CONCLUSIONS: The wide variation in antibiotic use observed across children's hospital PICUs suggests inappropriate antibiotic use.

Journal Title

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

Volume

19

Issue

6

First Page

519

Last Page

527

MeSH Keywords

Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Cross-Sectional Studies; Hospitals, Pediatric; Humans; Infant; Intensive Care Units, Pediatric; Practice Patterns, Physicians'; Retrospective Studies; United States

Keywords

Anti-Bacterial Agents; Pediatric Intensive Care Units

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