Variability in Antibiotic Use Across PICUs

Thomas V. Brogan*, Cary Thurm, Adam L. Hersh, Jeffrey S. Gerber, Michael J. Smith, Samir S. Shah, Joshua D. Courter, Sameer J Patel, Sarah K. Parker, Matthew P. Kronman, Brian R. Lee, Jason G. Newland

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)519-527
Number of pages9
JournalPediatric Critical Care Medicine
Volume19
Issue number6
DOIs
StatePublished - Jun 1 2018

Keywords

  • antimicrobial stewardship
  • children's hospitals
  • complex chronic conditions
  • critical care
  • pediatric intensive care units
  • transplantation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Fingerprint

Dive into the research topics of 'Variability in Antibiotic Use Across PICUs'. Together they form a unique fingerprint.

Cite this