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Variability in Antibiotic Use Across PICUs.
- Source :
-
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2018 Jun; Vol. 19 (6), pp. 519-527. - Publication Year :
- 2018
-
Abstract
- Objectives: To characterize and compare antibiotic prescribing across PICUs to evaluate the degree of variability.<br />Design: Retrospective analysis from 2010 through 2014 of the Pediatric Health Information System.<br />Setting: Forty-one freestanding children's hospital.<br />Subjects: Children aged 30 days to 18 years admitted to a PICU in children's hospitals contributing data to Pediatric Health Information System.<br />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.<br />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.<br />Conclusions: The wide variation in antibiotic use observed across children's hospital PICUs suggests inappropriate antibiotic use.
Details
- Language :
- English
- ISSN :
- 1529-7535
- Volume :
- 19
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
- Publication Type :
- Academic Journal
- Accession number :
- 29533352
- Full Text :
- https://doi.org/10.1097/PCC.0000000000001535