Considerable variability in antibiotic use among US children’s hospitals in 2017–2018

Griffith, Hannah; Dantuluri, Keerti; Thurm, Cary; Williams, Derek J.; Banerjee, Ritu; Howard, Leigh M.; Grijalva, Carlos G.

doi:10.1017/ice.2019.373

Cited by 13 publications

(10 citation statements)

References 20 publications

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“…Previous studies reported that 60% of all inpatients received antibiotic medications in 2008, 21 whereas 36% of inpatients received an antibiotic medication in 2017. 22 The use of chest radiography has also been reported to be decreasing among children with respiratory illness, 23 which was consistent with our results. Notably, although previous work has revealed increasing use of ECMO in adults with influenza, 24 we did not find increases in ECMO use among children.…”

Section: Discussionsupporting

confidence: 91%

Assessment of Temporal Patterns and Patient Factors Associated With Oseltamivir Administration in Children Hospitalized With Influenza, 2007-2020

et al. 2022

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ImportanceOseltamivir therapy is recommended for all pediatric inpatients with influenza, particularly those with high-risk conditions, although data regarding its uptake and benefits are limited.ObjectiveTo describe temporal patterns and independent patient factors associated with the use of oseltamivir and explore patterns in resource use and patient outcomes among children hospitalized with influenza.Design, Setting, and ParticipantsThis multicenter retrospective cross-sectional study was conducted at 36 tertiary pediatric hospitals participating in the Pediatric Health Information System in the US. A total of 70 473 children younger than 18 years who were hospitalized with influenza between October 1, 2007, and March 31, 2020, were included.ExposuresHospitalization with a diagnosis of influenza.Main Outcomes and MeasuresThe primary outcome was the use of oseltamivir, which was described by influenza season and by hospital. Patient factors associated with oseltamivir use were assessed using multivariable mixed-effects logistic regression models. Secondary outcomes were resource use (including antibiotic medications, chest radiography, supplemental oxygen, positive pressure ventilation, central venous catheter, and intensive care unit [ICU]) and patient outcomes (length of stay, late ICU transfer, 7-day hospital readmission, use of extracorporeal membrane oxygenation, and in-hospital mortality), which were described as percentages per influenza season.ResultsAmong 70 473 children hospitalized with influenza, the median (IQR) age was 3.65 (1.05-8.26) years; 30 750 patients (43.6%) were female, and 39 715 (56.4%) were male. Overall, 16 559 patients (23.5%) were Black, 36 184 (51.3%) were White, 14 133 (20.1%) were of other races (including 694 American Indian or Alaska Native [1.0%], 2216 Asian [3.0%], 372 Native Hawaiian or Pacific Islander [0.5%], and 10 850 other races [15.4%]), and 3597 (5.1%) were of unknown race. A total of 47 071 patients (66.8%) received oseltamivir, increasing from a low of 20.2% in the 2007-2008 influenza season to a high of 77.9% in the 2017-2018 season. Use by hospital ranged from 43.2% to 79.7% over the entire study period and from 56.5% to 90.1% in final influenza season studied (2019-2020). Factors associated with increased oseltamivir use included the presence of a complex chronic condition (odds ratio [OR], 1.42; 95% CI, 1.36-1.47), a history of asthma (OR, 1.31; 95% CI, 1.23-1.38), and early severe illness (OR, 1.19; 95% CI, 1.13-1.25). Children younger than 2 years (OR, 0.81; 95% CI, 0.77-0.85) and children aged 2 to 5 years (OR, 0.83; 95% CI, 0.79-0.88) had lower odds of receiving oseltamivir. From the beginning (2007-2008) to the end (2019-2020) of the study period, the use of antibiotic medications (from 74.4% to 60.1%) and chest radiography (from 59.2% to 51.7%) decreased, whereas the use of oxygen (from 33.6% to 29.3%), positive pressure ventilation (from 10.8% to 7.9%), and central venous catheters (from 2.5% to 1.0%) did not meaningfully change. Patient outcomes, including length of stay (median [IQR], 3 [2-5] days for all seasons), readmissions within 7 days (from 4.0% to 3.4%), use of extracorporeal membrane oxygenation (from 0.5% to 0.5%), and in-hospital mortality (from 1.1% to 0.8%), were stable from the beginning to the end of the study period.Conclusions and RelevanceIn this cross-sectional study of children hospitalized with influenza, the use of oseltamivir increased over time, particularly among patients with high-risk conditions, but with wide institutional variation. Patient outcomes remained largely unchanged. Further work is needed to evaluate the impact of oseltamivir therapy in this population.

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Section: Discussionsupporting

confidence: 91%

Assessment of Temporal Patterns and Patient Factors Associated With Oseltamivir Administration in Children Hospitalized With Influenza, 2007-2020

et al. 2022

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“…Moreover, even after controlling for region and many other patient and hospital characteristics, we found that a patient’s probability of receiving broad-spectrum empiric therapy could still be twice that of an otherwise equal patient, due solely to their different admitting hospitals. High, unexplained interhospital variability has also been documented for empiric therapy [ 49 ], broad-spectrum therapy [ 50 ], and total antibiotic usage [ 51 ] across US pediatric hospitals. Taken together, these findings—empiric antibiotic usage as a possible correlate of total antibiotic usage and existing high random variability—suggest that the empiric window is an underexploited but potentially “high-yield” target for antibiotic stewardship efforts.…”

Section: Discussionmentioning

confidence: 99%

Patterns, Predictors, and Intercenter Variability in Empiric Gram-Negative Antibiotic Use Across 928 United States Hospitals

Goodman

Baghdadi

Magder

et al. 2022

Clinical Infectious Diseases

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Background Empiric antibiotic use among hospitalized U.S. adults is largely undescribed. Identifying factors associated with broad-spectrum empiric therapy may inform antibiotic stewardship interventions and facilitate benchmarking. Methods We performed a retrospective cohort study of adults discharged in 2019 from 928 hospitals in the Premier Healthcare Database. “Empiric” Gram-negative antibiotics were defined by administration before Day 3 of hospitalization. Multivariable logistic regression models with random-effects by hospital were used to evaluate associations between patient and hospital characteristics and empiric receipt of broad-spectrum, compared to narrow-spectrum, Gram-negative antibiotics. Results 2,928,657 of 8,017,740 (37%) hospitalized adults received empiric Gram-negative antibiotics. Among 1,781,306 who received broad-spectrum therapy, 30% did not have a common infectious syndrome present-on-admission (pneumonia, urinary tract infection, sepsis, or bacteremia), or surgery or an ICU stay in the empiric window. Holding other factors constant, males were 22% more likely (aOR 1.22, 95% CI: 1.22–1.23), and all non-White racial groups were 6%-13% less likely (aOR range: 0.87–0.94), to receive broad-spectrum therapy. There were significant prescribing differences by region, with the highest adjusted odds of broad-spectrum therapy in the U.S. West South Central. Even after model adjustment, there remained substantial inter-hospital variability: among patients receiving empiric therapy, the probability of receiving broad-spectrum antibiotics varied as much as 34 + percentage-points due solely to the admitting hospital (95% interval of probabilities: 43% - 77%). Conclusions Empiric Gram-negative antibiotic use is highly variable across U.S. regions, and there is high, unexplained inter-hospital variability. Sex and racial disparities in the receipt of broad-spectrum therapy warrant further investigation.

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“…Systemic and broad-spectrum antibiotics were defined as previously published (Table 1). 6 We reported antibiotic use according to patient characteristics including age, gestational age at birth, sex, race or ethnicity, and service line (medical or surgical) as determined by all patient-refined diagnosis-related group (APR-DRG, version 32, 3M, Maplewood, MN). Differences between groups were measured using the χ 2 test or the Fisher exact test.…”

Section: Methodsmentioning

confidence: 99%

“…Hospital characteristics included geographic census region and case mix index (CMI), a surrogate for illness severity. 6 We calculated the prevalence of antibiotic use by dividing the number of patients who received at least 1 antibiotic (or 1 broad-spectrum antibiotic) by the number of patients hospitalized in NICUs on the study day. We also measured the association between NICU antibiotic use prevalence and median hospital CMI using the Pearson correlation.…”

Section: Methodsmentioning

confidence: 99%

Variation in antibiotic use among neonatal intensive care units in the United States

Spencer

Dantuluri

Thurm

et al. 2021

Infect. Control Hosp. Epidemiol.

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Considerable variability in antibiotic use among US children’s hospitals in 2017–2018

Cited by 13 publications

References 20 publications

Assessment of Temporal Patterns and Patient Factors Associated With Oseltamivir Administration in Children Hospitalized With Influenza, 2007-2020

Assessment of Temporal Patterns and Patient Factors Associated With Oseltamivir Administration in Children Hospitalized With Influenza, 2007-2020

Patterns, Predictors, and Intercenter Variability in Empiric Gram-Negative Antibiotic Use Across 928 United States Hospitals

Variation in antibiotic use among neonatal intensive care units in the United States

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