Fluoroquinolone Use Among Hospitalized Children: Diagnosis-Based Stratification to Identify Stewardship Targets

Abstract

Background As FQ (fluoroquinolone) use has shifted in pediatric populations, better metrics are needed to guide targeted antibiotic stewardship interventions and limit development of adverse events and resistance, particularly in medically complex children. In this study, we identify high-utilization groups based on underlying medical conditions and describe their relative FQ use over time. Methods This study is a retrospective analysis of data from the Pediatric Health Information System (PHIS) database from 2016-2020. We identify high-utilization groups based on underlying medical conditions using ICD-9/10 codes. We delineate overall trends in the use of FQs in the inpatient setting, including rate and proportional use by each patient group. Results Patients with an oncology diagnosis represent a large (25-44%) and rising proportion (+4.8%/yr, p = 0.001) of national FQ use over the study period. Patients with intraabdominal infections, including appendicitis, have had a significant increase in both their relative proportional use of FQ (+0.6%/yr, p = 0.037) and proportion of FQ use per admission encounter over the study period (+0.6%/yr, p = 0.008). Patients with cystic fibrosis (CF) represent a decreasing proportion of overall use (-2.1%/yr, p = 0.011) and have decreasing FQ use per inpatient encounter (-0.8%/yr, p = 0.001). Conclusions Patients with an oncology diagnosis and patients with an intraabdominal infection appear to be targets for FQ stewardship. Patients with CF have decreasing inpatient FQ use.