912. Pediatric Antimicrobial (AM) Use: Comparison of Number of Doses Administered (DA) and Days of Therapy (DOT) of Fluoroquinolone (FQ) Use and Their Correlation with Emergence of Resistance
Session: Poster Abstract Session: Antimicrobial Utilization and Resistance in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background:  In an effort to control AM resistance, recommendations have been made for hospitals to measure antibiotic use. The commonly used benchmark metric is the defined daily dose that cannot be applied to pediatric patients. Alternatives are DA and DOT, however, studies evaluating these metrics and emergence of resistance are lacking. The purpose of this study was to evaluate the correlation between DA and DOT and emergence of FQ resistance.

Methods: As part of a prospective AM surveillance, we measured ciprofloxacin and levofloxacin administered to hospitalized children at tertiary teaching hospital from 2001 to 2009.  AM use was measured as DA and DOT normalized by 1000 patient-days/year (PD/Y) 3 years before and 5 years after implementation of an antimicrobial stewardship program. Data was analyzed using SPSS. 

Results: FQ use increased from 28 DA/1000 PD/Y and 14 DOT/1000 PD/Y to 40 DA/1000 PD/Y and 23 DOT/1000 PD/Y due to an increased use of levofloxacin (none in 2001 to 17 DA/1000 PD/Y and 13 DOT/1000 PD/Y). Use of ciprofloxacin did not change overtime.  We found a significant correlation between FQ DA/1000 PD/Y and DOT/1000 PD/Y (r=0.977; p<0.001).  Correlation coefficients between ciprofloxacin and levofloxacin DA/1000 PD/Y and DOT/1000 PD/Y were r=0.955 (p<0.001) and r=0.848 (p<0.001), respectively.  Rates of GNR resistant to levofloxacin and ciprofloxacin steadily increased and showed a stronger correlation with  FQ use measured by DA/1000 PD/Y (r=.803; p<0.001) when compared with TDA/1000 PD/Y (r=0.553; p<0.001).

Conclusion: In pediatrics, measurement of FQ use by DA/1000 PD/Y and DA/1000 PD/Y is concordant, despite different dosage schedules of levofloxacin for children under 5 years of age. However, we found a stronger correlation of FQ use and resistance when using DA/1000 PD/Y as the metric to quantify antibiotic use.  Further studies are warranted to determine the best metric to measure AM use and its correlation with resistance compatible for both pediatric and adult hospitalized patients.

Subject Category: A. Antimicrobial agents and Resistance

M. Cecilia Di Pentima, MD, MPH, Pediatrics, Vanderbilt University, Nashville, TN, Shannon Chan, Pharm D, Alfred I. duPont Hospital for Children, Wilmington, DE, Marissa Coulter, MPH, Thomas Jefferson University, Philadelphia, PA and Jobayer Hossain, PhD, DuPont Hospital For Children, Wilmington, DE


M. C. Di Pentima, None

S. Chan, None

M. Coulter, None

J. Hossain, None

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