419. Antibiotic Prescribing in Pediatric Patients Hospitalized with Acute Bacterial Skin and Skin Structure Infection
Session: Poster Abstract Session: Pediatric Infections
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background:

Acute bacterial skin and skin structure infections (ABSSSI) respond to short courses of antibiotics with gram-positive activity. While use of broad-spectrum antibiotics and prolonged treatment are common in adults hospitalized with ABSSSI, little is known about children. Our objective was to evaluate antibiotic use in children hospitalized with ABSSSI.

Methods:

We report a planned secondary analysis of a pediatric cohort taken from a multicenter, retrospective study of patients hospitalized for ABSSSI during June 2010 – May 2012 in seven academic and community hospitals in Colorado. Cases were manually reviewed and classified as non-purulent cellulitis, wound infection or purulent cellulitis, or major cutaneous abscess.  The primary outcome was a composite of two markers of antibiotic overuse:  1) prescription of antibiotics with broad gram-negative activity, or 2) prolonged treatment duration (>10 days). 

Results:

102 children aged 45 days to 18 years presented with non-purulent cellulitis (42%), wound infection or purulent cellulitis (19%), or major cutaneous abscess (39%).  Empiric therapy included clindamycin in 67% of cases; 21% received combination therapy.  Staphylococcus aureusor streptococci were identified in 51 (86%) of 59 cases with positive cultures.  Although isolation of gram-negative organisms was uncommon (5 cases), broad gram-negative antibiotics accounted for 32% of all antibiotic-days.  The mean duration of therapy was 11(±2.9) days for the cohort. Broad gram-negative or prolonged therapy was prescribed in 65% [95% confidence interval (CI) 55-74%] of cases and was common among all three infection types. Multivariate modeling demonstrated that wound infection or purulent cellulitis (odds ratio [OR] 5.5 [95%CI 1.1-28.4]; p=0.04), admission to a medical (vs. surgical) service (OR 4.9 [95%CI 1.1-21.3]; p =0.04), and length of hospital stay (OR 2.07 per day [95%CI 1.2-3.5]; p=0.007) were independent predictors of antibiotic overuse.

Conclusion:

Among children hospitalized with ABSSSI, use of broad gram-negative antibiotics and prolonged treatment courses were common. This work suggests opportunity to reduce antibiotic overuse through interventions promoting shorter courses of narrow-spectrum antibiotics.

S. Jason Moore, PhD, PA1, Sean O'leary, MD, MPH2, Brooke Caldwell, MD3, Sean Pawlowski, MD4, William Burman, MD5 and Timothy Jenkins, MD5, (1)Vail Valley Medical Center, Vail, CO, (2)Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, (3)Children's Hospital Colorado, Aurora, CO, (4)Colorado Infectious Disease Associates, Denver, CO, (5)Denver Health Medical Center, Denver, CO

Disclosures:

S. J. Moore, None

S. O'leary, None

B. Caldwell, None

S. Pawlowski, None

W. Burman, None

T. Jenkins, None

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