966. Antimicrobial Use in Hospitalized Children: A Point Prevalence Study
Session: Poster Abstract Session: Stewardship: Epidemiology of Antibiotic Use
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C

Background: Antimicrobial stewardship (AS) efforts would benefit from data-driven approaches to identify high impact targets for optimizing antimicrobial use; however, few studies have summarized and compared antimicrobial prescribing across hospitals. We aimed to describe the frequency of and indications for antimicrobial use in hospitalized children.

Methods: Four U.S. sites, 3 children's hospitals and one academic medical center that cares for children, participated in the Antibiotic Resistance and Prescribing in European Children point prevalence survey. Data was collected in November 2012 during a one-day cross-sectional assessment of antimicrobial use in hospitalized patients less than 18 years old.

Results: Overall, 375 of 882 (42%) children received 641 antimicrobials, which is an average of 1.7 antimicrobials per patient (range 1–7). The proportion of patients on antimicrobials ranged from 24–46% across the four hospitals (figure). Patients in the neonatal intensive care unit (NICU), all level 3 units, had the lowest percentage of antimicrobial use.  The majority of antimicrobials prescribed were antibacterial agents (82%), including cephalosporins (18%), penicillins (11%), glycopeptides (exclusively vancomycin) (8%) and sulfonamides (8%). Antimicrobials were prescribed for treatment of community-acquired infections (39%), treatment of hospital-acquired infections (23%), medical prophylaxis (29%) or surgical prophylaxis (8%). The most commonly prescribed antibiotics by indication included azithromcyin for bacterial LRTI (16%); cefazolin for surgical prophylaxis (54%); and clindamycin (42%) or vancomycin (14%) for skin and soft tissue infections. Most patients received empiric therapy (70%). Provider notes included an indication for therapy for 82% of patients.

Conclusion: A substantial proportion of hospitalized children were exposed to antimicrobial agents, although use varied across hospitals. Prophylaxis accounted for nearly 40% of inpatient antimicrobial use and represents an important target for AS efforts. Future work should expand these analyses to additional centers and use these data to target additional antimicrobial indications with frequent use and high variability.

Salwa Sulieman, DO1, Rachael Ross, MPH2, Elaine Cox, MD3, Stephan Kohlhoff, MD4, Jason Newland, MD5, Herman Goossens, MD6, Ann Versporten7, Mike Sharland, MD8, Theoklis Zaoutis, MD, MSCE9 and Jeffrey S. Gerber, MD, PhD9, (1)Pediatric Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)The Children's Hospital of Philadelphia, Philadelphia, PA, (3)Pediatrics--Infectious Disease, Indiana University School of Medicine, Indianapolis, IN, (4)SUNY Downstate Medical Center, Brooklyn, NY, (5)Children's Mercy Hospital and Clinics, Kansas City, MO, (6)Department of Clinical Microbiology, Antwerp University Hospital, Antwerp, Belgium, (7)University of Antwerpen, Antwerp, Belgium, (8)St George's, University of London, London, United Kingdom, (9)Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, The Children's Hospital of Philadelphia, Philadelphia, PA


S. Sulieman, None

R. Ross, None

E. Cox, None

S. Kohlhoff, None

J. Newland, Pfizer: Grant Investigator, Research grant

H. Goossens, None

A. Versporten, None

M. Sharland, None

T. Zaoutis, None

J. S. Gerber, None

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.