2387. Variability in antibiotic use in pediatric intensive care units
Session: Oral Abstract Session: Pediatric Antimicrobial Stewardship: Controlling the Bugs and the Dollars
Saturday, October 29, 2016: 2:15 PM
Room: 275-277

Background: Antibiotic use among children admitted to pediatric intensive care units (PICUs) has not been well described.

Methods:  We analyzed systemic antibiotic use in children aged 30 days to 18 years admitted to a PICU at children’s hospitals contributing to the Pediatric Health Information System from 2010 through 2014. Antibiotic use, quantified as days of therapy (DOT)/1000 patient days, was compared between PICU and non-ICU patients. To adjust for potential differences in disease severity and case mix across centers, a sub analysis was performed of children admitted with one of the 20 All Patient Refined-Diagnosis Related Groups (APR-DRG) with the highest antibiotic use.

Results: Of 3,101,201 hospital discharges from 41 institutions, 386,914 (12.5%) children received care in the PICU. Median antibiotic use was 1043 DOT/1000 patient days (interquartile range (IQR): 977 - 1147 DOT/1000 patient days) among PICU patients and 893 DOT/1000 patient days (IQR: 805-968 DOT/1000 patient days) among non-ICU patients, Figure 1. Median use of broad-spectrum antibiotics was 386 DOT/1000 patient days (IQR: 298-444 DOT/1000 patient days) among PICU patients and and 277 DOT/1000 patient days (IQR:  231-312 DOT/1000 patient days) among non-ICU patients. Overall and broad-spectrum antibiotic use declined among both patient groups during the study period. After adjusting for potential confounders, PICU antibiotic use varied widely across centers, including among patients with the most common conditions contributing to PICU antibiotic use (Figure 2).  Weak correlation was observed between antibiotic use for PICU and non-ICU patients for all antibiotics and for broad spectrum antibiotics (R2 = 0.29 and 0.46 respectively, p < 0.001 for both), but stronger correlation was noted between antibiotic use for PICU- and non-ICU patients among overall antibiotic (R2 = 0.61, p < 0.001) and broad spectrum antibiotic therapy, (R2 = 0.77, p < 0.001, figure 3) for the top 20 PICU APR-DRGs.

Conclusion: PICU antibiotic use varies significantly across children’s hospitals, even after adjusting for patient-level factors that might drive antibiotic use. Antimicrobial use in the PICU represents an important target for stewardship and may influence antibiotic use in other units.

Figure 1

Figure 2.

Figure 3.

Michael Smith, MD, University of Louisville, Louisville, KY, Cary Thurm, PhD, Children's Hospital Association, Overland Park, KS, KS, Adam L. Hersh, MD, PhD, University of Utah School of Medicine, Salt Lake City, UT, Jeffrey S. Gerber, MD, PhD, Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, Thomas Brogan, MD, Seattle Children's, Seattle, WA, Samir Shah, MD, MSCE, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinati, OH, Joshua Courter, PharmD, Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, Sameer Patel, MD, MPH, Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, Sarah Parker, MD, Pediatric Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, Matthew Kronman, MD, MSCE, Pediatrics, University of Washington, Seattle, WA, Brian Lee, MPH, PhD, Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, MO and Jason Newland, MD, MEd, FPIDS, Division of Pediatric Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO

Disclosures:

M. Smith, None

C. Thurm, None

A. L. Hersh, Merck: Grant Investigator , Research grant

J. S. Gerber, None

T. Brogan, None

S. Shah, None

J. Courter, None

S. Patel, None

S. Parker, None

M. Kronman, None

B. Lee, None

J. Newland, None

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