1931. Variability in Use and Total Expense of Inhaled Tobramycin for Hospitals Contributing to Pediatric Hospital Information Systems (PHIS)
Session: Poster Abstract Session: Antibiotic Stewardship: Pediatrics
Saturday, October 29, 2016
Room: Poster Hall
Background: National guidelines recommend inhaled tobramycin for use in maintenance therapy in patients with cystic fibrosis (CF). The efficacy of inhaled tobramycin outside of CF patients has not been established. Thus, we aimed to describe the use and costs of this medication across US children’s hospitals.

Methods: Study design is was a cross sectional study of inhaled tobramycin use in hospitals contributing to the Pediatric Health Information Systems (PHIS) database in 2014. Inhaled tobramycin use was defined as Patients receiving inhaled forms of tobramycin (dry, 28 mg and/or solution 300 mg/4 ml or 5 ml, CTC codes 1211354241282 and 1211354242702, respectively) based upon billing data. Codes for CF, complex chronic conditions, primary diagnosis, and concomitant use of systemic anti-pseudomonal medications were included. Use of tobramycin was described as days of therapy per 1000 patient days (DOT). Concomitant use was defined as use of inhaled tobramycin on the same calendar day as another systemic anti-pseudomonal. PHIS charges were converted to costs using hospital specific charge to cost ratios.

Results: Inhaled tobramycin use varied significantly by hospital. For CF patients, the range in hospital use was 0 to 542 DOT/1000 patient days per year. For non-CF patients, the range was <1 to 21 DOT per year. There was no correlation of inhaled tobramycin use in non-CF patients with numbers of CF patients (R2=0.006, p=0.593) or use in CF patients (r2=0.005, p=0.625). Non-CF patients receiving inhaled tobramycin more often had a tracheostomy than non-CF patients (67% vs. 1%). Individual hospital yearly costs ranged from $99 to $912,904. Inhaled tobramycin ranked eleventh amongst antibiotic costs, totaling $5,670,799 combined for all PHIS hospitals. Concomitant anti-pseudomonal use occurred in 82% of CF patients and 62% of non-CF patients.

Conclusion: Use of inhaled tobramycin in non-CF patients varied across PHIS hospitals. Further clinical study to understand when this medication is effective, for example as a systemic sparing agent particularly in patients with tracheostomy, are of interest to understand if use justifies the financial burden. Reducing unnecessary use of inhaled tobramycin represents a potential area of cost savings for pediatric hospitals and units.

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


S. Parker, None

C. Thurm, None

J. Courter, None

T. Brogan, None

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

J. S. Gerber, None

M. Smith, None

S. Patel, None

M. Kronman, None

S. Shah, None

B. Lee, None

J. Newland, None

Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.