Methods: Antibacterial use (AU) was reviewed using the DASON Antimicrobial Stewardship Assessment Portal, which includes filters for National Healthcare Safety Network (NHSN) unit types. We performed a retrospective review of AU in pediatric units from 1/1 – 12/31/2017. AU was summarized by days of therapy (DOT) and percent of total DOT for specific unit types and agents. AU rates were reported by DOT/1000 patient days.
Results: A total of 41 pediatric units were included from the 28-hospital DASON cohort: 11 Neonatal Critical Care or Step Down Nurseries, 8 Pediatric Medical/Surgical Wards, and 22 Well Baby Units. There were no pediatric (non-neonatal) critical care or oncology units. A total of 21,731 antibiotic DOT were attributable to pediatric units, accounting for 1.6% of all AU in the cohort. These include 5585 (26%) DOT in Neonatal Critical Care (Level II/III) Units, 4898 (23%) in Pediatric Medical/Surgical Units, 3910 (18%) in Well Baby Units, 3307 (15%) in Neonatal Critical Care (Level III) Units, 3217 (15%) in Step Down Neonatal Nurseries (Level II), and 814 (4%) in Pediatric Medical Wards. Ampicillin (7229 DOT, 33%), gentamicin (6320 DOT, 29%), ceftriaxone (1750 DOT, 8%) and vancomycin (1462, 7%) were the most common antibiotics administered.
AU rates were 219 DOT/1000 patient days in children as compared to 979 in adults. Unit-specific rates ranged from 65 (Well Baby Units) to 1081 DOT/1000 pt days (Pediatric Medical/Surgical Units). Rates in level II and III nurseries ranged from 302-697 DOT/1000 patient days.
Conclusion: Pediatric patients accounted for a small proportion of AU in community hospitals. AU rates on pediatric medical/surgical units were comparable to adult units. Although rates were lower in neonatal units, these units accounted for 75% of pediatric AU. Antibiotic exposure in the neonatal period has been associated with short- and long-term outcomes including necrotizing enterocolitis, obesity, and atopy. This population would benefit from a dedicated focus from community hospital ASPs.
D. J. Anderson, None
A. Dyer, None
T. Jones, None
M. Johnson, None
A. Davis, None
R. W. Moehring, None
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