262. Pediatric Antibiotic Use in the Duke Antimicrobial Stewardship Outreach Network
Session: Poster Abstract Session: Pediatric Antimicrobial and Diagnostic Stewardship
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • SMITH_IDWEEK_2018.pdf (350.8 kB)
  • Background: The Duke Antimicrobial Stewardship Outreach Network (DASON) was established in 2013 to provide antimicrobial stewardship resources to community hospitals in the Southeast. Pediatric patients in community hospitals may benefit from antimicrobial stewardship program (ASP) activities.

    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.

    Michael Smith, MD, MSCE1, Elizabeth Dodds Ashley, PharmD, MHS, FCCP, BCPS2, Deverick J. Anderson, MD, MPH, FIDSA, FSHEA3, April Dyer, PharmD, MBA, MSCR, BCPS4, Travis Jones, PharmD3, Melissa Johnson, PharmD, MHS5, Angelina Davis, PharmD, MS, BCPS, AQ-ID6 and Rebekah W. Moehring, MD, MPH7, (1)Pediatric Infectious Diseases, Duke Univeristy, Durham, NC, (2)Duke University, Durham, NC, (3)Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, (4)Duke Antimicrobial Stewardship Outreach Network (DASON), Durham, NC, (5)Medicine, Duke University School of Medicine, Durham, NC, (6)Infectious Diseases, Duke Antimicrobial Stewardship Outreach Network (DASON), Duke University, Durham, NC, (7)Division of Infectious Diseases, Duke University Medical Center, Durham, NC

    Disclosures:

    M. Smith, None

    E. Dodds Ashley, None

    D. J. Anderson, None

    A. Dyer, None

    T. Jones, None

    M. Johnson, None

    A. Davis, None

    R. W. Moehring, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.