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Reserved antibiotic use differs greatly among children's hospitals
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The use of carbapenem, polymyxin and tigecycline varies significantly among children’s hospitals in the United States and is largely diagnoses dependent, according to recent data.
Researchers urged that patients who receive these antibiotics for high-usage conditions such as appendicitis should be considered important targets for antimicrobial stewardship efforts.
“The prevalence of infections caused by antibiotic resistant gram-negative organisms … is increasing worldwide and represents a major public health threat,” Kathleen Chiotos, MD, from the Division of Infectious Diseases at the Children’s Hospital of Philadelphia, and colleagues wrote. “The carbapenems are a mainstay of therapy for these highly drug resistant infections, but increasing reports of carbapenem resistance threatens the future efficacy of these agents.”
To calculate and compare use of reserved antibiotics among U.S. children’s hospitals, the researchers examined data from the Pediatric Health Information System (PHIS) database, which includes information from 48 children’s hospitals located in 38 states, as well as the District of Columbia. Forty-six of these hospitals that provided data between 2010 and 2014 were included.
During the time frame of the study, 1,618,885 children admitted into children’s hospitals were administered at least one dose of a parenteral antibiotic, including nonreserved broad-spectrum gram-negative agents (47%) and reserved agents (4%). Ninety-four percent of children who were exposed to reserve agents were administered a carbapenem, 7% received a polymyxin, and 1% were given tigecycline.
The most days of therapy were used for carbapenem use (516,837 days), and were most commonly used for all patient-refined diagnosis-related group (APR-DRG) codes related to neonatal care (11%), bone marrow transplant (9%), cystic fibrosis (9%), appendectomy (7%) tracheostomy with long–term mechanical ventilation with extensive procedure (4%), or major hematologic/immunologic diagnosis, excluding sickle cell disease/coagulopathy (4%).
According to study results, use of reserved antibiotics differed greatly among children’s hospitals; carbapenem use among patients with high-usage conditions, such as appendectomy, showed that only five hospitals made up for 73% of all days of therapy for this condition.
During the 5-year study, the use of these reserved agents decreased by 24%. Researchers suspect that this was due to a decrease in the use of carbapenems and polymyxins. Although rare in nature, the days of therapy that used tigecycline increased from 0.28 days of therapy per 1000 patient days to 0.49 days of therapy.
“While differences in prevalence of [multi-drug resistant] organisms could also account for some of the observed variability, which was not assessed in the present study, such disparate rates of antibiotic resistance across freestanding children’s hospitals have not been reported,” Chiotos and colleagues wrote. “This therefore represents a potential target for stewardship interventions, especially in light of recent comparative effectiveness data suggesting no difference in outcomes for patients undergoing appendectomy treated with narrower versus extended-spectrum antibiotics.” – by Katherine Bortz
Disclosure: The researchers report no relevant financial disclosures.
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