Discharge antibiotic prescribing at children's hospitals with established antimicrobial stewardship programs.

IF 3 4区医学 Q2 INFECTIOUS DISEASES

Infection Control and Hospital Epidemiology Pub Date : 2025-04-08 DOI:10.1017/ice.2025.59

Rebecca G Same, Giyoung Lee, Jared Olson, Brendan Bettinger, Adam L Hersh, Matthew P Kronman, Jason G Newland, Meg Grimshaw, Jeffrey S Gerber

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引用次数: 0

Abstract

Objective: Antibiotic stewardship programs (ASPs) target hospitalized children, but most do not routinely review antibiotic prescriptions at discharge, despite 30% of discharged children receiving additional antibiotics. Our objective is to describe discharge antibiotic prescribing in children hospitalized for uncomplicated community-acquired pneumonia (CAP), skin/soft tissue infection (SSTI), and urinary tract infection (UTI).

Design: Retrospective cohort study.

Setting: Four academic children's hospitals with established ASPs.

Patients: ICD-10 codes identified 3,847 encounters for children <18 years admitted from January 1, 2021 to December 31, 2021 and prescribed antibiotics at discharge for uncomplicated CAP, SSTI, or UTI. After excluding children with medical complexity and encounters with concomitant infections, >7 days hospital stay, or intensive care unit stay, 1,206 encounters were included.

Methods: Primary outcomes were the percentage of subjects prescribed optimal (1) total (inpatient plus outpatient) duration of therapy (DOT) and (2) antibiotic choice based on current national guidelines and available evidence.

Results: Of 226 encounters for CAP, 417 for UTI, and 563 for SSTI, the median age was 4 years, 52% were female, and the median DOT was 9 days (8 for CAP, 10 for UTI, and 9 for SSTI). Antibiotic choice was optimal for 77%, and DOT was optimal for 26%. Only 20% of antibiotic courses included both optimal DOT and antibiotic choice.

Conclusions: At 4 children's hospitals with established ASPs, 80% of discharge antibiotic courses for CAP, UTI, and SSTI were suboptimal either by choice of antibiotic or DOT. Discharge antibiotic prescribing represents an opportunity to improve antibiotic use in children.

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在已建立抗菌药物管理计划的儿童医院中解除抗生素处方。

目的：抗生素管理计划（asp）针对住院儿童，但大多数在出院时没有常规审查抗生素处方，尽管30%的出院儿童接受了额外的抗生素。我们的目的是描述无并发症社区获得性肺炎（CAP）、皮肤/软组织感染（SSTI）和尿路感染（UTI）住院儿童的出院抗生素处方。设计：回顾性队列研究。环境：四所学术儿童医院，均有明确的asp。患者：ICD-10代码确定了住院7天或重症监护病房儿童的3,847次就诊，其中包括1,206次就诊。方法：主要结局是受试者根据当前国家指南和现有证据规定最佳(1)总（住院加门诊）治疗时间（DOT）和(2)抗生素选择的百分比。结果：226例CAP， 417例UTI， 563例SSTI，中位年龄为4岁，52%为女性，中位时间为9天（CAP 8天，UTI 10天，SSTI 9天）。77%的人认为抗生素选择最优，26%的人认为DOT最优。只有20%的抗生素疗程包括最佳DOT和抗生素选择。结论：在4家建立了asp的儿童医院中，80%的CAP、UTI和SSTI的出院抗生素疗程在抗生素或DOT的选择上都是次优的。出院抗生素处方是改善儿童抗生素使用的一个机会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection Control and Hospital Epidemiology 医学-传染病学

CiteScore

6.40

自引率

6.70%

发文量

289

审稿时长

3-8 weeks

期刊介绍： Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. Written by infection control practitioners and epidemiologists and guided by an editorial board composed of the nation''s leaders in the field, ICHE provides a critical forum for this vital information.