498 - Antibiotic Diversity Within and Across Children’s Hospitals for Children Hospitalized with Common Infections
Saturday, April 29, 2023
3:30 PM – 6:00 PM ET
Poster Number: 498 Publication Number: 498.221
Jessica Markham, Children's Mercy Kansas City, Kansas City, MO, United States; Matt Hall, Children's Hospital Association, Lenexa, KS, United States; Samir S. Shah, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jennifer Goldman, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States
Dr. Children's Mercy Kansas City Kansas City, Missouri, United States
Background: Thirty to fifty percent of all pediatric antibiotic prescriptions are inappropriate (e.g., incorrect antibiotic selection, incorrect dosage, or unnecessary use) exposing children to both immediate and long-term medication adverse events and unintended consequences. Despite nationally endorsed treatment guidelines outlining best practice and the expansion of antimicrobial stewardship programs, deviation from evidence-based practice occurs signaling a non-standard approach to antibiotic prescribing that increases the risk of inappropriate use. Objective: To quantify antibiotic prescribing variability within and across children’s hospitals and to examine its association with length of stay. Design/Methods: We performed a retrospective cross-sectional study of common infections within and across 43 children’s hospitals using the Pediatric Health Information System database. We examined empiric antibiotic usage (day 0-1) during inpatient and observation stays for children 0 to 17 years of age hospitalized with prevalent infections during July 2018-June 2019. Encounters for children with complex chronic conditions, transfers in, and birth hospitalizations were excluded. Using the Shannon-Weiner index we quantified antibiotic diversity for each infection type using the D-measure of diversity in the Shannon index. Generalized linear mixed effects models were used to examine the association of hospital-level antibiotic diversity and risk-adjusted length of stay. Results: A total of 79,515 hospitalizations for prevalent infections were examined. Infections with low antibiotic diversity included appendicitis (Mean Diversity (mDiv)= 4.9, standard deviation (SD)=2.5) and deep neck space infections (mDiv=5.9, SD=1.9) (Table 1). Infections with high antibiotic diversity included pneumonia (mDiv=23.4, SD=5.6) and septicemia/bacteremia (mDiv=28.5, SD=12.1). Across all infection types, within hospital mean antibiotic diversity scores varied 2-fold from 8.5 to 19.1. Increased antibiotic diversity was associated with increased length of stay for appendicitis (p=0.038), bronchiolitis (p=0.013), and neonatal fever (p=0.043) (Table 2).
Conclusion(s): Empiric antibiotic exposure varies substantially within and across hospitals, with conditions such as pneumonia and septicemia/bacteremia demonstrating increased variation in empiric antibiotic use. Examining antibiotic diversity can highlight high priority areas for stewardship interventions within and across hospitals.
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