Appropriateness of Antibiotic Prescribing in United States Children’s Hospitals: A National Point Prevalence Survey
Authors: Tribble Alison C , Lee Brian R , Flett Kelly B , Handy Lori K , Gerber Jeffrey S , Hersh Adam L , Kronman Matthew P , Terrill Cindy M , Sharland Mike , Newland Jason G ,   for the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative, Maples Holly , Huynh Hoang , Mongkolrattanothai Kanokporn , Schwenk Hayden , Lee Betty P , Naeem Fouzia , Kuzmic Brenik , Hurst Amanda , Parker Sarah , Girotto Jennifer , Bennett Nicholas , Hamdy Rana F , Hammer Benjamin M , Chan Shannon , Namtu Katie , Berman David , Jaggi Preeti , Fernandez A J , Shapiro Craig , Heger Margaret , Johnson George , Patel Sameer J , Stach Leslie , Scardina Tony , Nichols Kristen , Manaloor John , Jones Sarah , Olivero Rosemary , Ogrin Sara , Stillwell Terri L , Lloyd Elizabeth C , Goldman Jennifer , Patel Karisma , Yu Diana , Nelson Miranda , Rosen David , Green Andrea , Zweiner Jennifer , Courter Joshua , Haslam David , Hymes Saul R , Jaggi Preeti , Tansmore Jessica , Metjian Talene , Lee Kelly , Arnold Sandra , Castagnini Luis , Kubes Sarah , Mazade Marc , Crawford Michelle , Merkel Kathryn , Fernandez Marisol , Chang Michael , Orr Hillary , Olsen Jared , Weissman Scott , Brothers Adam , Banerjee Ritu , Gillon Jessica , Henderson Sheryl , McCreary Erin , Maples Holly , Huynh Hoang , Mongkolrattanothai Kanokporn , Schwenk Hayden , Lee Betty P , Naeem Fouzia , Kuzmic Brenik , Hurst Amanda , Parker Sarah , Girotto Jennifer , Bennett Nicholas , Hamdy Rana F , Hammer Benjamin M , Chan Shannon , Namtu Katie , Berman David , Jaggi Preeti , Fernandez A J , Shapiro Craig , Heger Margaret , Johnson George , Patel Sameer J , Stach Leslie , Scardina Tony , Nichols Kristen , Manaloor John , Jones Sarah , Olivero Rosemary , Ogrin Sara , Stillwell Terri L , Lloyd Elizabeth C , Goldman Jennifer , Patel Karisma , Yu Diana , Nelson Miranda , Rosen David , Green Andrea , Zweiner Jennifer , Courter Joshua , Haslam David , Hymes Saul R , Jaggi Preeti , Tansmore Jessica , Metjian Talene , Lee Kelly , Arnold Sandra , Castagnini Luis , Kubes Sarah , Mazade Marc , Crawford Michelle , Merkel Kathryn , Fernandez Marisol , Chang Michael , Orr Hillary , Olsen Jared , Weissman Scott , Brothers Adam , Banerjee Ritu , Gillon Jessica , Henderson Sheryl , McCreary Erin 
Published: January 2020

Abstract

Background
Studies estimate that 30%–50% of antibiotics prescribed for hospitalized patients are inappropriate, but pediatric data are limited. Characterization of inappropriate prescribing practices for children is needed to guide pediatric antimicrobial stewardship.

Methods
Cross-sectional analysis of antibiotic prescribing at 32 children’s hospitals in the United States. Subjects included hospitalized children with ≥ 1 antibiotic order at 8:00 am on 1 day per calendar quarter, over 6 quarters (quarter 3 2016–quarter 4 2017). Antimicrobial stewardship program (ASP) physicians and/or pharmacists used a standardized survey to collect data on antibiotic orders and evaluate appropriateness. The primary outcome was the percentage of antibiotics prescribed for infectious use that were classified as suboptimal, defined as inappropriate or needing modification.

Results
Of 34 927 children hospitalized on survey days, 12 213 (35.0%) had ≥ 1 active antibiotic order. Among 11 784 patients receiving antibiotics for infectious use, 25.9% were prescribed ≥ 1 suboptimal antibiotic. Of the 17 110 antibiotic orders prescribed for infectious use, 21.0% were considered suboptimal. Most common reasons for inappropriate use were bug–drug mismatch (27.7%), surgical prophylaxis &gt; 24 hours (17.7%), overly broad empiric therapy (11.2%), and unnecessary treatment (11.0%). The majority of recommended modifications were to stop (44.7%) or narrow (19.7%) the drug. ASPs would not have routinely reviewed 46.1% of suboptimal orders.

Conclusions
Across 32 children’s hospitals, approximately 1 in 3 hospitalized children are receiving 1 or more antibiotics at any given time. One-quarter of these children are receiving suboptimal therapy, and nearly half of suboptimal use is not captured by current ASP practices.