Variability in Antibiotic Use Across PICUs

Objectives: To characterize and compare antibiotic prescribing across PICUs to evaluate the degree of variability. Design: Retrospective analysis from 2010 through 2014 of the Pediatric Health Information System. Setting: Forty-one freestanding children’s hospital. Subjects: Children aged 30 days to 18 years admitted to a PICU in children’s hospitals contributing data to Pediatric Health Information System. Interventions: To normalize for potential differences in disease severity and case mix across centers, a subanalysis was performed of children admitted with one of the 20 All Patient Refined-Diagnosis Related Groups and the seven All Patient Refined-Diagnosis Related Groups shared by all PICUs with the highest antibiotic use. Results: The study included 3,101,201 hospital discharges from 41 institutions with 386,914 PICU patients. All antibiotic use declined during the study period. The median-adjusted antibiotic use among PICU patients was 1,043 days of therapy/1,000 patient-days (interquartile range, 977–1,147 days of therapy/1,000 patient-days) compared with 893 among non-ICU children (interquartile range, 805–968 days of therapy/1,000 patient-days). For PICU patients, the median adjusted use of broad-spectrum antibiotics was 176 days of therapy/1,000 patient-days (interquartile range, 152–217 days of therapy/1,000 patient-days) and was 302 days of therapy/1,000 patient-days (interquartile range, 220–351 days of therapy/1,000 patient-days) for antimethicillin-resistant Staphylococcus aureus agents, compared with 153 days of therapy/1,000 patient-days (interquartile range, 130–182 days of therapy/1,000 patient-days) and 244 days of therapy/1,000 patient-days (interquartile range, 203–270 days of therapy/1,000 patient-days) for non-ICU children. After adjusting for potential confounders, significant institutional variability existed in antibiotic use in PICU patients, in the 20 All Patient Refined-Diagnosis Related Groups with the highest antibiotic usage and in the seven All Patient Refined-Diagnosis Related Groups shared by all 41 PICUs. Conclusions: The wide variation in antibiotic use observed across children’s hospital PICUs suggests inappropriate antibiotic use. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://ift.tt/2gIrZ5Y). Dr. Hersh’s institution received funding from the Agency for Healthcare Research and Quality and Merck. Dr. Lee’s institution received funding from the Patient-Centered Outcomes Research Institute and Pfizer. Dr. Newland’s institution received funding from Pfizer for antimicrobial stewardship. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: botcho@uw.edu ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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