Howard Leigh M, Thurm Cary, Dantuluri Keerti, Griffith Hannah G, Katz Sophie E, Ward Michael J, Banerjee Ritu, Grijalva Carlos G
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Children's Hospital Association, Overland Park, Kansas City, Kansas, USA.
Open Forum Infect Dis. 2020 Oct 22;7(10):ofaa357. doi: 10.1093/ofid/ofaa357. eCollection 2020 Oct.
Despite increasing recognition of the importance of optimal antibiotic selection and expansion of antimicrobial stewardship activities to ambulatory settings, few studies have examined the frequency of parenteral antibiotic use among ambulatory children. We assessed the prevalence and patterns of parenteral antibiotic administration among ambulatory children in pediatric emergency departments (EDs).
We conducted a cross-sectional assessment of parenteral antibiotic use among ambulatory children aged 0-18 years in 49 US children's hospital EDs in 2018. We assessed the prevalence rates of parenteral antibiotic use and stratified these by patient-, clinic-, and hospital-level characteristics. We also assessed the prevalence of use of specific antibiotics by age and diagnosis category. Among encounters associated with an infection diagnosis, we identified factors associated with parenteral antibiotic use using multivariable logistic regression.
Among 3452011 ambulatory ED encounters in 2018, parenteral antibiotics were administered in 62648 (1.8%). The highest proportion of parenteral antibiotic use occurred in the 15-18-year age group (3.3%) and among encounters in children with complex chronic conditions (8.9%) and with primary diagnoses of neoplasms (36%). Ceftriaxone was the most commonly administered parenteral antibiotic (61%). In multivariable analysis, several factors including age ≤2 months, White race, private insurance, complex chronic conditions, digestive and genitourinary system diseases, and encounters attributed to emergency medicine providers were significantly associated with higher odds of parenteral antibiotic use.
This study demonstrates substantial variability in the frequency of parenteral antibiotic administration by age and diagnosis in the ambulatory ED setting and highlights potential opportunities to target stewardship activities.
尽管人们越来越认识到优化抗生素选择的重要性，并将抗菌药物管理活动扩展到门诊环境，但很少有研究调查门诊儿童使用肠外抗生素的频率。我们评估了儿科急诊科门诊儿童肠外抗生素给药的患病率和模式。
2018年，我们对美国49家儿童医院急诊科0至18岁的门诊儿童使用肠外抗生素情况进行了横断面评估。我们评估了肠外抗生素使用的患病率，并按患者、诊所和医院层面的特征进行分层。我们还按年龄和诊断类别评估了特定抗生素的使用患病率。在与感染诊断相关的就诊病例中，我们使用多变量逻辑回归确定了与肠外抗生素使用相关的因素。
在2018年的3452011次门诊急诊就诊中，62648例（1.8%）使用了肠外抗生素。肠外抗生素使用比例最高的是15至18岁年龄组（3.3%），以及患有复杂慢性病的儿童就诊病例（8.9%）和原发性肿瘤诊断病例（36%）。头孢曲松是最常用的肠外抗生素（61%）。在多变量分析中，包括年龄≤2个月、白人种族、私人保险、复杂慢性病、消化和泌尿系统疾病以及急诊医学提供者负责的就诊病例等几个因素与肠外抗生素使用几率较高显著相关。
本研究表明，在门诊急诊环境中，肠外抗生素给药频率因年龄和诊断存在很大差异，并突出了针对性管理活动的潜在机会。
