Same Rebecca G, Lee Giyoung, Olson Jared, Bettinger Brendan, Hersh Adam L, Kronman Matthew P, Newland Jason G, Grimshaw Meg, Gerber Jeffrey S
Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Infect Control Hosp Epidemiol. 2025 Apr 8:1-6. doi: 10.1017/ice.2025.59.
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).
Retrospective cohort study.
Four academic children's hospitals with established ASPs.
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.
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.
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.
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.
抗生素管理计划（ASP）以住院儿童为目标人群，但尽管30%出院儿童会接受额外的抗生素治疗，大多数计划并未在出院时常规审查抗生素处方。我们的目的是描述因非复杂性社区获得性肺炎（CAP）、皮肤/软组织感染（SSTI）和尿路感染（UTI）住院的儿童出院时的抗生素处方情况。
回顾性队列研究。
四家设有ASP的学术性儿童医院。
国际疾病分类第十版（ICD-10）编码确定了2021年1月1日至2021年12月31日期间收治的18岁以下儿童中3847例因非复杂性CAP、SSTI或UTI住院且出院时开具抗生素处方的病例。排除患有复杂疾病以及伴有合并感染、住院时间超过7天或入住重症监护病房的儿童后，纳入了1206例病例。
主要结局指标为接受最佳治疗的受试者百分比，最佳治疗指（1）总（住院加门诊）治疗时长（DOT），以及（2）根据当前国家指南和现有证据选择的抗生素。
在226例CAP病例、417例UTI病例和563例SSTI病例中，中位年龄为4岁，52%为女性，中位DOT为9天（CAP为8天，UTI为10天，SSTI为9天）。77%的抗生素选择是最佳的，26%的DOT是最佳的。只有20%的抗生素疗程在DOT和抗生素选择方面均为最佳。
在四家设有ASP的儿童医院中，80%的CAP、UTI和SSTI出院抗生素疗程在抗生素选择或DOT方面欠佳。出院时开具抗生素处方是改善儿童抗生素使用情况的一个契机。
