Antibiotic exposure in hospitalized pediatric patients in the United States: prevalence and length of stay

ABSTRACT

Background

Hospital antibiotic use is rising. We aimed to evaluate the antibiotic-use prevalence and length of stay.

Methods

We conducted a single-center retrospective study of patients < 18-years-old admitted to general pediatric services who received ≥ 1 antibiotic over six months. Demographics, culture results and antibiotic details were collected. The primary outcome was to identify the total number and classes of antibiotics prescribed during the admission. Secondary outcomes included length of stay (LOS), culture results, and the most commonly used antibiotics.

Results

Forty-eight percent of patients received monotherapy (single class antibiotic). Cephalosporins (55%), vancomycin (35%), and clindamycin (22%) were prescribed more commonly than other antibiotic classes. Children were exposed up to 4 classes of antibiotics (range 1–4). A moderate correlation existed between the length of stay and the number of antibiotic classes used (R² = 0.38). Two or more classes of antibiotic use prolonged the length of stay. Cephalosporin use was associated with 35% reduced LOS (95 CI, 21%-57%), and penicillin use correlated with 38% more prolonged LOS (95 CI, 22%-66%).

Conclusions

Antibiotic use in pediatric hospitals was high, and children received multiple classes of antibiotics. Inappropriate antibiotic use and culture results may have an untoward effect on hospital length of stay.

KEYWORDS:

• Antibiotic Exposure
• Prevalence
• Antibiotic Misuse
• Antibiotic stewardship
• Length of stay
• Pediatrics

Article highlights

• Pediatric monotherapy prevalence is high. Most of the uncomplicated medical conditions are treated with a single antibiotic.

• Polymicrobial exposure is inevitable, but actionable and can be avoided. This will reduce harm and enhance drug safety.

• Antibiotic use can be associated with a prolonged hospital stay. Prolonged stay is affected by many factors, but a certain type and number of antibiotic uses can add to the problem.

• Antibiotic stewardship emphasizes judicious and culture-directed antibiotic prescriptions.

• Antibiotic stewardship expansion to surgical prophylaxis is in practice. Evidence-based guidelines on this topic are emerging; adhering to the best practice of antibiotic use and monotherapy is important.

Author contributions

Conception or design of the work: A. Gourishankar, A. Agbasi, C. Kain, E. Lin. Data collection A. Agbasi, C. Kain, E. Lin. Data analysis and interpretation: A. Gourishankar, E. Lin. Drafting the article: A. Gourishankar, A. Agbasi, C. Kain, E. Lin. Critical revision of the article: A. Gourishankar, E. Lin. Final approval of the version to be published: A. Gourishankar, A. Agbasi, C. Kain, E. Lin.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.