First name
Scott
Middle name
J
Last name
Weissman

Title

Accuracy of Administrative Data for Antimicrobial Administration in Hospitalized Children.

Year of Publication

2017

Date Published

2017 Aug 18

ISSN Number

2048-7207

Abstract

<p>Administrative data are often used as a proxy for medication-administration record (MAR) data. Multicenter MAR data were compared retrospectively with administrative data from January 2010 through June 2013 from the Pediatric Health Information Systems database. We found that administrative data were more concordant with bill-upon-administration than bill-upon-dispense data.</p>

DOI

10.1093/jpids/pix064

Alternate Title

J Pediatric Infect Dis Soc

PMID

28992185

Title

Antibiotic prophylaxis is associated with subsequent resistant infections in children with an initial extended-spectrum cephalosporin-resistant Enterobacteriaceae infection.

Year of Publication

2017

Date Published

2017 Mar 13

ISSN Number

1098-6596

Abstract

<p>The objective of this study was to assess the association between previous antibiotic use, particularly long-term prophylaxis, and occurrence of subsequent resistant infections in children with index infections due to extended-spectrum cephalosporin-resistant Enterobacteriaceae We also investigated the concordance of index and subsequent isolates. Extended-spectrum cephalosporin-resistant E. coli and Klebsiella spp. isolated from normally sterile sites of patients aged &lt;22 years were collected along with associated clinical data from four freestanding pediatric centers. Subsequent isolates were categorized as concordant if the species, resistance determinants, and fumC/fimH (E. coli) or tonB (K. pneumoniae) type were identical to the index isolate. In total, 323 patients had 396 resistant isolates; 45 (14%) patients had ≥1 subsequent resistant infection, totaling 73 subsequent resistant isolates. The median time between index and first subsequent infection was 123 days (interquartile range 43, 225). In multivariable Cox proportional hazards analyses, patients were 2.07 times as likely to have a subsequent resistant infection (95% confidence interval, 1.11 to 3.87) if they received prophylaxis in the 30 days prior to the index infection. In 26 (58%) patients, all subsequent isolates were concordant with their index isolate and 7 (16%) additional patients had at least 1 concordant subsequent isolate. In 12 (71%) of 17 patients with E. coli ST131-associated type 40-30, all subsequent isolates were concordant. Subsequent extended-spectrum cephalosporin-resistant infections are relatively frequent and are most commonly due to bacterial strains concordant with the index isolate. Further study is needed to assess the role prophylaxis plays in these resistant infections.</p>

DOI

10.1128/AAC.02656-16

Alternate Title

Antimicrob. Agents Chemother.

PMID

28289030

Title

Extended- Versus Narrower-Spectrum Antibiotics for Appendicitis.

Year of Publication

2016

Date Published

2016 Jul

ISSN Number

1098-4275

Abstract

<p><strong>BACKGROUND AND OBJECTIVES: </strong>Appendicitis guidelines recommend either narrower- or extended-spectrum antibiotics for treatment of complicated appendicitis. The goal of this study was to compare the effectiveness of extended-spectrum versus narrower-spectrum antibiotics for children with appendicitis.</p>

<p><strong>METHODS: </strong>We performed a retrospective cohort study of children aged 3 to 18 years discharged between 2011 and 2013 from 23 freestanding children's hospitals with an appendicitis diagnosis and appendectomy performed. Subjects were classified as having complicated appendicitis if they had a postoperative length of stay ≥3 days, a central venous catheter placed, major or severe illness classification, or ICU admission. The exposure of interest was receipt of systemic extended-spectrum antibiotics (piperacillin ± tazobactam, ticarcillin ± clavulanate, ceftazidime, cefepime, or a carbapenem) on the day of appendectomy or the day after. The primary outcome was 30-day readmission for wound infection or repeat abdominal surgery. Multivariable logistic regression, propensity score weighting, and subgroup analyses were used to control for confounding by indication.</p>

<p><strong>RESULTS: </strong>Of 24 984 patients, 17 654 (70.7%) had uncomplicated appendicitis and 7330 (29.3%) had complicated appendicitis. Overall, 664 (2.7%) patients experienced the primary outcome, 1.1% among uncomplicated cases and 6.4% among complicated cases (P &lt; .001). Extended-spectrum antibiotic exposure was significantly associated with the primary outcome in complicated (adjusted odds ratio, 1.43 [95% confidence interval, 1.06 to 1.93]), but not uncomplicated, (adjusted odds ratio, 1.32 [95% confidence interval, 0.88 to 1.98]) appendicitis. These odds ratios remained consistent across additional analyses.</p>

<p><strong>CONCLUSIONS: </strong>Extended-spectrum antibiotics seem to offer no advantage over narrower-spectrum agents for children with surgically managed acute uncomplicated or complicated appendicitis.</p>

DOI

10.1542/peds.2015-4547

Alternate Title

Pediatrics

PMID

27354453

Title

Antimicrobial stewardship in pediatric care: strategies and future directions.

Year of Publication

2012

Number of Pages

735-43

Date Published

2012 Aug

ISSN Number

1875-9114

Abstract

<p>Antimicrobial stewardship programs (ASPs) are an effective strategy for improving the quality and safety of antimicrobial prescribing for hospitalized patients. Pediatric ASPs are in their early stages of development, and there are unique issues relevant to children. The imperative to ensure that antimicrobials are prescribed judiciously is highlighted by the ongoing epidemic increase in antimicrobial-resistant infections and the simultaneous decline in the rate of new drug development. In this review we describe the process of ASP development for pediatrics, review existing data regarding the impact of pediatric ASPs, and describe the priorities and challenges for ASP research including study design and appropriate end points.</p>

DOI

10.1002/j.1875-9114.2012.01155.x

Alternate Title

Pharmacotherapy

PMID

23307521

Title

Prevalence and characteristics of antimicrobial stewardship programs at freestanding children's hospitals in the United States.

Year of Publication

2014

Number of Pages

265-71

Date Published

2014 Mar

ISSN Number

1559-6834

Abstract

<p><strong>BACKGROUND AND OBJECTIVE: </strong>Antimicrobial stewardship programs (ASPs) are a mechanism to ensure the appropriate use of antimicrobials. The extent to which ASPs are formally implemented in freestanding children's hospitals is unknown. The objective of this study was to determine the prevalence and characteristics of ASPs in freestanding children's hospitals.</p>

<p><strong>METHODS: </strong>We conducted an electronic survey of 42 freestanding children's hospitals that are members of the Children's Hospital Association to determine the presence and characteristics of their ASPs. For hospitals without an ASP, we determined whether stewardship strategies were in place and whether there were barriers to implementing a formal ASP.</p>

<p><strong>RESULTS: </strong>We received responses from 38 (91%) of 42. Among responding institutions, 16 (38%) had a formal ASP, and 15 (36%) were in the process of implementing a program. Most ASPs (13 [81%] of 16) were started after 2007. The median number of full-time equivalents dedicated to ASPs was 0.63 (range, 0.1-1.8). The most common antimicrobials monitored by ASPs were linezolid, vancomycin, and carbapenems. Many hospitals without a formal ASP were performing stewardship activities, including elements of prospective audit and feedback (9 [41%] of 22), formulary restriction (9 [41%] of 22), and use of clinical guidelines (17 [77%] of 22). Antimicrobial outcomes were more likely to be monitored by hospitals with ASPs (100% vs 68%; P = .01), although only 1 program provided support for a data analyst.</p>

<p><strong>CONCLUSIONS: </strong>Most freestanding children's hospitals have implemented or are developing an ASP. These programs differ in structure and function, and more data are needed to identify program characteristics that have the greatest impact.</p>

DOI

10.1086/675277

Alternate Title

Infect Control Hosp Epidemiol

PMID

24521592

Title

The use of intravenous colistin among children in the United States: results from a multicenter, case series.

Year of Publication

2013

Number of Pages

17-22

Date Published

2013 Jan

ISSN Number

1532-0987

Abstract

<p><strong>BACKGROUND: </strong>A rapid increase in multidrug-resistant Gram-negative infections has led to a reemergence of colistin use globally. Although it is well described among adults, colistin use and its associated toxicities in children are poorly understood. We report findings from the largest case series of pediatric colistin use to date.</p>

<p><strong>METHODS: </strong>We queried pediatric infectious diseases specialists from the Emerging Infections Network to identify members who had prescribed intravenous colistin within the past 7 years. We collected relevant demographic and clinical data. Bivariate analyses and multivariable logistic regression were performed.</p>

<p><strong>RESULTS: </strong>Two hundred twenty-nine pediatric infectious diseases specialists completed the survey (84% response); 22% had prescribed colistin to children. Among respondents, 92 cases of colistin use from 25 institutions were submitted. The most commonly targeted organisms were multidrug-resistant Pseudomonas (67.4%), multidrug-resistant Acinetobacter -baumanii (11.9%), carbapenemase-producing Enterobacteriaceae (13.0%) and extended-spectrum β-lactamase producing Enterobacteriaceae (5.4%). Development of resistance to colistin was observed in 20.5% of patients. Additional antimicrobial therapy was administered to 84% of patients, and 22% of children experienced nephrotoxicity (not associated with dosage or interval of colistin prescribed). Renal function returned to baseline in all patients. Children aged ≥13 years had approximately 7 times the odds of developing nephrotoxicity than younger children, even after controlling for receipt of additional nephrotoxic agents (odds ratio 7.16; 95% confidence interval: 1.51-14.06; P = 0.013). Four children exhibited reversible neurotoxicity.</p>

<p><strong>CONCLUSIONS: </strong>Most pediatric infectious diseases specialists have no experience prescribing colistin. Colistin use in children has been associated primarily with nephrotoxicity and, to a lesser extent, neurotoxicity, both of which are reversible. Emergence of resistance to colistin is concerning.</p>

DOI

10.1097/INF.0b013e3182703790

Alternate Title

Pediatr. Infect. Dis. J.

PMID

22935871

Title

Antimicrobial stewardship programs in freestanding children's hospitals.

Year of Publication

2015

Number of Pages

33-9

Date Published

01/2015

ISSN Number

1098-4275

Abstract

<p><strong>BACKGROUND AND OBJECTIVE: </strong>Single-center evaluations of pediatric antimicrobial stewardship programs (ASPs) suggest that ASPs are effective in reducing and improving antibiotic prescribing, but studies are limited. Our objective was to compare antibiotic prescribing rates in a group of pediatric hospitals with formalized ASPs (ASP+) to a group of concurrent control hospitals without formalized stewardship programs (ASP-).</p>

<p><strong>METHODS: </strong>We evaluated the impact of ASPs on antibiotic prescribing over time measured by days of therapy/1000 patient-days in a group of 31 freestanding children's hospitals (9 ASP+, 22 ASP-). We compared differences in average antibiotic use for all ASP+ and ASP- hospitals from 2004 to 2012 before and after release of 2007 Infectious Diseases Society of America guidelines for developing ASPs. Antibiotic use was compared for both all antibacterials and for a select subset (vancomycin, carbapenems, linezolid). For each ASP+ hospital, we determined differences in the average monthly changes in antibiotic use before and after the program was started by using interrupted time series via dynamic regression.</p>

<p><strong>RESULTS: </strong>In aggregate, as compared with those years preceding the guidelines, there was a larger decline in average antibiotic use in ASP+ hospitals than in ASP- hospitals from 2007 to 2012, the years after the release of Infectious Diseases Society of America guidelines (11% vs 8%, P = .04). When examined individually, relative to preimplementation trends, 8 of 9 ASP+ hospitals revealed declines in antibiotic use, with an average monthly decline in days of therapy/1000 patient-days of 5.7%. For the select subset of antibiotics, the average monthly decline was 8.2%.</p>

<p><strong>CONCLUSIONS: </strong>Formalized ASPs in children's hospitals are effective in reducing antibiotic prescribing.</p>

DOI

10.1542/peds.2014-2579

Alternate Title

Pediatrics

PMID

25489018

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