Antibiotic Utilization in Pediatric Soft Tissue Infections
Antibiotic Utilization in Pediatric Soft Tissue Infections
Background: Hospitalizations for acute bacterial skin and skin structure infection (ABSSSI) in children are increasingly frequent, but little is known about antibiotic utilization. In adults, recent studies suggest substantial opportunity to reduce broad-spectrum antibiotic use and shorten therapy. We sought to determine whether similar opportunity exists in children.
Methods: This was a planned secondary analysis of a pediatric cohort taken from a multicenter, retrospective cohort of patients hospitalized for ABSSSI between June 1, 2010, and May 31, 2012. The prespecified primary endpoint was a composite of 2 prescribing practices: (1) use of antibiotics with broad Gram-negative activity or (2) treatment duration >10 days.
Results: One-hundred and two patients ≤18 years old were included: 43 had non-purulent cellulitis, 19 had wound infection or purulent cellulitis and 40 had cutaneous abscess. The median age was 5 years (range 45 days to 18 years). Clindamycin was the most frequently prescribed antibiotic during hospitalization (67% of cases) and at discharge (66% of cases). The median duration of therapy was 11 days (interquartile range 10–12) and was similar for all 3 types of ABSSSI. The primary endpoint occurred in 67% of cases, including broad Gram-negative therapy in 25% and treatment duration >10 days in 61%. By multivariate logistic regression, admission through an emergency department and management by a medical (vs. surgical) service were independently associated with the primary endpoint.
Conclusions: Children hospitalized for ABSSSI are frequently exposed to antibiotics with broad Gram-negative activity or treated longer than 10 days suggesting opportunity to reduce antibiotic use.
Acute bacterial skin and skin structure infections (ABSSSI) are among the most common infections requiring hospitalization and exert a substantial burden on the health care system. In the United States, ABSSSI result in approximately 3 million pediatric health care visits per year. With the emergence and epidemic of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), hospitalizations for ABSSSI among children have more than doubled over the last 15 years, now exceeding over 70,000 per year. Such hospitalizations have been associated with an increasing cost of care and need for invasive procedures.
Understanding current antibiotic prescribing patterns for common infections is essential to improving antibiotic use in hospitals. Despite the increasing frequency of hospitalizations for ABSSSI among children, there are limited data regarding antibiotic utilization in such cases. One study demonstrated that in children hospitalized with S. aureus skin and soft tissue infections, use of clindamycin has substantially increased whereas use of β-lactams has declined in the era of CA-MRSA. In adults, recent studies have demonstrated frequent use of overly broad-spectrum antibiotic regimens and prolonged treatment durations suggesting substantial opportunity to reduce unnecessary antibiotic use. We sought to evaluate whether similar opportunity existed in pediatric patients. The objectives of this study were to describe antibiotic prescribing practices in pediatric patients hospitalized with ABSSSI and identify factors associated with use of broad-spectrum and prolonged treatment courses.
Abstract and Introduction
Abstract
Background: Hospitalizations for acute bacterial skin and skin structure infection (ABSSSI) in children are increasingly frequent, but little is known about antibiotic utilization. In adults, recent studies suggest substantial opportunity to reduce broad-spectrum antibiotic use and shorten therapy. We sought to determine whether similar opportunity exists in children.
Methods: This was a planned secondary analysis of a pediatric cohort taken from a multicenter, retrospective cohort of patients hospitalized for ABSSSI between June 1, 2010, and May 31, 2012. The prespecified primary endpoint was a composite of 2 prescribing practices: (1) use of antibiotics with broad Gram-negative activity or (2) treatment duration >10 days.
Results: One-hundred and two patients ≤18 years old were included: 43 had non-purulent cellulitis, 19 had wound infection or purulent cellulitis and 40 had cutaneous abscess. The median age was 5 years (range 45 days to 18 years). Clindamycin was the most frequently prescribed antibiotic during hospitalization (67% of cases) and at discharge (66% of cases). The median duration of therapy was 11 days (interquartile range 10–12) and was similar for all 3 types of ABSSSI. The primary endpoint occurred in 67% of cases, including broad Gram-negative therapy in 25% and treatment duration >10 days in 61%. By multivariate logistic regression, admission through an emergency department and management by a medical (vs. surgical) service were independently associated with the primary endpoint.
Conclusions: Children hospitalized for ABSSSI are frequently exposed to antibiotics with broad Gram-negative activity or treated longer than 10 days suggesting opportunity to reduce antibiotic use.
Introduction
Acute bacterial skin and skin structure infections (ABSSSI) are among the most common infections requiring hospitalization and exert a substantial burden on the health care system. In the United States, ABSSSI result in approximately 3 million pediatric health care visits per year. With the emergence and epidemic of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), hospitalizations for ABSSSI among children have more than doubled over the last 15 years, now exceeding over 70,000 per year. Such hospitalizations have been associated with an increasing cost of care and need for invasive procedures.
Understanding current antibiotic prescribing patterns for common infections is essential to improving antibiotic use in hospitals. Despite the increasing frequency of hospitalizations for ABSSSI among children, there are limited data regarding antibiotic utilization in such cases. One study demonstrated that in children hospitalized with S. aureus skin and soft tissue infections, use of clindamycin has substantially increased whereas use of β-lactams has declined in the era of CA-MRSA. In adults, recent studies have demonstrated frequent use of overly broad-spectrum antibiotic regimens and prolonged treatment durations suggesting substantial opportunity to reduce unnecessary antibiotic use. We sought to evaluate whether similar opportunity existed in pediatric patients. The objectives of this study were to describe antibiotic prescribing practices in pediatric patients hospitalized with ABSSSI and identify factors associated with use of broad-spectrum and prolonged treatment courses.
