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Discharge antibiotic prescribing at children’s hospitals with established antimicrobial stewardship programs

Published online by Cambridge University Press:  08 April 2025

Rebecca G. Same Open the ORCID record for Rebecca G. Same [Opens in a new window] ,
Giyoung Lee ,
Jared Olson ,
Brendan Bettinger ,
Adam L. Hersh ,
Matthew P. Kronman Open the ORCID record for Matthew P. Kronman [Opens in a new window] ,
Jason G. Newland Open the ORCID record for Jason G. Newland [Opens in a new window] ,
Meg Grimshaw Open the ORCID record for Meg Grimshaw [Opens in a new window]  and
Jeffrey S. Gerber Open the ORCID record for Jeffrey S. Gerber [Opens in a new window]
Rebecca G. Same*
Affiliation:
Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Giyoung Lee
Affiliation:
Children’s Hospital of Philadelphia, Philadelphia, PA, USA Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
Jared Olson
Affiliation:
Primary Children’s Hospital, Salt Lake City, UT, USA
Brendan Bettinger
Affiliation:
Seattle Children’s Hospital, Seattle, WA, USA
Adam L. Hersh
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, University of Utah, Salt Lake City, UT, USA
Matthew P. Kronman
Affiliation:
Seattle Children’s Hospital, Seattle, WA, USA Department of Pediatrics, University of Washington, Seattle, WA, USA
Jason G. Newland
Affiliation:
Pediatric Infectious Diseases, Nationwide Children’s Hospital, Columbus, OH, USA
Meg Grimshaw
Affiliation:
Spencer Fox Eccles School of Medicine, Salt Lake City, UT, USA
Jeffrey S. Gerber*
Affiliation:
Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Children’s Hospital of Philadelphia, Philadelphia, PA, USA
*
Corresponding authors: Rebecca G. Same, Jeffrey S. Gerber; Emails: [email protected], [email protected]
Corresponding authors: Rebecca G. Same, Jeffrey S. Gerber; Emails: [email protected], [email protected]
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Abstract

Objective:

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).

Design:

Retrospective cohort study.

Setting:

Four academic children’s hospitals with established ASPs.

Patients:

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.

Methods:

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.

Results:

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.

Conclusions:

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , First View , pp. 1 - 6
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

A preliminary analysis of these findings was presented as a poster at IDWeek 2022.

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