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Patterns of inpatient antibiotic utilization by race and ethnicity at US children’s hospitals

Published online by Cambridge University Press:  21 November 2024

Bethany A. Wattles Open the ORCID record for Bethany A. Wattles [Opens in a new window] ,
Jeffrey I. Campbell ,
Theresa Kluthe Open the ORCID record for Theresa Kluthe [Opens in a new window] ,
Yana B. Feygin Open the ORCID record for Yana B. Feygin [Opens in a new window] ,
Kahir Jawad ,
Michelle D. Stevenson ,
Deborah Winders Davis Open the ORCID record for Deborah Winders Davis [Opens in a new window] ,
Jennifer Porter ,
V. Faye Jones  and
Matt Hall
...Show all authors
Bethany A. Wattles
Affiliation:
Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
Jeffrey I. Campbell
Affiliation:
Department of Pediatrics, Boston Medical Center, Boston, MA, USA
Theresa Kluthe
Affiliation:
Norton Children’s Research Institute affiliated with the University of Louisville School of Medicine, Louisville, KY, USA
Yana B. Feygin
Affiliation:
Norton Children’s Research Institute affiliated with the University of Louisville School of Medicine, Louisville, KY, USA
Kahir Jawad
Affiliation:
Norton Children’s Research Institute affiliated with the University of Louisville School of Medicine, Louisville, KY, USA
Michelle D. Stevenson
Affiliation:
Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA Norton Children’s Research Institute affiliated with the University of Louisville School of Medicine, Louisville, KY, USA
Deborah Winders Davis
Affiliation:
Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA Norton Children’s Research Institute affiliated with the University of Louisville School of Medicine, Louisville, KY, USA
Jennifer Porter
Affiliation:
Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA Norton Children’s Research Institute affiliated with the University of Louisville School of Medicine, Louisville, KY, USA
V. Faye Jones
Affiliation:
Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY, USA
Matt Hall
Affiliation:
Children’s Hospital Association, Lenexa, KS, USA
Michael J. Smith*
Affiliation:
Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
*
Corresponding author: Michael J. Smith; Email: [email protected]
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Abstract

Background and Objectives:

Racial and ethnic variations in antibiotic utilization are well-reported in outpatient settings but little is known about inpatient settings. Our objective was to describe national inpatient antibiotic utilization among children by race and ethnicity.

Methods:

This study included hospital visit data from the Pediatric Health Information System between 01/01/2022 and 12/31/2022 for patients <20 years. Primary outcomes were the percentage of hospitalization encounters that received an antibiotic and antibiotic days of therapy (DOT) per 1000 patient days. Mixed-effect regression models were used to determine the association of race-ethnicity with outcomes, adjusting for covariates.

Results:

There were 846,530 hospitalizations. 45.2% of children were Non-Hispanic (NH) White, 27.1% were Hispanic, 19.2% were NH Black, 4.5% were NH Other, 3.5% were NH Asian, 0.3% were NH Native Hawaiian/Other Pacific Islander (NHPI) and 0.2% were NH American Indian. Adjusting for covariates, NH Black children had lower odds of receiving antibiotics compared to NH White children (aOR 0.96, 95%CI 0.94–0.97), while NH NHPI had higher odds of receiving antibiotics (aOR 1.16, 95%CI 1.05–1.29). Children who were Hispanic, NH Asian, NH American Indian, and children who were NH Other received antibiotic DOT compared to NH White children, while NH NHPI children received more antibiotic DOT.

Conclusions:

Antibiotic utilization in children’s hospitals differs by race and ethnicity. Hospitals should assess policies and practices that may contribute to disparities in treatment; antibiotic stewardship programs may play an important role in promoting inpatient pharmacoequity. Additional research is needed to examine individual diagnoses, clinical outcomes, and drivers of variation.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 46 , Issue 1 , January 2025 , pp. 57 - 65
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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