New research gives clues of antibiotic use and resistance in US children’s hospitals
Two studies published in the December issue of Infection Control and Hospital Epidemiology show antibiotic resistance patterns for children have held stable over a seven-year period and surgical patients in U.S. children’s hospitals account for 43 percent of all antibiotic use in children’s hospitals, presenting an opportunity for targeted intervention.
The release of the findings coincides with the Centers for Disease Control and Prevention’s (CDC) Get Smart about Antibiotics Week, an annual weeklong observance on antibiotic resistance and the importance of appropriate antibiotic use. The Society for Healthcare Epidemiology of America publishes Infection Control and Hospital Epidemiology and is a proud partner of Get Smart about Antibiotics Week.
“Inappropriate use of antibiotics can have serious and global consequences on the utility of these drugs and the spread of resistant bacteria,” said Neil Fishman, MD, a past-president of SHEA and Associate Chief Medical Officer at the University of Pennsylvania Health System. “These studies help complement our collective knowledge of the resistant bacteria in vulnerable children populations and give us a better understanding of how children’s hospitals use antibiotics.”
Antibiotic Resistance Holds Stable in Children’s Hospitals
Because there are few data describing antibiotic resistance in pediatric healthcare institutions, researchers from Johns Hopkins University School of Medicine reviewed institutional patterns of antibiotic susceptibility from 55 institutions reflecting data from 2005-2011.
They found antibiotic resistance has remained relatively stable for the majority of tested organisms over the seven-year period. The results must be considered with caution in the context of the limited number of new antibiotic agents coming down the pipeline and the increasing prevalence of drug-resistant infections among adults.
“Unless we are judicious with our use of antibiotics in children, we may encounter a resistance scenario similar to what is occurring in the adult population,” said Pranita Tamma, MD, lead author of the study. “Pooling these data allows us to identify nationwide patterns of antibiotic resistance in children’s hospitals, allows cross-hospital benchmarking, and allows under-resourced hospitals to use this information to better inform empiric antibiotic treatment practices.”
Antimicrobial Stewardship in Children’s Hospitals
Although mechanisms for implementing antimicrobial stewardship programs (ASPs) have been reported elsewhere, data-driven approaches to prioritize specific conditions and antibiotics for intervention have not been established. Researchers from The Children’s Hospital of Philadelphia used a retrospective cross-sectional study to develop a strategy for identifying high-impact targets for stewardship efforts.
“The majority of patients admitted to U.S. children’s hospitals receive antibiotic therapy,” said Jeffrey Gerber, MD, lead author of the study. “Antimicrobial stewardship programs have been recommended to optimize antibiotic use and manage and reduce variability in care, helping reduce costs while maintaining or improving outcomes.”
Analyzing more than 500,000 inpatient admissions and nearly three million patient-days from 32 hospitals, researchers found that surgical patients received 43 percent of all prescribed antibiotic therapy and a small number of clinical conditions contributed significantly to overall use, presenting an opportunity for ASPs to target these areas.
What is Antibiotic Resistance and Why is it a problem?
Antibiotic resistance occurs when an antibiotic has lost its ability to effectively control or kill bacterial growth; in other words, the bacteria are “resistant” and continue to multiply in the presence of therapeutic levels of an antibiotic.
With the discovery of antimicrobials in the 1940s, scientists prophesied the defeat of infectious diseases that had plagued humankind throughout history. However, the remarkable healing power of antibiotics invites widespread and often inappropriate use. This misuse and overuse of antibiotics leads to antibiotic resistance among bacteria and consequent treatment complications and increased healthcare costs.
Antimicrobial resistance has cast a shadow over the medical miracles we take for granted, undermining every clinical and public health program designed to contain infectious diseases worldwide. Limited access to medical care and effective treatments, the common practice of self-medication, and the availability of counterfeit drugs have exacerbated drug resistance in the developing world. In affluent nations, infections acquired in settings such as hospitals and nursing homes are a major source of illness and death. In addition, community-acquired infections are emerging, both as independent epidemics and as primary sources of resistance in hospitals. If resistance to treatment continues to spread, our interconnected, high-tech world may find itself back in the dark ages of medicine, before today’s miracle drugs ever existed.
The four conditions associated with the highest use of antibiotics among pediatric patients were pneumonia, appendicitis, cystic fibrosis, and skin and soft-tissue infections. These conditions represented one percent of diagnoses, but accounted for more than 10 percent of antibiotic use.
Wide variability in antibiotic use occurred among three of the conditions: pneumonia, appendicitis, and cystic fibrosis. The researchers believe pediatric antimicrobial stewardship efforts should prioritize standardizing treatment approaches for these conditions.
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Pranita D. Tamma, Gwen L. Robinson, Jeffrey S. Gerber, Jason G. Newland, Chloe M. DeLisle, Theoklis E. Zaoutis, Aaron M. Milstone. “Pediatric Antimicrobial Susceptibility Trends across the United States.” Infection Control and Hospital Epidemiology 34:12 (December 2013).
Jeffrey S. Gerber, Matthew P. Kronman, Rachel K. Ross, Adam L. Hersh, Jason G. Newland, Talene A. Metjian, Theoklis E. Zaoutis. “Identifying Targets for Antimicrobial Stewardship in Children’s Hospitals.” Infection Control and Hospital Epidemiology 34:12 (December 2013).
Published through a partnership between the Society for Healthcare Epidemiology of America and The University of Chicago Press, Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 13 out of 158 journals in its discipline in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.
SHEA is a professional society representing more than 2,000 physicians and other healthcare professionals around the world with expertise in healthcare epidemiology and infection prevention and control. SHEA’s mission is to prevent and control healthcare-associated infections and advance the field of healthcare epidemiology. The society leads this field by promoting science and research and providing high-quality education and training in epidemiologic methods and prevention strategies. SHEA upholds the value and critical contributions of healthcare epidemiology to improving patient care and healthcare worker safety in all healthcare settings.
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Tamara Moore
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Society for Healthcare Epidemiology of America