Parenteral Antibiotic Use Among Ambulatory Children in United States Children's Hospital Emergency Departments.
Parenteral Antibiotic Use Among Ambulatory Children in United States Children's Hospital Emergency Departments.
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DOI：
10.1093/ofid/ofaa357
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发表时间：
2020-10
影响因子：
4.2
通讯作者：
Grijalva CG
中科院分区：
文献类型：
--
作者：
Howard LM;Thurm C;Dantuluri K;Griffith HG;Katz SE;Ward MJ;Banerjee R;Grijalva CG
尽管越来越多的人认识到最佳抗生素选择和将抗菌药物管理活动扩大到门诊环境的重要性，但很少有研究研究在门诊儿童中使用非肠道抗生素的频率。我们评估了儿科急诊科(EDS)门诊儿童使用非肠道抗生素的流行率和模式。2018年，我们在49家美国儿童医院急诊室对0-18岁流动儿童进行了肠外抗生素使用的横断面评估。我们评估了非肠道抗生素使用的流行率，并根据患者、诊所和医院的特点对其进行了分层。我们还根据年龄和诊断类别评估了特定抗生素的使用情况。在与感染诊断相关的接触中，我们使用多变量Logistic回归确定了与非肠道抗生素使用相关的因素。在2018年的3次 452 011门诊急诊中，62例 648(1.8%)使用了非肠道抗生素。使用非肠道抗生素的比例最高的是15-18岁年龄组(3.3%)，以及接触过患有复杂慢性病的儿童(8.9%)和最初诊断为肿瘤的儿童(36%)。头孢曲松是最常用的非肠道抗生素(61%)。在多变量分析中，年龄≤2个月、白人种族、私人保险、复杂的慢性疾病、消化系统和泌尿生殖系统疾病以及急救药物提供者的遭遇等几个因素与肠外抗生素的使用几率显著相关。这项研究表明，在门诊急诊室中，非肠道抗生素给药的频率因年龄和诊断的不同而有很大差异，并强调了针对管理活动的潜在机会。
Despite increasing recognition of the importance of optimal antibiotic selection and expansion of antimicrobial stewardship activities to ambulatory settings, few studies have examined the frequency of parenteral antibiotic use among ambulatory children. We assessed the prevalence and patterns of parenteral antibiotic administration among ambulatory children in pediatric emergency departments (EDs). We conducted a cross-sectional assessment of parenteral antibiotic use among ambulatory children aged 0–18 years in 49 US children’s hospital EDs in 2018. We assessed the prevalence rates of parenteral antibiotic use and stratified these by patient-, clinic-, and hospital-level characteristics. We also assessed the prevalence of use of specific antibiotics by age and diagnosis category. Among encounters associated with an infection diagnosis, we identified factors associated with parenteral antibiotic use using multivariable logistic regression. Among 3 452 011 ambulatory ED encounters in 2018, parenteral antibiotics were administered in 62 648 (1.8%). The highest proportion of parenteral antibiotic use occurred in the 15–18-year age group (3.3%) and among encounters in children with complex chronic conditions (8.9%) and with primary diagnoses of neoplasms (36%). Ceftriaxone was the most commonly administered parenteral antibiotic (61%). In multivariable analysis, several factors including age ≤2 months, White race, private insurance, complex chronic conditions, digestive and genitourinary system diseases, and encounters attributed to emergency medicine providers were significantly associated with higher odds of parenteral antibiotic use. This study demonstrates substantial variability in the frequency of parenteral antibiotic administration by age and diagnosis in the ambulatory ED setting and highlights potential opportunities to target stewardship activities.
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影响因子：
2.4
作者：
Feudtner C;Feinstein JA;Zhong W;Hall M;Dai D
通讯作者：
Dai D
影响因子：
8
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Isaacman, DJ;Kaminer, K;Mason, JD
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Mason, JD
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8
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Waynik, Ilana Y.
影响因子：
120.7
作者：
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通讯作者：
Hicks, Lauri A.
影响因子：
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作者：
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Shah, Samir S.