title: Variability in antibiotic use at children's hospitals.
abstract: BACKGROUND
  Variation in medical practice has identified opportunities for quality improvement in patient care. The degree of variation in the use of antibiotics in children's hospitals is unknown.
  
  
  METHODS
  We conducted a retrospective cohort study of 556,692 consecutive pediatric inpatient discharges from 40 freestanding children's hospitals between January 1, 2008, and December 31, 2008. We used the Pediatric Health Information System to acquire data on antibiotic use and clinical diagnoses.
  
  
  RESULTS
  Overall, 60% of the children received at least 1 antibiotic agent during their hospitalization, including >90% of patients who had surgery, underwent central venous catheter placement, had prolonged ventilation, or remained in the hospital for >14 days. Even after adjustment for both hospital- and patient-level demographic and clinical characteristics, antibiotic use varied substantially across hospitals, including both the proportion of children exposed to antibiotics (38%-72%) and the number of days children received antibiotics (368-601 antibiotic-days per 1000 patient-days). In general, hospitals that used more antibiotics also used a higher proportion of broad-spectrum antibiotics.
  
  
  CONCLUSIONS
  Children's hospitals vary substantially in their use of antibiotics to a degree unexplained by patient- or hospital-level factors typically associated with the need for antibiotic therapy, which reveals an opportunity to improve the use of these drugs.
authors.affiliation: Division of Infectious Diseases, Children's Hospital of Philadelphia, CHOP North, Suite 1518, Philadelphia, PA 19104, USA. gerberj@email.chop.edu
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.forename: Cary
authors.initials: C
authors.lastname: Thurm
authors.forename: Priya A
authors.initials: PA
authors.lastname: Prasad
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000600:supply & distribution*; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement; D012189:Retrospective Studies; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents