title: Rates and appropriateness of antimicrobial prescribing at an academic children's hospital, 2007-2010.
abstract: OBJECTIVE
  Antimicrobial use in hospitalized children has not been well described. To identify targets for antimicrobial stewardship interventions, we retrospectively examined pediatric utilization rates for 48 antimicrobials from 2007 to 2010 as well as appropriateness of vancomycin and cefepime use in 2010.
  
  
  METHODS
  All children hospitalized between 2007 and 2010 at the Mayo Clinic Children's Hospital, a 120-bed facility within a larger adult hospital in Rochester, Minnesota.
  
  
  METHODS
  We calculated antimicrobial utilization rates in days of therapy per 1,000 patient-days. Details of vancomycin and cefepime use in 2010 were abstracted by chart review. Two pediatric infectious disease physicians independently assessed appropriateness of antibiotic use.
  
  
  RESULTS
  From 2007 to 2010, 9,880 of 17,242 (57%) hospitalized children received 1 or more antimicrobials. Antimicrobials (days of therapy per 1,000 patient-days) used most frequently in 2010 were cefazolin (97.8), vancomycin (97.1), fluconazole (76.4), piperacillin-tazobactam (70.7), and cefepime (67.6). Utilization rates increased significantly from 2007 to 2010 for 10 antimicrobials, including vancomycin, fluconazole, piperacillin-tazobactam, cefepime, trimethoprim-sulfamethoxazole, caspofungin, and cefotaxime. In 2010, inappropriate use of vancomycin and cefepime was greater in the pediatric intensive care unit than ward (vancomycin: 17.8% vs 6.4%, P = .001; cefepime: 9.2% vs 3.9%, P = .142) and on surgical versus medical services (vancomycin: 20.5% vs 8.0%, P = .001; cefepime: 19.4% vs 3.4%, P ≤ .001). The most common reason for inappropriate antibiotic use was failure to discontinue or de-escalate therapy.
  
  
  CONCLUSIONS
  In our children's hospital, use of 10 antimicrobials increased during the study period. Inappropriate use of vancomycin and cefepime was greatest on the critical care and surgical services, largely as a result of failure to de-escalate therapy, suggesting targets for future antimicrobial stewardship interventions.
authors.affiliation: Department of Pediatrics, University of California, San Francisco, California 94143, USA. emily.levy@ucsf.edu
authors.forename: E R
authors.initials: ER
authors.lastname: Levy
authors.forename: S
authors.initials: S
authors.lastname: Swami
authors.forename: S G
authors.initials: SG
authors.lastname: Dubois
authors.forename: R
authors.initials: R
authors.lastname: Wendt
authors.forename: R
authors.initials: R
authors.lastname: Banerjee
mesh_terms: D000046:Academic Medical Centers / Q000592:standards / Q000706:statistics & numerical data*; D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization / Q000592:standards / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D005260:Female; D006776:Hospitals, Pediatric / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008910:Minnesota; D055553:Prescription Drugs / Q000627:therapeutic use; D012189:Retrospective Studies; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D002511:Cephalosporins; D055553:Prescription Drugs; D014640:Vancomycin; D000077723:Cefepime