title: Clinical characteristics and antibiotic utilization in pediatric patients hospitalized with acute bacterial skin and skin structure infection.
abstract: BACKGROUND
  Hospitalizations for acute bacterial skin and skin structure infection (ABSSSI) in children are increasingly frequent, but little is known about antibiotic utilization. In adults, recent studies suggest substantial opportunity to reduce broad-spectrum antibiotic use and shorten therapy. We sought to determine whether similar opportunity exists in children.
  
  
  METHODS
  This was a planned secondary analysis of a pediatric cohort taken from a multicenter, retrospective cohort of patients hospitalized for ABSSSI between June 1, 2010, and May 31, 2012. The prespecified primary endpoint was a composite of 2 prescribing practices: (1) use of antibiotics with broad Gram-negative activity or (2) treatment duration >10 days.
  
  
  RESULTS
  One-hundred and two patients ≤ 18 years old were included: 43 had non-purulent cellulitis, 19 had wound infection or purulent cellulitis and 40 had cutaneous abscess. The median age was 5 years (range 45 days to 18 years). Clindamycin was the most frequently prescribed antibiotic during hospitalization (67% of cases) and at discharge (66% of cases). The median duration of therapy was 11 days (interquartile range 10-12) and was similar for all 3 types of ABSSSI. The primary endpoint occurred in 67% of cases, including broad Gram-negative therapy in 25% and treatment duration >10 days in 61%. By multivariate logistic regression, admission through an emergency department and management by a medical (vs. surgical) service were independently associated with the primary endpoint.
  
  
  CONCLUSIONS
  Children hospitalized for ABSSSI are frequently exposed to antibiotics with broad Gram-negative activity or treated longer than 10 days suggesting opportunity to reduce antibiotic use.
authors.affiliation: From the *Department of Trauma and Critical Care Services, Vail Valley Medical Center, Vail; †Department of Pediatrics; ‡Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora; §Department of Patient Safety and Quality, Denver Health; ¶Colorado Infectious Disease Associates; ‖Denver Public Health, **Department of Medicine, ††Division of Infectious Diseases, Denver Health, Denver; and ‡‡Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
authors.forename: S Jason
authors.initials: SJ
authors.lastname: Moore
authors.forename: Sean T
authors.initials: ST
authors.lastname: O'Leary
authors.forename: Brooke
authors.initials: B
authors.lastname: Caldwell
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Knepper
authors.forename: Sean W
authors.initials: SW
authors.lastname: Pawlowski
authors.forename: William J
authors.initials: WJ
authors.lastname: Burman
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Jenkins
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006760:Hospitalization; D006801:Humans; D007223:Infant; D016015:Logistic Models; D055656:Prescriptions; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents