title: Identifying Antimicrobial Stewardship Targets for Pediatric Surgical Patients.
abstract: BACKGROUND
  More than 80% of surgical inpatients at US children's hospitals receive antibiotics, accounting for >40% of all inpatient pediatric antibiotic use. We aimed to examine the collective pool of all systemic antibiotics prescribed to children hospitalized for surgical conditions and identify common surgical conditions with highly variable and potentially unnecessary antibiotic use, because these conditions may represent antimicrobial stewardship priorities.
  
  
  METHODS
  We conducted a retrospective cross-sectional study of surgical inpatients discharged in 2012 at 37 freestanding children's hospitals. We captured all systemic antibiotic use as days of therapy (DOT), and we reported surgical conditions by frequency and contribution to overall antibiotic use. We used multivariable logistic and Poisson regression with marginal standardization to estimate (1) the standardized proportion and (2) DOT of condition-specific targeted antibiotic use among top surgical condition patients.
  
  
  RESULTS
  Among 151 345 surgical inpatients, 82.9% received antimicrobials for a median 2 DOT per subject (interquartile range, 1-5; range, 1-958). The most commonly received antibiotics were cefazolin (16.7% of all DOT), vancomycin (12.5%), and piperacillin/tazobactam (6.9%). The top 10 conditions contributing most to antibiotic use accounted for 51.3% of all antibiotic use. Among these, adjusted use of postoperative and perioperative vancomycin varied across hospitals among craniotomy and cardiothoracic surgery subjects (all P < .001); adjusted use of broad-spectrum antipseudomonal agents varied across hospitals among gastrointestinal surgery subjects (all P < .001).
  
  
  CONCLUSIONS
  Use of (1) vancomycin for pediatric cardiothoracic and neurosurgical patients and (2) broad-spectrum antipseudomonal agents for gastrointestinal surgery patients represent potentially high-yield targets for stewardship efforts to reduce unnecessary antimicrobial use.
authors.affiliation: Department of Pediatrics, Division of Infectious Diseases Department of Center for Clinical and Translational Research, Seattle Children's Hospital Research Institute, Washington.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Kronman
authors.affiliation: Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.affiliation: Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
authors.affiliation: Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania.
authors.forename: Rachael K
authors.initials: RK
authors.lastname: Ross
authors.affiliation: Division of Infectious Diseases, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
authors.affiliation: Department of Pediatric Surgery, University of Washington, Seattle.
authors.forename: Adam
authors.initials: A
authors.lastname: Goldin
authors.affiliation: Department of Pediatric Surgery, Harvard Medical School, Boston, Massachusetts.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.affiliation: Department of Center for Clinical and Translational Research, Seattle Children's Hospital Research Institute, Washington.
authors.forename: Assaf P
authors.initials: AP
authors.lastname: Oron
authors.affiliation: Department of Pediatrics, Division of Infectious Diseases Department of Center for Clinical and Translational Research, Seattle Children's Hospital Research Institute, Washington.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Zerr
mesh_terms: D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D013505:Digestive System Surgical Procedures; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients; D008297:Male; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures
chemical_list: D000890:Anti-Infective Agents
keywords: antibiotics; antimicrobial stewardship; epidemiology; infectious diseases; pediatrics