Faculty Collaboration Database

Hospital-Level Variability in Broad-Spectrum Antibiotic Use for Children With Acute Leukemia Undergoing Hematopoietic Cell Transplantation. Infect Control Hosp Epidemiol 2018 Jul;39(7):797-805

Date

05/08/2018

Pubmed ID

29734957

Pubmed Central ID

PMC6081961

DOI

10.1017/ice.2018.96

Scopus ID

2-s2.0-85046538311 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

OBJECTIVETo explore the prevalence and drivers of hospital-level variability in antibiotic utilization among hematopoietic cell transplant (HCT) recipients to inform antimicrobial stewardship initiatives.DESIGNRetrospective cohort study using data merged from the Pediatric Health Information System and the Center for International Blood and Marrow Transplant Research.SETTINGThe study included 27 transplant centers in freestanding children's hospitals.METHODSThe primary outcome was days of broad-spectrum antibiotic use in the interval from day of HCT through neutrophil engraftment. Hospital antibiotic utilization rates were reported as days of therapy (DOTs) per 1,000 neutropenic days. Negative binomial regression was used to estimate hospital utilization rates, adjusting for patient covariates including demographics, transplant characteristics, and severity of illness. To better quantify the magnitude of hospital variation and to explore hospital-level drivers in addition to patient-level drivers of variation, mixed-effects negative binomial models were also constructed.RESULTSAdjusted hospital rates of antipseudomonal antibiotic use varied from 436 to 1121 DOTs per 1,000 neutropenic days, and rates of broad-spectrum, gram-positive antibiotic use varied from 153 to 728 DOTs per 1,000 neutropenic days. We detected variability by hospital in choice of antipseudomonal agent (ie, cephalosporins, penicillins, and carbapenems), but gram-positive coverage was primarily driven by vancomycin use. Considerable center-level variability remained even after controlling for additional hospital-level factors. Antibiotic use was not strongly associated with days of significant illness or mortality.CONCLUSIONAmong a homogenous population of children undergoing HCT for acute leukemia, both the quantity and spectrum of antibiotic exposure in the immediate posttransplant period varied widely. Antimicrobial stewardship initiatives can apply these data to optimize the use of antibiotics in transplant patients.Infect Control Hosp Epidemiol 2018;797-805.

Author List

Elgarten CW, Arnold SD, Li Y, Huang YV, Riches ML, Gerber JS, Aplenc R, Saber W, Fisher BT

Author

Wael Saber MD, MS Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Anti-Bacterial Agents
Antimicrobial Stewardship
Carbapenems
Child
Child, Preschool
Drug Utilization
Female
Gram-Positive Bacteria
Hematopoietic Stem Cell Transplantation
Hospital Mortality
Hospitals, Pediatric
Humans
Leukemia
Male
Penicillins
Registries
Regression Analysis
Retrospective Studies
Vancomycin