Antibiotic resistance patterns for children have been stable over a seven-year period, according to two studies.
Surgical patients account for 43% of all antibiotic use in children’s hospitals, presenting an opportunity for targeted intervention, researchers reported in the December issue of Infection Control and Hospital Epidemiology.
“Inappropriate use of antibiotics can have serious and global consequences on the utility of these drugs and the spread of resistant bacteria,” Neil Fishman, MD, a past-president of the Society for Healthcare Epidemiology of America, which publishes ICHE, and associate chief medical officer at the University of Pennsylvania Health System, said in a news release. “These studies help complement our collective knowledge of the resistant bacteria in vulnerable children populations and give us a better understanding of how children’s hospitals use antibiotics.”
Because there are few data describing antibiotic resistance in pediatric healthcare institutions, researchers from Johns Hopkins University School of Medicine reviewed institutional patterns of antibiotic susceptibility from 55 institutions, reflecting data from 2005-2011.
They found antibiotic resistance has remained relatively stable for the majority of tested organisms over the seven-year period. No antibiotic had more than 90% activity against Pseudomonas aeruginosa, the authors wrote. Approximately 50% of all Staphylococcus aureus isolates were methicillin resistant. Overall, 21% of S. aureus isolates had resistance to clindamycin. Among Enterococcus faecium isolates, the prevalence of susceptibility to ampicillin (25%) and vancomycin (45%) was low but improved over time, and 8% of E. faecium isolates were resistant to linezolid.
That resistance rates have remained steady might seem reassuring, the researchers noted, but the results must be considered with caution in the context of the limited number of new antibiotic agents coming down the pipeline and the increasing prevalence of drug-resistant infections among adults. Unless we are judicious with our use of antibiotics in children, we may encounter a resistance scenario similar to what is occurring in the adult population, they wrote.
“Pooling these data allows us to identify nationwide patterns of antibiotic resistance in children’s hospitals, allows cross-hospital benchmarking, and allows under-resourced hospitals to use this information to better inform empiric antibiotic treatment practices,” Pranita Tamma, MD, lead author of the study, said in the news release.
Antimicrobial stewardship in childrens hospitals
Although mechanisms for implementing antimicrobial stewardship programs have been reported elsewhere, data-driven approaches to prioritize specific conditions and antibiotics for intervention have not been established. Researchers from The Children’s Hospital of Philadelphia used a retrospective cross-sectional study to develop a strategy for identifying high-impact targets for stewardship efforts.
“The majority of patients admitted to U.S. children’s hospitals receive antibiotic therapy,” Jeffrey Gerber, MD, lead author of the study, said in the news release. “Antimicrobial stewardship programs have been recommended to optimize antibiotic use and manage and reduce variability in care, helping reduce costs while maintaining or improving outcomes.”
Analyzing more than 500,000 inpatient admissions and nearly 3 million patient-days from 32 hospitals, the researchers found that surgical patients received 43% of all prescribed antibiotic therapy, and a small number of clinical conditions contributed significantly to overall use, presenting an opportunity for antimicrobial stewardship programs to target these areas.
The four conditions associated with the highest use of antibiotics among pediatric patients were pneumonia, appendicitis, cystic fibrosis and skin and soft-tissue infections. These conditions represented 1% of diagnoses, but accounted for more than 10% of antibiotic use.
Wide variability in antibiotic use occurred with pneumonia, appendicitis and cystic fibrosis. The researchers believe pediatric antimicrobial stewardship efforts should prioritize standardizing treatment approaches for these conditions.
The release of the findings coincides with the CDCs Get Smart about Antibiotics Week (http://www.cdc.gov/getsmart), an annual weeklong observance on antibiotic resistance and the importance of appropriate antibiotic use. The Society for Healthcare Epidemiology in America is a partner of Get Smart about Antibiotics Week.