Variation in Antibiotic Selection and Clinical Outcomes in Infants <60 Days Hospitalized With Skin and Soft Tissue Infections

Jessica L. Markham, Matthew Hall, Mary Ann Queen, Paul L. Aronson, Sowdhamini S. Wallace, Dana M. Foradori, Gabrielle Hester, Jennifer Nead, Michelle A. Lopez, Andrea T. Cruz, Russell J. McCulloh

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To describe variation in empirical antibiotic selection in infants <60 days old who are hospitalized with skin and soft-tissue infections (SSTIs) and to determine associations with outcomes, including length of stay (LOS), 30-day returns (emergency department revisit or readmission), and standardized cost. METHODS: Using the Pediatric Health Information System, we conducted a retrospective study of infants hospitalized with SSTI from 2009 to 2014. We analyzed empirical antibiotic selection in the first 2 days of hospitalization and categorized antibiotics as those typically administered for (1) staphylococcal infection, (2) neonatal sepsis, or (3) combination therapy (staphylococcal infection and neonatal sepsis). We examined the association of antibiotic selection and outcomes using generalized linear mixed-effects models. RESULTS: A total of 1319 infants across 36 hospitals were included; the median age was 30 days (interquartile range [IQR]: 17-42 days). We observed substantial variation in empirical antibiotic choice, with 134 unique combinations observed before categorization. The most frequently used antibiotics included staphylococcal therapy (50.0% [IQR: 39.2-58.1]) and combination therapy (45.4% [IQR: 36.0-56.0]). Returns occurred in 9.2% of infants. Compared with administration of staphylococcal antibiotics, use of combination therapy was associated with increased LOS (adjusted rate ratio: 1.35; 95% confidence interval: 1.17-1.53) and cost (adjusted rate ratio: 1.39; 95% confidence interval: 1.21-1.58), but not with 30-day returns. CONCLUSIONS: Infants who are hospitalized with SSTI experience wide variation in empirical antibiotic selection. Combination therapy was associated with increased LOS and cost, with no difference in returns. Our findings reveal the need to identify treatment strategies that can be used to optimize resource use for infants with SSTI.

Original languageEnglish (US)
Pages (from-to)30-38
Number of pages9
JournalHospital Pediatrics
Volume9
Issue number1
DOIs
StatePublished - Jan 1 2019

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Soft Tissue Infections
Anti-Bacterial Agents
Skin
Staphylococcal Infections
Length of Stay
Costs and Cost Analysis
Therapeutics
Confidence Intervals
Health Information Systems
Hospital Emergency Service
Hospitalization
Retrospective Studies
Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pediatrics

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Variation in Antibiotic Selection and Clinical Outcomes in Infants <60 Days Hospitalized With Skin and Soft Tissue Infections. / Markham, Jessica L.; Hall, Matthew; Queen, Mary Ann; Aronson, Paul L.; Wallace, Sowdhamini S.; Foradori, Dana M.; Hester, Gabrielle; Nead, Jennifer; Lopez, Michelle A.; Cruz, Andrea T.; McCulloh, Russell J.

In: Hospital Pediatrics, Vol. 9, No. 1, 01.01.2019, p. 30-38.

Research output: Contribution to journalArticle

Markham, JL, Hall, M, Queen, MA, Aronson, PL, Wallace, SS, Foradori, DM, Hester, G, Nead, J, Lopez, MA, Cruz, AT & McCulloh, RJ 2019, 'Variation in Antibiotic Selection and Clinical Outcomes in Infants <60 Days Hospitalized With Skin and Soft Tissue Infections', Hospital Pediatrics, vol. 9, no. 1, pp. 30-38. https://doi.org/10.1542/hpeds.2017-0237
Markham, Jessica L. ; Hall, Matthew ; Queen, Mary Ann ; Aronson, Paul L. ; Wallace, Sowdhamini S. ; Foradori, Dana M. ; Hester, Gabrielle ; Nead, Jennifer ; Lopez, Michelle A. ; Cruz, Andrea T. ; McCulloh, Russell J. / Variation in Antibiotic Selection and Clinical Outcomes in Infants <60 Days Hospitalized With Skin and Soft Tissue Infections. In: Hospital Pediatrics. 2019 ; Vol. 9, No. 1. pp. 30-38.
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AU - Markham, Jessica L.

AU - Hall, Matthew

AU - Queen, Mary Ann

AU - Aronson, Paul L.

AU - Wallace, Sowdhamini S.

AU - Foradori, Dana M.

AU - Hester, Gabrielle

AU - Nead, Jennifer

AU - Lopez, Michelle A.

AU - Cruz, Andrea T.

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N2 - OBJECTIVES: To describe variation in empirical antibiotic selection in infants <60 days old who are hospitalized with skin and soft-tissue infections (SSTIs) and to determine associations with outcomes, including length of stay (LOS), 30-day returns (emergency department revisit or readmission), and standardized cost. METHODS: Using the Pediatric Health Information System, we conducted a retrospective study of infants hospitalized with SSTI from 2009 to 2014. We analyzed empirical antibiotic selection in the first 2 days of hospitalization and categorized antibiotics as those typically administered for (1) staphylococcal infection, (2) neonatal sepsis, or (3) combination therapy (staphylococcal infection and neonatal sepsis). We examined the association of antibiotic selection and outcomes using generalized linear mixed-effects models. RESULTS: A total of 1319 infants across 36 hospitals were included; the median age was 30 days (interquartile range [IQR]: 17-42 days). We observed substantial variation in empirical antibiotic choice, with 134 unique combinations observed before categorization. The most frequently used antibiotics included staphylococcal therapy (50.0% [IQR: 39.2-58.1]) and combination therapy (45.4% [IQR: 36.0-56.0]). Returns occurred in 9.2% of infants. Compared with administration of staphylococcal antibiotics, use of combination therapy was associated with increased LOS (adjusted rate ratio: 1.35; 95% confidence interval: 1.17-1.53) and cost (adjusted rate ratio: 1.39; 95% confidence interval: 1.21-1.58), but not with 30-day returns. CONCLUSIONS: Infants who are hospitalized with SSTI experience wide variation in empirical antibiotic selection. Combination therapy was associated with increased LOS and cost, with no difference in returns. Our findings reveal the need to identify treatment strategies that can be used to optimize resource use for infants with SSTI.

AB - OBJECTIVES: To describe variation in empirical antibiotic selection in infants <60 days old who are hospitalized with skin and soft-tissue infections (SSTIs) and to determine associations with outcomes, including length of stay (LOS), 30-day returns (emergency department revisit or readmission), and standardized cost. METHODS: Using the Pediatric Health Information System, we conducted a retrospective study of infants hospitalized with SSTI from 2009 to 2014. We analyzed empirical antibiotic selection in the first 2 days of hospitalization and categorized antibiotics as those typically administered for (1) staphylococcal infection, (2) neonatal sepsis, or (3) combination therapy (staphylococcal infection and neonatal sepsis). We examined the association of antibiotic selection and outcomes using generalized linear mixed-effects models. RESULTS: A total of 1319 infants across 36 hospitals were included; the median age was 30 days (interquartile range [IQR]: 17-42 days). We observed substantial variation in empirical antibiotic choice, with 134 unique combinations observed before categorization. The most frequently used antibiotics included staphylococcal therapy (50.0% [IQR: 39.2-58.1]) and combination therapy (45.4% [IQR: 36.0-56.0]). Returns occurred in 9.2% of infants. Compared with administration of staphylococcal antibiotics, use of combination therapy was associated with increased LOS (adjusted rate ratio: 1.35; 95% confidence interval: 1.17-1.53) and cost (adjusted rate ratio: 1.39; 95% confidence interval: 1.21-1.58), but not with 30-day returns. CONCLUSIONS: Infants who are hospitalized with SSTI experience wide variation in empirical antibiotic selection. Combination therapy was associated with increased LOS and cost, with no difference in returns. Our findings reveal the need to identify treatment strategies that can be used to optimize resource use for infants with SSTI.

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