{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T12:23:00Z","timestamp":1791116580590,"version":"4.1.0"},"reference-count":34,"publisher":"Cambridge University Press (CUP)","issue":"12","license":[{"start":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T00:00:00Z","timestamp":1687996800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X23001071_as1\"><jats:title>Objective:<\/jats:title><jats:p>To investigate differences in the rate of firstline antibiotic prescribing for common pediatric infections in relation to different socioeconomic statuses and the impact of an antimicrobial stewardship program (ASP) in pediatric urgent-care clinics (PUCs).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23001071_as2\"><jats:title>Design:<\/jats:title><jats:p>Quasi-experimental.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23001071_as3\"><jats:title>Setting:<\/jats:title><jats:p>Three PUCs within a Midwestern pediatric academic center.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23001071_as4\"><jats:title>Patients and participants:<\/jats:title><jats:p>Patients aged &gt;60 days and &lt;18 years with acute otitis media, group A streptococcal pharyngitis, community-acquired pneumonia, urinary tract infection, or skin and soft-tissue infections who received systemic antibiotics between July 2017 and December 2020. We excluded patients who were transferred, admitted, or had a concomitant diagnosis requiring systemic antibiotics.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23001071_as5\"><jats:title>Intervention:<\/jats:title><jats:p>We used national guidelines to determine the appropriateness of antibiotic choice in 2 periods: prior to (July 2017\u2013July 2018) and following ASP implementation (August 2018\u2013December 2020). We used multivariable regression analysis to determine the odds ratios of appropriate firstline agent by age, sex, race and ethnicity, language, and insurance type.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23001071_as6\"><jats:title>Results:<\/jats:title><jats:p>The study included 34,603 encounters. Prior to ASP implementation in August 2018, female patients, Black non-Hispanic children, those &gt;2 years of age, and those who self-paid had higher odds of receiving recommended firstline antibiotics for all diagnoses compared to male patients, children of other races and ethnicities, other ages, and other insurance types, respectively. Although improvements in prescribing occurred after implementation of our ASP, the difference within the socioeconomic subsets persisted.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23001071_as7\"><jats:title>Conclusions:<\/jats:title><jats:p>We observed socioeconomic differences in firstline antibiotic prescribing for common pediatric infections in the PUCs setting despite implementation of an ASP. Antimicrobial stewardship leaders should consider drivers of these differences when developing improvement initiatives.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2023.107","type":"journal-article","created":{"date-parts":[[2023,6,29]],"date-time":"2023-06-29T07:05:46Z","timestamp":1688022346000},"page":"2009-2016","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":11,"title":["Socioeconomic differences in antibiotic use for common infections in pediatric urgent-care centers\u2014A quasi-experimental study"],"prefix":"10.1017","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5564-3762","authenticated-orcid":false,"given":"Amanda C.","family":"Nedved","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1337-1105","authenticated-orcid":false,"given":"Brian R.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7011-4826","authenticated-orcid":false,"given":"Ann","family":"Wirtz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5277-7469","authenticated-orcid":false,"given":"Elizabeth","family":"Monsees","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4261-6076","authenticated-orcid":false,"given":"Alaina","family":"Burns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances G.","family":"Turcotte Benedict","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7533-1144","authenticated-orcid":false,"given":"Rana E.","family":"El Feghaly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2023,6,29]]},"reference":[{"key":"S0899823X23001071_ref24","volume-title":"2019 National Healthcare Quality and Disparities Report","year":"2020"},{"key":"S0899823X23001071_ref29","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsy104"},{"key":"S0899823X23001071_ref11","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-019-0471-0"},{"key":"S0899823X23001071_ref14","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2018.05381"},{"key":"S0899823X23001071_ref28","first-page":"140","article-title":"Allergy testing in children with low-risk penicillin allergy symptoms","author":"Vyles","year":"2017","journal-title":"Pediatrics"},{"key":"S0899823X23001071_ref1","first-page":"144","article-title":"The impact of racism on child and adolescent health","author":"Trent","year":"2019","journal-title":"Pediatrics"},{"key":"S0899823X23001071_ref19","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-3026"},{"key":"S0899823X23001071_ref22","unstructured":"22. Provider resources for antimicrobial stewardship. Children\u2019s Mercy Kansas City website. https:\/\/www.childrensmercy.org\/health-care-providers\/pediatrician-guides\/antimicrobial-stewardship\/provider-resources-for-antimicrobial-stewardship\/. Published 2021. 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Institute for Healthcare Improvement website. https:\/\/www.chausa.org\/docs\/default-source\/health-equity\/4_ihi_improvinghealthequity_eliminateracismoppressionguide.pdf. Published 2019. Accessed September 6, 2022."},{"key":"S0899823X23001071_ref8","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14274"},{"key":"S0899823X23001071_ref10","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2020-005785"},{"key":"S0899823X23001071_ref31","first-page":"144","article-title":"Racial differences in sepsis recognition in the emergency department","author":"Raman","year":"2019","journal-title":"Pediatrics"},{"key":"S0899823X23001071_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2021.02.009"},{"key":"S0899823X23001071_ref7","doi-asserted-by":"publisher","DOI":"10.1080\/02770903.2020.1784191"},{"key":"S0899823X23001071_ref23","doi-asserted-by":"publisher","DOI":"10.1177\/2372732214548430"},{"key":"S0899823X23001071_ref17","unstructured":"17. Outpatient antibiotic handbook. Children\u2019s Mercy Kansas City website. https:\/\/www.childrensmercy.org\/siteassets\/media-documents-for-depts-section\/documents-for-health-care-providers\/evidence-based-practice\/clinical-practice-guidelines--care-process-models\/outpatient-antibiotic-handbook.pdf. Published 2022. 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