{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:26:00Z","timestamp":1791379560566,"version":"4.3.3"},"reference-count":19,"publisher":"Cambridge University Press (CUP)","issue":"11","license":[{"start":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T00:00:00Z","timestamp":1681257600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X23000569_as1\"><jats:title>Objective:<\/jats:title><jats:p>To describe patterns of inappropriate antibiotic prescribing at US children\u2019s hospitals and how these patterns vary by clinical service.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000569_as2\"><jats:title>Design:<\/jats:title><jats:p>Serial, cross-sectional study using quarterly surveys.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000569_as3\"><jats:title>Setting:<\/jats:title><jats:p>Surveys were completed in quarter 1 2019\u2013quarter 3 2020 across 28 children\u2019s hospitals in the United States.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000569_as4\"><jats:title>Participants:<\/jats:title><jats:p>Patients at children\u2019s hospitals with \u22651 antibiotic order at 8:00 <jats:sc>a.m.<\/jats:sc> on institution-selected quarterly survey days.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000569_as5\"><jats:title>Methods:<\/jats:title><jats:p>Antimicrobial stewardship physicians and pharmacists collected data on antibiotic orders and evaluated appropriateness of prescribing. The primary outcome was percentage of inappropriate antibiotics, stratified by clinical service and antibiotic class. Secondary outcomes included reasons for inappropriate use and association of infectious diseases (ID) consultation with appropriateness.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000569_as6\"><jats:title>Results:<\/jats:title><jats:p>Of 13,344 orders, 1,847 (13.8%) were inappropriate; 17.5% of patients receiving antibiotics had \u22651 inappropriate order. Pediatric intensive care units (PICU) and hospitalists contributed the most inappropriate orders (n = 384 and n = 314, respectively). Surgical subspecialists had the highest percentage of inappropriate orders (22.5%), and 56.8% of these were for prolonged or unnecessary surgical prophylaxis. ID consultation in the previous 7 days was associated with fewer inappropriate orders (15% vs 10%; <jats:italic>P<\/jats:italic> &lt; .001); this association was most pronounced for hospitalist, PICU, and surgical and medical subspecialty services.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X23000569_as7\"><jats:title>Conclusions:<\/jats:title><jats:p>Inappropriate antibiotic use for hospitalized children persists and varies by clinical service. Across 28 children\u2019s hospitals, PICUs and hospitalists contributed the most inappropriate antibiotic orders, and surgical subspecialists\u2019 orders were most often judged inappropriate. Understanding service-specific prescribing patterns will enable antimicrobial stewardship programs to better design interventions to optimize antibiotic use.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2023.56","type":"journal-article","created":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T11:27:17Z","timestamp":1681298837000},"page":"1711-1717","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":5,"title":["Appropriateness of antibiotic prescribing varies by clinical services at United States children\u2019s hospitals"],"prefix":"10.1017","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9094-8249","authenticated-orcid":false,"given":"Devin T.","family":"Diggs","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2357-8190","authenticated-orcid":false,"given":"Alison C.","family":"Tribble","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca G.","family":"Same","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason G.","family":"Newland","sequence":"additional","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"}]}],"member":"56","published-online":{"date-parts":[[2023,4,12]]},"reference":[{"key":"S0899823X23000569_ref2","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1542\/peds.2010-1275","article-title":"Variability in antibiotic use at children\u2019s 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2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}