{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T23:04:27Z","timestamp":1772838267201,"version":"3.50.1"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2023,5,29]],"date-time":"2023-05-29T00:00:00Z","timestamp":1685318400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>As FQ (fluoroquinolone) use has shifted in pediatric populations, better metrics are needed to guide targeted antibiotic stewardship interventions and limit development of adverse events and resistance, particularly in medically complex children. In this study, we identify high-utilization groups based on underlying medical conditions and describe their relative FQ use over time.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This study is a retrospective analysis of data from the Pediatric Health Information System database from 2016 to 2020. We identify high-utilization groups based on underlying medical conditions using International Classification of Diseases, Ninth or Tenth Revision codes. We delineate overall trends in the use of FQs in the inpatient setting, including rate and proportional use by each patient group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Patients with an oncology diagnosis represent a large (25%\u201344%) and rising proportion (+4.8%\/year, P = .001) of national FQ use over the study period. Patients with intra-abdominal infections, including appendicitis, have had a significant increase in both their relative proportional use of FQs (+0.6%\/year, P = .037) and proportion of FQ use per admission encounter over the study period (+0.6%\/year, P = .008). Patients with cystic fibrosis represent a decreasing proportion of overall use (\u22122.1%\/year, P = .011) and have decreasing FQ use per inpatient encounter (\u22120.8%\/year, P = .001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Patients with an oncology diagnosis and patients with an intra-abdominal infection appear to be targets for FQ stewardship. Patients with cystic fibrosis have decreasing inpatient FQ use.<\/jats:p>\n                  <jats:p>Key Points: This study describes fluoroquinolone use among hospitalized children from 2016 to 2020, stratified by underlying diagnoses. These trends are used to identify high-yield antibiotic stewardship targets.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofad297","type":"journal-article","created":{"date-parts":[[2023,5,29]],"date-time":"2023-05-29T16:44:20Z","timestamp":1685378660000},"source":"Crossref","is-referenced-by-count":5,"title":["Fluoroquinolone Use Among Hospitalized Children: Diagnosis-Based Stratification to Identify Stewardship Targets"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4057-862X","authenticated-orcid":false,"given":"Simon","family":"Parzen-Johnson","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shan","family":"Sun","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tonya","family":"Scardina","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sameer J","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois , USA"},{"name":"Feinberg School of Medicine, Northwestern University , Chicago, Illinois , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,5,29]]},"reference":[{"key":"2023061319475098300_ofad297-B1","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1002\/jcph.715","article-title":"Safety concerns surrounding quinolone use in children","volume":"56","author":"Patel","year":"2016","journal-title":"J Clin Pharmacol"},{"key":"2023061319475098300_ofad297-B2","doi-asserted-by":"crossref","first-page":"e20162706","DOI":"10.1542\/peds.2016-2706","article-title":"The use of systemic and topical fluoroquinolones","volume":"138","author":"Jackson","year":"2016","journal-title":"Pediatrics"},{"key":"2023061319475098300_ofad297-B3","doi-asserted-by":"crossref","first-page":"1594","DOI":"10.3201\/eid2209.160148","article-title":"Fluoroquinolone-resistant and extended-spectrum \u03b2-lactamase\u2013producing Escherichia coli infections in patients with pyelonephritis, United States","volume":"22","author":"Talan","year":"2016","journal-title":"Emerg Infect Dis"},{"key":"2023061319475098300_ofad297-B4","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/INF.0000000000002121","article-title":"Oral fluoroquinolone prescribing to children in the United States from 2006 to 2015","volume":"38","author":"Etminan","year":"2019","journal-title":"Pediatr Infect Dis J"},{"key":"2023061319475098300_ofad297-B5","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1093\/jpids\/piaa156","article-title":"Outpatient fluoroquinolone use in children, 2000\u20132018","volume":"10","author":"Ross","year":"2021","journal-title":"J Pediatric Infect Dis Soc"},{"key":"2023061319475098300_ofad297-B6","doi-asserted-by":"crossref","first-page":"e159","DOI":"10.1016\/S2666-5247(20)30202-0","article-title":"Antibiotic prophylaxis and the gastrointestinal resistome in paediatric patients with acute lymphoblastic leukaemia: a cohort study with metagenomic sequencing analysis","volume":"2","author":"Margolis","year":"2021","journal-title":"Lancet Microbe"},{"key":"2023061319475098300_ofad297-B7","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1093\/cid\/ciab525","article-title":"Association between number of intravenous antipseudomonal antibiotics and clinical outcomes of pediatric cystic fibrosis pulmonary exacerbations","volume":"73","author":"Cogen","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2023061319475098300_ofad297-B8","author":"National Healthcare Safety Network","year":"2021"},{"key":"2023061319475098300_ofad297-B9","author":"National Healthcare Safety Network","year":"2020"},{"key":"2023061319475098300_ofad297-B10","author":"National Healthcare Safety Network","year":"2019"},{"key":"2023061319475098300_ofad297-B11","author":"Children\u2019s Hospital Association"},{"key":"2023061319475098300_ofad297-B12","doi-asserted-by":"crossref","first-page":"3257","DOI":"10.1002\/sim.7336","article-title":"Intermediate and advanced topics in multilevel logistic regression analysis","volume":"36","author":"Austin","year":"2017","journal-title":"Stat Med"},{"key":"2023061319475098300_ofad297-B13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.idc.2017.11.001","article-title":"The growing threat of antibiotic resistance in children","volume":"32","author":"Medernach","year":"2018","journal-title":"Infect Dis Clin North Am"},{"key":"2023061319475098300_ofad297-B14","doi-asserted-by":"crossref","first-page":"688","DOI":"10.5114\/aoms.2017.72407","article-title":"Frequency of infections caused by ESBL-producing bacteria in a pediatric ward\u2014single-center five-year observation","volume":"15","author":"B\u0119dzichowska","year":"2019","journal-title":"Arch Med Sci"},{"key":"2023061319475098300_ofad297-B15","doi-asserted-by":"crossref","first-page":"e158","DOI":"10.1097\/INF.0000000000000238","article-title":"The quest for the best metric of antibiotic use and its correlation with the emergence of fluoroquinolone resistance in children","volume":"33","author":"Rose","year":"2014","journal-title":"Pediatr Infect Dis J"},{"key":"2023061319475098300_ofad297-B16","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1128\/AAC.01228-08","article-title":"Prevalence and risk factors for selection of quinolone-resistant Escherichia coli strains in fecal flora of patients receiving quinolone therapy","volume":"53","author":"Yagci","year":"2009","journal-title":"Antimicrob Agents Chemother"},{"key":"2023061319475098300_ofad297-B17","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1093\/cid\/ciab1000","article-title":"Cessation of ciprofloxacin prophylaxis in haemato-oncology patients","volume":"75","author":"Caldwell","year":"2022","journal-title":"Clin Infect Dis"},{"key":"2023061319475098300_ofad297-B18","author":"World Health Organization"},{"key":"2023061319475098300_ofad297-B19","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1016\/j.clinthera.2021.09.009","article-title":"Use of the electronic health record to optimize antimicrobial prescribing","volume":"43","author":"Parzen-Johnson","year":"2021","journal-title":"Clin Ther"},{"key":"2023061319475098300_ofad297-B20","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1017\/ice.2018.246","article-title":"Utilizing the electronic health record to construct antibiograms for previously healthy children with urinary tract infections","volume":"39","author":"Chao","year":"2018","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2023061319475098300_ofad297-B21","doi-asserted-by":"crossref","first-page":"3043","DOI":"10.1200\/JCO.18.00374","article-title":"Antimicrobial prophylaxis for adult patients with cancer-related immunosuppression: ASCO and IDSA clinical practice guideline update","volume":"36","author":"Taplitz","year":"2018","journal-title":"J Clin Oncol"},{"key":"2023061319475098300_ofad297-B22","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.1200\/JCO.22.02224","article-title":"Guideline for the management of fever and neutropenia in pediatric patients with cancer and hematopoietic cell transplantation recipients: 2023 update","volume":"41","author":"Lehrnbecher","year":"2023","journal-title":"J Clin Oncol"},{"key":"2023061319475098300_ofad297-B23","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1001\/jama.2018.12512","article-title":"Effect of levofloxacin prophylaxis on bacteremia in children with acute leukemia or undergoing hematopoietic stem cell transplantation: a randomized clinical trial","volume":"320","author":"Alexander","year":"2018","journal-title":"JAMA"},{"key":"2023061319475098300_ofad297-B24","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1093\/cid\/cix644","article-title":"Levofloxacin prophylaxis during induction therapy for pediatric acute lymphoblastic leukemia","volume":"65","author":"Wolf","year":"2017","journal-title":"Clin Infect Dis"},{"key":"2023061319475098300_ofad297-B25","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1093\/cid\/ciab404","article-title":"Colonization with fluoroquinolone-resistant Enterobacterales decreases the effectiveness of fluoroquinolone prophylaxis in hematopoietic cell transplant recipients","volume":"73","author":"Satlin","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2023061319475098300_ofad297-B26","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1017\/ice.2018.359","article-title":"Transmission pathways of multidrug-resistant organisms in the hospital setting: a scoping review","volume":"40","author":"Blanco","year":"2019","journal-title":"Infect Control Hosp Epidemiol"},{"key":"2023061319475098300_ofad297-B27","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.jpedsurg.2021.11.009","article-title":"Ceftriaxone with metronidazole versus piperacillin\/tazobactam in the management of complicated appendicitis in children: results from a multicenter pediatric NSQIP analysis","volume":"57","author":"Kashtan","year":"2022","journal-title":"J Pediatr Surg"},{"key":"2023061319475098300_ofad297-B28","doi-asserted-by":"crossref","first-page":"e20154547","DOI":"10.1542\/peds.2015-4547","article-title":"Extended- versus narrower-spectrum antibiotics for appendicitis","volume":"138","author":"Kronman","year":"2016","journal-title":"Pediatrics"},{"key":"2023061319475098300_ofad297-B29","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1097\/SLA.0000000000005006","article-title":"IMPPACT (Intravenous Monotherapy for Postoperative Perforated Appendicitis in Children Trial): randomized clinical trial of monotherapy versus multi-drug antibiotic therapy","volume":"274","author":"Lee","year":"2021","journal-title":"Ann Surg"},{"key":"2023061319475098300_ofad297-B30","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/0002-9610(94)90207-0","article-title":"Peritoneal cultures and antibiotic therapy in pediatric perforated appendicitis","volume":"167","author":"Mosdell","year":"1994","journal-title":"Am J Surg"},{"key":"2023061319475098300_ofad297-B31","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/S0022-3468(99)90368-8","article-title":"The impact of intraoperative culture on treatment and outcome in children with perforated appendicitis","volume":"34","author":"Kokoska","year":"1999","journal-title":"J Pediatr Surg"},{"key":"2023061319475098300_ofad297-B32","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.jcf.2013.10.002","article-title":"Hypersensitivity to antibiotics in patients with cystic fibrosis","volume":"13","author":"Roehmel","year":"2014","journal-title":"J Cyst Fibros"},{"key":"2023061319475098300_ofad297-B33","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.anai.2021.05.022","article-title":"Enabling antibiotic allergy evaluations and reintroduction of first-line antibiotics for patients with cystic fibrosis","volume":"127","author":"Anstey","year":"2021","journal-title":"Ann Allergy Asthma Immunol"},{"key":"2023061319475098300_ofad297-B34","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.1056\/NEJMoa1908639","article-title":"Elexacaftor-tezacaftor-ivacaftor for cystic fibrosis with a single Phe508del allele","volume":"381","author":"Middleton","year":"2019","journal-title":"N Engl J Med"},{"key":"2023061319475098300_ofad297-B35","doi-asserted-by":"crossref","first-page":"e0171216","DOI":"10.1371\/journal.pone.0171216","article-title":"Prevalence of ESBL-producing Enterobacteriaceae in pediatric bloodstream infections: a systematic review and meta-analysis","volume":"12","author":"Flokas","year":"2017","journal-title":"PLoS One"},{"key":"2023061319475098300_ofad297-B36","first-page":"1389","article-title":"Extended-spectrum \u03b2-lactamase-producing Enterobacteriaceae in children: old foe, emerging threat","volume":"60","author":"Lukac","year":"2015","journal-title":"Clin Infect Dis"},{"key":"2023061319475098300_ofad297-B37","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s13756-021-00983-y","article-title":"Trends in prevalence of extended-spectrum beta-lactamase-producing Escherichia coli isolated from patients with community- and healthcare-associated bacteriuria: results from 2014 to 2020 in an urban safety-net healthcare system","volume":"10","author":"Raphael","year":"2021","journal-title":"Antimicrob Resist Infect Control"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofad297\/50482212\/ofad297.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/10\/6\/ofad297\/50598173\/ofad297.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/10\/6\/ofad297\/50598173\/ofad297.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T20:23:08Z","timestamp":1686687788000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofad297\/7185607"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,29]]},"references-count":37,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2023,6,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofad297","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,6]]},"published":{"date-parts":[[2023,5,29]]},"article-number":"ofad297"}}