804 infection control & hospital epidemiology july 2018, vol. 39, no. 7


practices or resistance patterns that could vary by institution and thus explain some of the detected variability. Although misclassification is a limitation when using administrative data, the process of merging an administrative dataset with data from CIBMTR ensures that all patients included in this cohort did undergo transplant on the date identified. Addi- tionally, the use of billing data rather than actual drug administration potentially overestimates DOTs.38 Finally, the study population included in this analysis is only generalizable to freestanding academic children’s hospitals. However, most pediatric HCTs occur in this setting. In summary, we found substantial variation in antibiotic use


in children undergoing HCT for acute leukemia that was not explained by severity of illness, demographics, transplant characteristics, or hospital-level factors. Variation of antibiotic utilization in this homogenous patient population represents a unique opportunity to implement interventions that optimize use. Contemporary and prospective assessment of antibiotic utilization practices by hospital is necessary to inform targeted benchmarks for appropriate utilization and to provide feed- back to sites aiming to achieve these benchmarks. Additionally, further study is needed to determine the clinical implications of antibiotic choice on noninfectious adverse outcomes after pediatric HCT.


acknowledgments


Financial support: This study was supported by a training grant from the National Institutes of Health, Clinical Pharmacoepidemiology training grant (grant no. T32-GM075766 to C.W.E.). Potential conflicts of interest: All authors report no conflicts of interest rele-


vant to this article. Address correspondence to Caitlin W. Elgarten, MD, 3501 Civic Center


Blvd, Clinical and Translational Research Building, 10th floor, Philadelphia, PA 19104 (elgartenc@email.chop.edu).


supplementary material


To view supplementary material for this article, please visit https://doi.org/10.1017/ice.2018.96


references 1. Hicks LA, Bartoces MG, Roberts RM, et al. US outpatient anti- biotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin Infect Dis 2015;60:1308–1316.


2. MacDougall C, Polk RE. Variability in rates of use of anti- bacterials among 130 US hospitals and risk-adjustment models for interhospital comparison. Infect Control Hosp Epidemiol 2008;29:203–211.


3. Spellberg B, Guidos R, Gilbert D, et al. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis 2008;46:155–164.


4. Dellit TH,Owens RC,McGowan JE Jr,et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology


5. Gerber JS, Newland JG, Coffin SE, et al. Variability in antibiotic use at children’s hospitals. Pediatrics 2010;126:1067–1073.


of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44: 159–177.


6. Polk RE, Hohmann SF, Medvedev S, Ibrahim O. Benchmarking risk-adjusted adult antibacterial drug use in 70 US academic medical center hospitals. Clin Infect Dis 2011;53:1100–1110.


7. Kanerva M, Ollgren J, Lyytikainen O, Finnish Prevalence Survey Study Group. Benchmarking antibiotic use in Finnish acute care hospitals using patient case-mix adjustment. J Antimicrob Chemother 2011;66:2651–2654.


8. Tan C, Vermeulen M, Wang X, Zvonar R, Garber G, Daneman N. Variability in antibiotic use across Ontario acute care hospitals. J Antimicrob Chemother 2017;72:554–563.


9. Kronman MP, Gerber JS, Prasad PA, et al. Variation in antibiotic use for children hospitalized with inflammatory bowel disease exacerbation: a multicenter validation study. J Pediatr Infect Dis Soc 2012;1:306–313.


11. Peled JU, Jenq RR, Holler E, van den Brink MR. Role of gut flora after bone marrow transplantation. Nat Microbiol 2016;1:16036.


10. Fisher BT, Gerber JS, Leckerman KH, et al. Variation in hospital antibiotic prescribing practices for children with acute lympho- blastic leukemia. Leukemia Lymphoma 2013;54:1633–1639.


12. Weber D, Jenq RR, Peled JU, et al. Microbiota disruption induced by early use of broad-spectrum antibiotics is an independent risk factor of outcome after allogeneic stem cell transplantation. Biol Blood Marrow Transpl 2017;23:845–852.


13. Fisher BT, Sammons JS, Li Y, et al. Variation in risk of hospital- onset clostridium difficile infection across beta-lactam antibiotics in children with new-onset acute lymphoblastic leukemia. J Pediatr Infect Dis Soc 2014;3:329–335.


14. Downes KJ, Cowden C, Laskin BL, et al. Association of acute kidney injury with concomitant vancomycin and piperacillin/ tazobactam treatment among hospitalized children. JAMA Pediatr 2017;171:e173219.


15. Trifilio S, Verma A, Mehta J. Antimicrobial prophylaxis in hematopoietic stem cell transplant recipients: heterogeneity of current clinical practice. Bone Marrow Transpl 2004;33: 735–739.


16. Whangbo J, Ritz J, Bhatt A. Antibiotic-mediated modification of the intestinal microbiome in allogeneic hematopoietic stem cell transplantation. Bone Marrow Transpl 2017;52:183–190.


17. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis 2011;52:e56–e93.


18. Current uses and outcomes of hematopoietic stem cell transplan- tation: CIBMTR summary slides. Center for International Blood and Marrow Transplant Research website. https://www.cibmtr. org/ReferenceCenter/SlidesReports/SummarySlides/pages/index. aspx. Published 2015. Accessed April 10, 2018.


19. Arnold SD, Brazauskas R, He N, et al. Role of donor source on clinical outcomes and inpatient resource utilization for hemato- poietic cell transplantation in children with acute leukemia. Blood 2016;128:1.


20. Centers for Disease Control and Prevention. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, GA: US Department of Health and Human Services, CDC; 2014.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124  |  Page 125  |  Page 126  |  Page 127  |  Page 128  |  Page 129  |  Page 130  |  Page 131  |  Page 132  |  Page 133  |  Page 134  |  Page 135  |  Page 136  |  Page 137  |  Page 138  |  Page 139  |  Page 140  |  Page 141  |  Page 142  |  Page 143  |  Page 144