Identifying Successful Pediatric Outpatient Antimicrobial Stewardship Strategies through Benchmarking: A Multi-Institutional Project.

Background: We evaluated the impact of benchmarking on antibiotic use and identified antibiotic stewardship (AS) strategies affecting pediatric outpatient antibiotic prescribing.

Methods: The Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS)-Outpatient Collaborative shared quarterly benchmarking reports with 22 institutions on antibiotic use metrics (percentage of acute and acute respiratory infection [ARI] encounters with antibiotic prescriptions, and among ARI, rates of amoxicillin and azithromycin use) for emergency departments, urgent care clinics, and primary care clinics. Data on antibiotic duration of ≤7 days were available from a subset of institutions.

Assessing insurance claims as a measure for outpatient antimicrobial stewardship.

Objective: This study evaluated Medicaid claims (MC) data as a valid source for outpatient antimicrobial stewardship programs (ASPs) by comparing it to electronic medical record (EMR) data from a single academic center.

Methods: This retrospective study compared pediatric patients' MC data with EMR data from the Marshall Health Network (MHN). Claims were matched to EMR records based on patient Medicaid ID, service date, and provider NPI number.

The association between four neighborhood disadvantage indices and child chronic health classifications.

Background: Neighborhood advantage/disadvantage is a social determinant of health. We aimed to examine the distribution and associations between child chronic health conditions and four commonly used indices.

Methods: Children with outpatient visits and valid addresses (n = 115,738) were included and outcomes were categorized as having no chronic disease (N-CD), non-complex chronic disease (NC-CD), and complex chronic disease (C-CD).

Perspectives of paediatric providers on antibiotic stewardship in a high-prescribing rural region.

Purpose: Understanding drivers of antibiotic use is key to limiting the development of antimicrobial resistance. Outpatient antibiotic prescribing rates vary substantially across and within states. Kentucky is one of the highest prescribing states, and the southeastern region has rates that are drastically higher than the national average and urban areas of the state.

Ambulatory amoxicillin use for common acute respiratory infections during a national shortage: Results from the SHARPS-OP benchmarking collaborative.

We quantified antibiotic prescribing for ambulatory pediatric acute respiratory illness at 22 institutions in "pre-shortage" (Jan 2019-Sep 2022) and "shortage" (Oct 2022-Mar 2023) periods for amoxicillin. While acute respiratory illness prescribing increased across settings, the proportion of amoxicillin prescriptions decreased. Variation was seen within and between institutions.

Inappropriate Prescribing of Antibiotics to Pediatric Patients Receiving Medicaid: Comparison of High-Volume and Non-High-Volume Antibiotic Prescribers-Kentucky, 2019.

Inappropriate antibiotic prescribing to pediatric Medicaid patients was compared among high-volume and non-high-volume prescribers. High-volume prescribers had a higher percentage of inappropriate prescriptions than non-high-volume prescribers (17.2% versus 15.

Use of the Child Opportunity Index to Examine Racial Variations in Outpatient Antibiotic Prescribing to Children.

To examine further racial and ethnic variations in antibiotic prescribing to children, we used the Child Opportunity Index. Black children were less likely to be prescribed an antibiotic. Low- and moderate-opportunity areas were associated with greater rates of antibiotic prescribing, after adjusting for race and other factors.

Benchmarking of Outpatient Pediatric Antibiotic Prescribing: Results of a Multicenter Collaborative.

Background: Most antibiotic use occurs in ambulatory settings. No benchmarks exist for pediatric institutions to assess their outpatient antibiotic use and compare prescribing rates to peers. We aimed to share pediatric outpatient antibiotic use reports and benchmarking metrics nationally.

Quality of antibiotic prescribing to children through the coronavirus disease 2019 (COVID-19) pandemic.

Objective: To describe pediatric outpatient visits and antibiotic prescribing during the coronavirus disease 2019 (COVID-19) pandemic.

Design: An observational, retrospective control study from January 2019 to October 2021.

Setting: Outpatient clinics, including 27 family medicine clinics, 27 pediatric clinics, and 26 urgent or prompt care clinics.

Recurrent Antibiotic Use in Kentucky Children With 6 Years of Continuous Medicaid Enrollment.

Background: Little is known about the distribution of antibiotic use in individual children over time. The amoxicillin index is a recently proposed metric to assess first-line antibiotic prescribing to children.

Methods: We constructed a cohort of continuously enrolled Medicaid children using enrollment claims from 2012 to 2017.

Proposed metrics to benchmark antibiotic prescribing in pediatric outpatient settings.

Metrics to track and compare outpatient pediatric antibiotic prescribing are needed to improve antibiotic use and prevent unwanted consequences of antibiotic overuse. We have considered the impact and feasibility of available metrics and propose select high-priority measures for electronic reporting of pediatric outpatient antibiotic use. Streamlined use of antibiotic prescribing metrics will allow for national benchmarking, monitoring and identification of targets and goals for improvement.

Antibiotic prescribing to Kentucky Medicaid children, 2012-2017: Prescribing is higher in rural areas.

Purpose: Antibiotic resistance is a major public health threat. Antibiotic use is the main driver of resistance, with children and the state of Kentucky having particularly high rates of outpatient antibiotic prescribing. The purpose of this study was to describe patient and provider characteristics associated with pediatric antibiotic use in Kentucky Medicaid children.

Inappropriate outpatient antibiotic use in children insured by Kentucky Medicaid.

Objective: To describe risk factors associated with inappropriate antibiotic prescribing to children.

Design: Cross-sectional, retrospective analysis of antibiotic prescribing to children, using Kentucky Medicaid medical and pharmacy claims data, 2017.

Participants: Population-based sample of pediatric Medicaid patients and providers.

Cytomegalovirus Treatment in Pediatric Hematopoietic Stem Cell Transplant Patients.

Cytomegalovirus (CMV) is a frequent complication of hematopoietic stem cell transplant in pediatric patients, with significant morbidity and mortality. Antiviral drugs are used as prophylactic, preemptive or therapeutic medicines; however, no uniform guidelines exist for the best strategy to prevent CMV disease. Resistance to standard antiviral therapies can lead to further difficulty in managing CMV disease.