The use of continuous electronic prescribing data to infer trends in antimicrobial consumption and estimate the impact of stewardship interventions in hospitalized children
Abstract Background Understanding antimicrobial consumption is essential to mitigate the development of antimicrobial resistance, yet robust data in children are sparse and methodologically limited. Electronic prescribing systems provide an important opportunity to analyse and report antimicrobial c...
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| Veröffentlicht in: | Journal of antimicrobial chemotherapy 2021-08, Vol.76 (9), p.2464-2471 |
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| container_title | Journal of antimicrobial chemotherapy |
| container_volume | 76 |
| creator | Channon-Wells, S. Kwok, M. Booth, J. Bamford, A. Konstanty, P. Hatcher, J. Dixon, G. Diggle, P. J. Standing, J. F. Irwin, A. D. |
| description | Abstract
Background
Understanding antimicrobial consumption is essential to mitigate the development of antimicrobial resistance, yet robust data in children are sparse and methodologically limited. Electronic prescribing systems provide an important opportunity to analyse and report antimicrobial consumption in detail.
Objectives
We investigated the value of electronic prescribing data from a tertiary children’s hospital to report temporal trends in antimicrobial consumption in hospitalized children and compare commonly used metrics of antimicrobial consumption.
Methods
Daily measures of antimicrobial consumption [days of therapy (DOT) and DDDs] were derived from the electronic prescribing system between 2010 and 2018. Autoregressive moving-average models were used to infer trends and the estimates were compared with simulated point prevalence surveys (PPSs).
Results
More than 1.3 million antimicrobial administrations were analysed. There was significant daily and seasonal variation in overall consumption, which reduced annually by 1.77% (95% CI 0.50% to 3.02%). Relative consumption of meropenem decreased by 6.6% annually (95% CI −3.5% to 15.8%) following the expansion of the hospital antimicrobial stewardship programme. DOT and DDDs exhibited similar trends for most antimicrobials, though inconsistencies were observed where changes to dosage guidelines altered consumption calculation by DDDs, but not DOT. PPS simulations resulted in estimates of change over time, which converged on the model estimates, but with much less precision.
Conclusions
Electronic prescribing systems offer significant opportunities to better understand and report antimicrobial consumption in children. This approach to modelling administration data overcomes the limitations of using interval data and dispensary data. It provides substantially more detailed inferences on prescribing patterns and the potential impact of stewardship interventions. |
| doi_str_mv | 10.1093/jac/dkab187 |
| format | Article |
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Background
Understanding antimicrobial consumption is essential to mitigate the development of antimicrobial resistance, yet robust data in children are sparse and methodologically limited. Electronic prescribing systems provide an important opportunity to analyse and report antimicrobial consumption in detail.
Objectives
We investigated the value of electronic prescribing data from a tertiary children’s hospital to report temporal trends in antimicrobial consumption in hospitalized children and compare commonly used metrics of antimicrobial consumption.
Methods
Daily measures of antimicrobial consumption [days of therapy (DOT) and DDDs] were derived from the electronic prescribing system between 2010 and 2018. Autoregressive moving-average models were used to infer trends and the estimates were compared with simulated point prevalence surveys (PPSs).
Results
More than 1.3 million antimicrobial administrations were analysed. There was significant daily and seasonal variation in overall consumption, which reduced annually by 1.77% (95% CI 0.50% to 3.02%). Relative consumption of meropenem decreased by 6.6% annually (95% CI −3.5% to 15.8%) following the expansion of the hospital antimicrobial stewardship programme. DOT and DDDs exhibited similar trends for most antimicrobials, though inconsistencies were observed where changes to dosage guidelines altered consumption calculation by DDDs, but not DOT. PPS simulations resulted in estimates of change over time, which converged on the model estimates, but with much less precision.
Conclusions
Electronic prescribing systems offer significant opportunities to better understand and report antimicrobial consumption in children. This approach to modelling administration data overcomes the limitations of using interval data and dispensary data. It provides substantially more detailed inferences on prescribing patterns and the potential impact of stewardship interventions.</description><identifier>ISSN: 0305-7453</identifier><identifier>EISSN: 1460-2091</identifier><identifier>DOI: 10.1093/jac/dkab187</identifier><identifier>PMID: 34109397</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Anti-Bacterial Agents - therapeutic use ; Anti-Infective Agents ; Antimicrobial Stewardship ; Child ; Child, Hospitalized ; Electronic Prescribing ; Humans ; Original Research</subject><ispartof>Journal of antimicrobial chemotherapy, 2021-08, Vol.76 (9), p.2464-2471</ispartof><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c412t-65fa4f4c79cb732f4fa2030c4cf14d6cc1d403271f1a1ad80652d6da2a1f8e93</citedby><cites>FETCH-LOGICAL-c412t-65fa4f4c79cb732f4fa2030c4cf14d6cc1d403271f1a1ad80652d6da2a1f8e93</cites><orcidid>0000-0002-8166-8680 ; 0000-0002-4561-7173 ; 0000-0001-8974-6789</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,1578,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34109397$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Channon-Wells, S.</creatorcontrib><creatorcontrib>Kwok, M.</creatorcontrib><creatorcontrib>Booth, J.</creatorcontrib><creatorcontrib>Bamford, A.</creatorcontrib><creatorcontrib>Konstanty, P.</creatorcontrib><creatorcontrib>Hatcher, J.</creatorcontrib><creatorcontrib>Dixon, G.</creatorcontrib><creatorcontrib>Diggle, P. J.</creatorcontrib><creatorcontrib>Standing, J. F.</creatorcontrib><creatorcontrib>Irwin, A. D.</creatorcontrib><title>The use of continuous electronic prescribing data to infer trends in antimicrobial consumption and estimate the impact of stewardship interventions in hospitalized children</title><title>Journal of antimicrobial chemotherapy</title><addtitle>J Antimicrob Chemother</addtitle><description>Abstract
Background
Understanding antimicrobial consumption is essential to mitigate the development of antimicrobial resistance, yet robust data in children are sparse and methodologically limited. Electronic prescribing systems provide an important opportunity to analyse and report antimicrobial consumption in detail.
Objectives
We investigated the value of electronic prescribing data from a tertiary children’s hospital to report temporal trends in antimicrobial consumption in hospitalized children and compare commonly used metrics of antimicrobial consumption.
Methods
Daily measures of antimicrobial consumption [days of therapy (DOT) and DDDs] were derived from the electronic prescribing system between 2010 and 2018. Autoregressive moving-average models were used to infer trends and the estimates were compared with simulated point prevalence surveys (PPSs).
Results
More than 1.3 million antimicrobial administrations were analysed. There was significant daily and seasonal variation in overall consumption, which reduced annually by 1.77% (95% CI 0.50% to 3.02%). Relative consumption of meropenem decreased by 6.6% annually (95% CI −3.5% to 15.8%) following the expansion of the hospital antimicrobial stewardship programme. DOT and DDDs exhibited similar trends for most antimicrobials, though inconsistencies were observed where changes to dosage guidelines altered consumption calculation by DDDs, but not DOT. PPS simulations resulted in estimates of change over time, which converged on the model estimates, but with much less precision.
Conclusions
Electronic prescribing systems offer significant opportunities to better understand and report antimicrobial consumption in children. This approach to modelling administration data overcomes the limitations of using interval data and dispensary data. It provides substantially more detailed inferences on prescribing patterns and the potential impact of stewardship interventions.</description><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Anti-Infective Agents</subject><subject>Antimicrobial Stewardship</subject><subject>Child</subject><subject>Child, Hospitalized</subject><subject>Electronic Prescribing</subject><subject>Humans</subject><subject>Original Research</subject><issn>0305-7453</issn><issn>1460-2091</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNp9Uctu1TAQtRCIXgor9sgrhITS2rHz2iChipdUic3dWxN73LgkcbCdVvBNfCRO76Wim64sa85j5hxCXnN2xlknzq9Bn5sf0PO2eUJ2XNasKFnHn5IdE6wqGlmJE_IixmvGWF3V7XNyIuTG7Jod-bMfkK4RqbdU-zm5efVrpDiiTsHPTtMlYNTB9W6-ogYS0OSpmy0GmgLOJuYPhUycnA6-dzBuOnGdluT8NjEUY55CQpqyl5sW0GmziwlvIZg4uCVrJAw3OG-cO8XBx8UlGN1vNFQPbjTZ7CV5ZmGM-Or4npL950_7i6_F5fcv3y4-XhZa8jIVdWVBWqmbTveNKK20UOYotNSWS1NrzY1komy45cDBtDmV0tQGSuC2xU6ckg8H2WXtJzQ6rxVgVEvIV4RfyoNTDyezG9SVv1GtqLkQPAu8OwoE_3PN56vJRY3jCDPmdFVZia5tupZVGfr-AM3hxRjQ3ttwpraSVK5XHevN6Df_b3aP_ddnBrw9APy6PKr0F0DhtgM</recordid><startdate>20210812</startdate><enddate>20210812</enddate><creator>Channon-Wells, S.</creator><creator>Kwok, M.</creator><creator>Booth, J.</creator><creator>Bamford, A.</creator><creator>Konstanty, P.</creator><creator>Hatcher, J.</creator><creator>Dixon, G.</creator><creator>Diggle, P. J.</creator><creator>Standing, J. F.</creator><creator>Irwin, A. D.</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-8166-8680</orcidid><orcidid>https://orcid.org/0000-0002-4561-7173</orcidid><orcidid>https://orcid.org/0000-0001-8974-6789</orcidid></search><sort><creationdate>20210812</creationdate><title>The use of continuous electronic prescribing data to infer trends in antimicrobial consumption and estimate the impact of stewardship interventions in hospitalized children</title><author>Channon-Wells, S. ; Kwok, M. ; Booth, J. ; Bamford, A. ; Konstanty, P. ; Hatcher, J. ; Dixon, G. ; Diggle, P. J. ; Standing, J. F. ; Irwin, A. D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c412t-65fa4f4c79cb732f4fa2030c4cf14d6cc1d403271f1a1ad80652d6da2a1f8e93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Anti-Infective Agents</topic><topic>Antimicrobial Stewardship</topic><topic>Child</topic><topic>Child, Hospitalized</topic><topic>Electronic Prescribing</topic><topic>Humans</topic><topic>Original Research</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Channon-Wells, S.</creatorcontrib><creatorcontrib>Kwok, M.</creatorcontrib><creatorcontrib>Booth, J.</creatorcontrib><creatorcontrib>Bamford, A.</creatorcontrib><creatorcontrib>Konstanty, P.</creatorcontrib><creatorcontrib>Hatcher, J.</creatorcontrib><creatorcontrib>Dixon, G.</creatorcontrib><creatorcontrib>Diggle, P. J.</creatorcontrib><creatorcontrib>Standing, J. F.</creatorcontrib><creatorcontrib>Irwin, A. D.</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of antimicrobial chemotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Channon-Wells, S.</au><au>Kwok, M.</au><au>Booth, J.</au><au>Bamford, A.</au><au>Konstanty, P.</au><au>Hatcher, J.</au><au>Dixon, G.</au><au>Diggle, P. J.</au><au>Standing, J. F.</au><au>Irwin, A. D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The use of continuous electronic prescribing data to infer trends in antimicrobial consumption and estimate the impact of stewardship interventions in hospitalized children</atitle><jtitle>Journal of antimicrobial chemotherapy</jtitle><addtitle>J Antimicrob Chemother</addtitle><date>2021-08-12</date><risdate>2021</risdate><volume>76</volume><issue>9</issue><spage>2464</spage><epage>2471</epage><pages>2464-2471</pages><issn>0305-7453</issn><eissn>1460-2091</eissn><abstract>Abstract
Background
Understanding antimicrobial consumption is essential to mitigate the development of antimicrobial resistance, yet robust data in children are sparse and methodologically limited. Electronic prescribing systems provide an important opportunity to analyse and report antimicrobial consumption in detail.
Objectives
We investigated the value of electronic prescribing data from a tertiary children’s hospital to report temporal trends in antimicrobial consumption in hospitalized children and compare commonly used metrics of antimicrobial consumption.
Methods
Daily measures of antimicrobial consumption [days of therapy (DOT) and DDDs] were derived from the electronic prescribing system between 2010 and 2018. Autoregressive moving-average models were used to infer trends and the estimates were compared with simulated point prevalence surveys (PPSs).
Results
More than 1.3 million antimicrobial administrations were analysed. There was significant daily and seasonal variation in overall consumption, which reduced annually by 1.77% (95% CI 0.50% to 3.02%). Relative consumption of meropenem decreased by 6.6% annually (95% CI −3.5% to 15.8%) following the expansion of the hospital antimicrobial stewardship programme. DOT and DDDs exhibited similar trends for most antimicrobials, though inconsistencies were observed where changes to dosage guidelines altered consumption calculation by DDDs, but not DOT. PPS simulations resulted in estimates of change over time, which converged on the model estimates, but with much less precision.
Conclusions
Electronic prescribing systems offer significant opportunities to better understand and report antimicrobial consumption in children. This approach to modelling administration data overcomes the limitations of using interval data and dispensary data. It provides substantially more detailed inferences on prescribing patterns and the potential impact of stewardship interventions.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>34109397</pmid><doi>10.1093/jac/dkab187</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-8166-8680</orcidid><orcidid>https://orcid.org/0000-0002-4561-7173</orcidid><orcidid>https://orcid.org/0000-0001-8974-6789</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of antimicrobial chemotherapy, 2021-08, Vol.76 (9), p.2464-2471 |
| issn | 0305-7453 1460-2091 |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Free Full-Text Journals in Chemistry |
| subjects | Anti-Bacterial Agents - therapeutic use Anti-Infective Agents Antimicrobial Stewardship Child Child, Hospitalized Electronic Prescribing Humans Original Research |
| title | The use of continuous electronic prescribing data to infer trends in antimicrobial consumption and estimate the impact of stewardship interventions in hospitalized children |
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