Using risk adjustment to improve the interpretation of global inpatient pediatric antibiotic prescribing

作者：Bielicki Julia A^*; Sharland Mike; Versporten Ann; Goossens Herman; Cromwell David A

来源：PLos One, 2018, 13(7): e0199878.

DOI：10.1371/journal.pone.0199878

Objectives
Assessment of regional pediatric last-resort antibiotic utilization patterns is hampered by potential confounding from population differences. We developed a risk-adjustment model from readily available, internationally used survey data and a simple patient classification to aid such comparisons.
Design
We investigated the association between pediatric conserve antibiotic (pCA) exposure and patient / treatment characteristics derived from global point prevalence surveys of antibiotic prescribing, and developed a risk-adjustment model using multivariable logistic regression. The performance of a simple patient classification of groups with different expected pCA exposure levels was compared to the risk model.
Setting
226 centers in 41 countries across 5 continents.
Participants
Neonatal and pediatric inpatient antibiotic prescriptions for sepsis/bloodstream infection for 1281 patients.
Results
Overall pCA exposure was high (35%), strongly associated with each variable (patient age, ward, underlying disease, community acquisition or nosocomial infection and empiric or targeted treatment), and all were included in the final risk-adjustment model. The model demonstrated good discrimination (c-statistic = 0.83) and calibration (p = 0.38). The simple classification model demonstrated similar discrimination and calibration to the risk model. The crude regional pCA exposure rates ranged from 10.3% (Africa) to 67.4% (Latin America). Risk adjustment substantially reduced the regional variation, the adjusted rates ranging from 17.1% (Africa) to 42.8% (Latin America).
Conclusions
Greater comparability of pCA exposure rates can be achieved by using a few easily collected variables to produce risk-adjusted rates.

• 出版日期2018-7-6