Paediatric antibiotic prescriptions for different indications in a Norwegian university hospital and a district hospital
| Indications for antibiotic treatment | Total | University hospital | District hospital | P value* |
| All indications† | ||||
| Treatments, n | 345 | 142 | 203 | |
| Healthcare-acquired infections, n (%) | 17 (5) | 11 (8) | 6 (3) | 0.04 |
| Treatments involving BSA‡, n (%) | 72 (21) | 34 (24) | 38 (19) | NS |
| Treatments according to guideline§¶, n (%) | 232 (72) | 96 (75) | 136 (69) | NS |
| Pneumonia | ||||
| Treatments, n (% of all treatments) | 110 (32) | 32 (23) | 78 (38) | <0.01 |
| Treatments involving BSA, n (%) | 24 (22) | 11 (34) | 13 (17) | NS |
| Treatments according to guideline, n (%) | 57 (52) | 15 (47) | 42 (54) | NS |
| Days of treatment in hospital, median (IQR) | 2.0 (3.0) | 3.0 (4.5) | 2.0 (2.3) | NS |
| Treatments to patients with comorbidities, n (%) | 54 (49) | 19 (59) | 35 (45) | NS |
| BSA treatments to patients with comorbidities**, n (% of BSA) | 23 (96) | 11 (100) | 12 (92) | NS |
| Urinary tract infection | ||||
| Treatments, n (% of all treatments) | 59 (17) | 28 (20) | 31 (15) | NS |
| Treatments involving BSA, n (%) | 6 (2) | 2 (7) | 4 (13) | NS |
| Treatment according to guideline, n (%) | 50 (85) | 26 (93) | 24 (77) | NS |
| Days of treatment in hospital, median (IQR) | 2.0 (2.0) | 2.0 (1.8) | 3.0 (3.0) | NS |
| Treatments to patients with comorbidities, n (%) | 20 (34) | 7 (25) | 13 (42) | NS |
| BSA treatments to patients with comorbidities, n (% of BSA) | 5 (83) | 2 (100) | 3 (75) | N/A |
| Infection in skin, soft tissue, bone and joint | ||||
| Treatments, n (% of all treatments) | 56 (16) | 33 (23) | 23 (11) | <0.01 |
| Treatments involving BSA, n (%) | 8 (14) | 6 (18) | 2 (9) | NS |
| Treatments according to guideline, n (%) | 41 (73) | 23 (70) | 18 (78) | NS |
| Days of treatment in hospital, median (IQR) | 2.0 (4.0) | 3.0 (5.0) | 1.5 (3.0) | NS |
| Treatments to patients with comorbidities, n (%) | 10 (18) | 1 (3) | 9 (38) | <0.01 |
| BSA treatments to patients with comorbidities, n (% of BSA) | 1 (10) | 0 (0) | 1 (50) | N/A |
| Sepsis | ||||
| Treatments, n (% of all treatments) | 34 (9) | 19 (13) | 15 (7) | NS |
| Treatments involving BSA, n (%) | 7 (21) | 4 (21) | 3 (20) | NS |
| Treatments according to guideline, n (%) | 30 (88) | 18 (95) | 12 (80) | NS |
| Days of treatment in hospital, median (IQR) | 3.5 (4.0) | 3.0 (3.0) | 5.0 (5.0) | NS |
| Treatments to patients with comorbidities, n (%) | 14 (41) | 8 (42) | 6 (40) | NS |
| BSA treatments to patients with comorbidities, n (% of BSA) | 6 (86) | 3 (100) | 3 (75) | N/A |
| Upper respiratory tract infections | ||||
| Treatments, n (%) | 42 (12) | 7 (5) | 35 (17) | <0.01 |
| Treatments involving BSA, n (%) | 2 (5) | 1 (14) | 1 (3) | NS |
| Treatments according to guideline, n (%) | 34 (81) | 7 (100) | 27 (77) | NS |
| Days of treatment in hospital, median (IQR) | 2.0 (2.0) | 2.0 (2.0) | 2.0 (2.0) | NS |
| Treatments to patients with comorbidities, n (%) | 10 (24) | 2 (29) | 8 (23) | NS |
| BSA treatments to patients with comorbidities, n (% of BSA) | 1 (50) | 1 (100) | 0 (0) | N/A |
| CNS infections | ||||
| Treatments, n (%) | 23 (7) | 9 (6) | 14 (7) | NS |
| Treatment involving BSA, n (%) | 20 (87) | 7 (78) | 13 (93) | NS |
| Treatments according to guideline, n (%) | 20 (87) | 7 (78) | 13 (93) | NS |
| Days of treatment in hospital, median (IQR) | 1.0 (2.0) | 2 (3.0) | 1 (1.25) | NS |
| Treatments to patients with comorbidities, n (%) | 1 (4) | 1 (11) | 0 (0) | NS |
| BSA treatments to patients with comorbidities, n (% of BSA) | 1 (5) | 1 (14) | 0 (0) | NS |
| Other infections | ||||
| Treatments, n (%) | 23 (7) | 14 (10) | 7 (3) | 0.03 |
| Treatments with BSA, n (%) | 5 (22) | 3 (21) | 2 (29) | NS |
*A χ2 test was used for proportions and Moods median test for medians. Non-significant results are marked NS. N/A means that the numbers are too small for statistical testing.
†For adherence rate and BSA use, we controlled for age differences between the hospitals by using multivariable logistic regression, and the significant levels remained the same for all indications. P-value < 0.05 was regarded significant.
‡Broad-spectrum antibiotics (BSA) were defined as second-generation and third-generation cephalosporins, carbapenems, piperacillin/tazobactam and ceftolazan/tazobactam.
§The entire treatment is in adherence with the empirical recommendation in The Norwegian guideline28 and/or in accordance with blood cultures, bone/joint cultures or respiratory tract samples from cystic fibrosis patients (means using any antibiotic(s) that was susceptible by the bacteria, regardless of how the patient was treated initially).
¶Other infections were not included when calculating total compliance with guidelines.
**University hospital: cystic fibrosis with pathogenic bacteria (9), cerebral palsy (1), recent CNS operation (1), district hospital: cystic fibrosis with pathogenic bacteria (8), lymphoma (1), neurological multifunction disability (1), heart disease (1), syndrome (1).
CNS, central nervous system.