DUE Diligence: Using Drug Use Evaluations of Ciprofloxacin and Meropenem to Identify Opportunities for Antimicrobial Stewardship at a Pediatric Tertiary Care Facility
Bibliographic record
Abstract
Background. Drug use evaluations (DUEs) can provide information on antimicrobial prescribing patterns within a hospital. At our institution, we believed that ciprofloxacin and meropenem use would be limited to microbiologically confirmed or classically recommended indications as both agents have restricted use criteria. A DUE of meropenem and ciprofloxacin was conducted to assess hospital-wide use of these agents. Methods. A retrospective chart review was conducted for all patients receiving greater than 48 hours of ciprofloxacin or meropenem between January 1 and December 31, 2015. Data was abstracted from electronic and paper charts using standardized case report forms. Each prescription was reviewed independently by 2 infectious disease physicians (including one trained in microbiology). Based on clinical syndrome, microbiology, past infecting pathogens and medical history, each prescription was assessed as having a definite, possible or no indication. Results. A total of 60 courses of ciprofloxacin and 34 courses of meropenem were assessed. For meropenem, 41.2% (n = 14) had a definite, 17.6 % (n = 6) had a possible and 41.2% (n = 14) had no indication. For ciprofloxacin, 28.3 % (n = 17) had a definite, 21.7 % (n = 13) had a possible and 50 % (n = 30) had no indication. For meropenem prescriptions with no indication, 7 of 14 (50%) were started in the PICU, mostly for lower respiratory (n = 2), abdominal (n = 2) and central nervous system (n = 2) indications. For ciprofloxacin prescriptions without an indication, 43% (n = 13) were prescribed by general surgery and 77% (n = 10) of these were for appendicitis. All patients on meropenem had at least one bacterial culture performed at the time of prescribing, compared to only 41 (68.3%) patients on ciprofloxacin. Conclusion. Only one-third of prescriptions for meropenem and ciprofloxacin were deemed to be definitively indicated. At our institution, empiric meropenem use without adequate microbiological data should be addressed. ASP efforts focusing on the use of ciprofloxacin for appendicitis and the role of intraoperative cultures in general surgery are indicated. DUEs of broad-spectrum agents are helpful in identifying “covert” antimicrobial use. Disclosures. All authors: No reported disclosures
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".