Pediatric antibiogram software for children's hospitals, pediatric units and the NICU, built from your own cultures

Most pediatricians still do not have one

Access is the real gap. A South Carolina group that built a statewide pediatric antibiogram (Bailey and colleagues, Antimicrobial Stewardship and Healthcare Epidemiology, 2023) cites an Illinois survey in which only 25 percent of pediatricians had access to a pediatric-specific antibiogram. Their own project pooled four pediatric hospitals of about 700 beds combined and three NICUs, and only one of the seven institutions had dedicated pediatric stewardship physicians or pharmacists.

That is the typical situation: the pediatric data exists in the lab system, but nobody has the hours to cut it by age, apply the first-isolate rule again inside the cut, and deal with the small cells. The larger children's hospitals solve it with an analyst. Children's Hospital of Philadelphia, for example, published its build of an electronic antibiogram inside its EHR, with results grouped into clinical scenarios by specimen source, unit and infection type. Most hospitals do not have that team.

What a pediatric antibiogram has to get right

A pediatric report follows the same CLSI M39 rules as the hospital report, but the order in which they are applied, and the size of the cells, change the answer.

• Define pediatric once and write it on the report. Most hospitals use patients under 18 at the time of collection. Whatever cutoff the committee picks, apply it to the collection date, not the discharge date
• Cut first, then de-duplicate. The first isolate per patient per organism is chosen inside the pediatric cut, so an adolescent whose first isolate of the year came from an adult clinic is still counted once
• Keep the NICU separate. Neonates grow group B streptococcus, E. coli and coagulase-negative staphylococci, carry few prior exposures and produce small counts. Blending them with older children hides both groups
• Report urine separately, with the urine cefazolin breakpoint for E. coli when your lab reports it. The Georgia collaborative reported 89 percent cefazolin susceptibility for E. coli using the urine-specific breakpoint, which is the number a pediatrician treating cystitis needs
• Suppress cells under 30 isolates and pool two or three years where needed, with the window printed on the report
• Leave out surveillance swabs such as MRSA nares screens, which measure colonization rather than infection

Children's hospital or a hospital with pediatric units

The right setup depends on how much of your census is pediatric.

A freestanding children's hospital has a pediatric lab export by definition. Every isolate in the file is from a child, so the house-wide antibiogram is the pediatric antibiogram, and the useful cuts are by source and period: urine, blood, respiratory, and this year against last year. That is the Lab plan at $249 a month, bought by card.

A general hospital with a pediatric ward, a PICU or a NICU needs a pediatric cut of a mostly adult file. Antimicrobe cuts by unit, so the practical route is to map the pediatric locations once (PICU, NICU, pediatric floor, pediatric emergency department if it is a separate location) and filter to that group. Children seen in a shared emergency department are then missed, so some hospitals ask the lab for a second export limited to patients under 18 and load it as its own facility. Unit cuts and a second facility are both on the Stewardship plan at $749 a month.

Pediatric antibiogram options compared

A pooled regional antibiogram is a reasonable fallback when your own counts are too small, and building one across several hospitals is covered in regional antibiogram software for health systems. It does not replace a report built from your own patients.

How many isolates does a NICU antibiogram need?

The same 30 isolates per organism as any other cut, and most NICUs will not reach it in one year for anything except coagulase-negative staphylococci. The South Carolina authors reported that cells under 30 isolates were most frequent in the NICU. The honest options are to pool two or three years, to report counts instead of percentages, or to combine two NICUs in the same system and say so on the report.

A NICU cut is still worth running even when most cells are suppressed. A line that reads 14 E. coli isolates in two years, with the count resistant to ampicillin beside it, is information the neonatologists will use, as long as nobody turns it into a percentage.

Unit cuts for adult intensive care follow the same logic and are covered on the ICU antibiogram software page.

Pediatric urine antibiograms for UTI order sets

Urinary tract infection is the most common reason a pediatric antibiogram gets consulted outside the hospital, and it is the cut that community pediatricians ask for. Build it from urine isolates only, first isolate per patient, with inpatient and outpatient kept apart where the counts allow. Outpatient pediatric E. coli usually looks better than inpatient, and an empiric cephalexin recommendation for a clinic should rest on the clinic number.

The adult and general version of this report, including the 20 percent rule used for trimethoprim-sulfamethoxazole, is on the UTI antibiotic resistance page. Pediatric practices whose cultures go to a reference lab can use the outpatient antibiogram software route instead.

How it works

The builder at the top of this page runs the same rules on sample data, so you can see the suppression and the cuts before you buy.

• Ask the lab for 12 to 24 months of finalized susceptibility results as CSV, with patient key, collection date, specimen source, unit, organism, antibiotic and S, I or R. A children's hospital sends everything; a general hospital sends pediatric locations or an under-18 extract
• Map free-text units once (PICU, NICU, pediatric floor) and remove screening swabs
• Choose the cut: all pediatric isolates, NICU only, or urine only. The first-isolate rule runs inside that cut and cells under 30 isolates are suppressed
• Export the pediatric antibiogram with its rule receipt for the pharmacy and therapeutics committee, and refresh it from the next export

Which plan fits

A freestanding children's hospital with one lab usually needs the Lab plan: $249 a month for 1 facility, 25,000 isolates a year and 2 seats, with cuts by source and period, CLSI breakpoints and CSV and print exports. It is bought by card, with no implementation fee.

A general hospital that needs pediatric unit cuts, a NICU report, or a separate under-18 facility alongside the adult report needs Stewardship: $749 a month for up to 3 facilities, 150,000 isolates a year and 8 seats, with cuts by source, unit, period and syndrome, quarterly trends and MDRO alerts.

A children's health system or a statewide pediatric collaborative that wants every member hospital side by side uses Network at $2,400 a month for up to 12 facilities.

Every limit is on the pricing page. The adult house-wide report is covered on hospital antibiogram software.

What this does not do

• No age field is calculated for you. A mixed hospital cuts by pediatric unit, or loads an under-18 export from the lab as its own facility
• No weight-based dosing or pediatric dose checking. It summarizes susceptibility; dosing stays with your pharmacists and your dosing references
• No EHR or HL7 interface on the Lab and Stewardship plans. It works from exported files
• No real-time alerts on individual patients and no NHSN submission