Abstract
BACKGROUND: Antibiotics are frequently used for community-acquired pneumonia (CAP), although viral etiologies predominate. We sought to determine factors associated with antibiotic use among children hospitalized with suspected CAP. METHODS: We conducted a prospective cohort study of children who presented to the emergency department (ED) and were hospitalized for suspected CAP. We estimated risk factors associated with receipt of $1 dose of inpatient antibiotics and a full treatment course using multivariable Poisson regression with an interaction term between chest radiograph (CXR) findings and ED antibiotic use. We performed a subgroup analysis of children with nonradiographic CAP. RESULTS: Among 477 children, 60% received inpatient antibiotics and 53% received a full course. Factors associated with inpatient antibiotics included antibiotic receipt in the ED (relative risk 4.33 [95% confidence interval, 2.63–7.13]), fever (1.66 [1.22–2.27]), and use of supplemental oxygen (1.29 [1.11–1.50]). Children with radiographic CAP and equivocal CXRs had an increased risk of inpatient antibiotics compared with those with normal CXRs, but the increased risk was modest when antibiotics were given in the ED. Factors associated with a full course were similar. Among patients with nonradiographic CAP, 29% received inpatient antibiotics, 21% received a full course, and ED antibiotics increased the risk of inpatient antibiotics. CONCLUSIONS: Inpatient antibiotic utilization was associated with ED antibiotic decisions, CXR findings, and clinical factors. Nearly one-third of children with nonradiographic CAP received antibiotics, highlighting the need to reduce likely overuse. Antibiotic decisions in the ED were strongly associated with decisions in the inpatient setting, representing a modifiable target for future interventions.
| Original language | English (US) |
|---|---|
| Article number | e2021054677 |
| Journal | Pediatrics |
| Volume | 150 |
| Issue number | 2 |
| DOIs | |
| State | Published - Aug 1 2022 |
Funding
FUNDING: This study was supported by the NIH/National Institute of Allergy and Infectious Diseases (K23AI121325 to TAF and K01AI125413 to LA), the Gerber Foundation (to TAF), and the NIH/NCRR and Cincinnati Center for Clinical and Translational Science and Training (5KL2TR000078 to TAF). The funders did not have any role in study design, data collection, statistical analysis, or manuscript preparation. Funded by the National Institutes of Health (NIH). CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no potential conflicts of interest relevant to this article to disclose. We acknowledge Jessi Lipscomb and Judd Jacobs for their role in data management for the CARPE DIEM study. Mantosh Rattan, MD, and Eric Crotty, MD, from the Department of Radiology at Cincinnati Children’s Hospital Medical Center reviewed and interpreted all chest radiographs. We would also like to acknowledge Caitlin Clohessy and Andrea Kachelmeyer for recruiting patients and performing chart review to verify the collected data. We are grateful to the entire research team and patient services staff in the Divisions of Emergency Medicine and Hospital Medicine at CCHMC for their assistance with study procedures. Finally, we are especially grateful to the patients and families who enrolled in the CARPE DIEM study. This study was supported by the NIH/National Institute of Allergy and Infectious Diseases (K23AI121325 to TAF and K01AI125413 to LA), the Gerber Foundation (to TAF), and the NIH/NCRR and Cincinnati Center for Clinical and Translational Science and Training (5KL2TR000078 to TAF). The funders did not have any role in study design, data collection, statistical analysis, or manuscript preparation. Funded by the National Institutes of Health (NIH).
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health