Impact of a National Guideline on Antibiotic Selection for Hospitalized Pneumonia
Derek J Williams1,2, Matthew Hall3, Jeffrey S Gerber4,5
1Division of Hospital Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, derek.williams@vanderbilt.edu.
Insights
The 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America pneumonia guideline increased penicillin use in hospitalized children. Local implementation efforts also boosted penicillin prescribing, showing greater relevance than organizational readiness.
Area of Science:
- Pediatric infectious diseases
- Antibiotic stewardship
- Clinical guideline implementation
Background:
- The 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America (PIDS/IDSA) pneumonia guideline aimed to optimize antibiotic prescribing for children.
- Hospital-level implementation strategies were employed to promote guideline adoption and adherence.
- Antibiotic prescribing patterns for pediatric pneumonia require evaluation following guideline dissemination.
Purpose of the Study:
- To assess the impact of the 2011 PIDS/IDSA pneumonia guideline on antibiotic prescribing for hospitalized children.
- To evaluate the role of hospital-level implementation efforts in antibiotic prescribing changes.
- To examine the relationship between organizational readiness and guideline impact on prescribing practices.
Main Methods:
- A multi-hospital assessment of inpatient antibiotic prescribing for pneumonia was conducted from August 2009 to March 2015.
- Segmented linear regression analyzed trends in penicillin use pre- and post-guideline publication.
- Hospital surveys assessed local implementation efforts and organizational readiness; Pearson's correlation examined relationships.
Main Results:
- Penicillin prescribing increased significantly after guideline publication, reaching 27.6% by March 2015.
- Local implementation efforts showed a median increase of 29.5% in penicillin use, comparable to the guideline's impact.
- Organizational readiness was not correlated with observed changes in antibiotic prescribing.
Conclusions:
- The PIDS/IDSA pneumonia guideline publication led to sustained increases in penicillin use for pediatric pneumonia.
- Local implementation initiatives appear to enhance guideline adoption and may be more critical than organizational readiness.
- Optimizing antibiotic prescribing for pediatric pneumonia involves both national guidelines and targeted local implementation strategies.
Background:
We evaluated the impact of the 2011 Pediatric Infectious Diseases Society/Infectious Diseases Society of America pneumonia guideline and hospital-level implementation efforts on antibiotic prescribing for children hospitalized with pneumonia.
Methods:
We assessed inpatient antibiotic prescribing for pneumonia at 28 children's hospitals between August 2009 and March 2015. Each hospital was also surveyed regarding local implementation efforts targeting antibiotic prescribing and organizational readiness to adopt guideline recommendations. To estimate guideline impact, we used segmented linear regression to compare the proportion of children receiving penicillins in March 2015 with the expected proportion at this same time point had the guideline not been published based on a projection of a preguideline trend. A similar approach was used to estimate the short-term (6-month) impact of local implementation efforts. The correlations between organizational readiness and the impact of the guideline were estimated by using Pearson's correlation coefficient.
Results:
Before guideline publication, penicillin prescribing was rare (<10%). After publication, an absolute increase in penicillin use was observed (27.6% [95% confidence interval: 23.7%-31.5%]) by March 2015. Among hospitals with local implementation efforts (n = 20, 71%), the median increase was 29.5% (interquartile range: 19.6%-39.1%) compared with 20.1% (interquartile rage: 9.5%-44.5%) among hospitals without such activities (P = .51). The independent, short-term impact of local implementation efforts was similar in magnitude to that of the national guideline. Organizational readiness was not correlated with prescribing changes.
Conclusions:
The publication of the Pediatric Infectious Diseases Society/Infectious Diseases Society of America guideline was associated with sustained increases in the use of penicillins for children hospitalized with pneumonia. Local implementation efforts may have enhanced guideline adoption and appeared more relevant than hospitals' organizational readiness to change.
More Related Videos
11:17Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
11:32Following in Real Time the Impact of Pneumococcal Virulence Factors in an Acute Mouse Pneumonia Model Using Bioluminescent Bacteria
Published on: February 23, 2014
Related Concept Videos
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:30Pneumonia III: Complications and Assessment
00:57Antibiotic Selection
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...