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Management of Community-Acquired Pneumonia in Pediatrics: Adherence to Clinical Guidelines
Rim Tannous1, Raymond N Haddad2, Paul-Henri Torbey3
1Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.
Insights
Adherence to pediatric community-acquired pneumonia (CAP) inpatient care guidelines varied. While antibiotic choice was appropriate, treatment duration and hospitalization indications require improvement for better pediatric pneumonia management.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Medicine
- Clinical Practice Guidelines
Background:
- Community-acquired pneumonia (CAP) is a leading cause of pediatric hospitalizations.
- Variability exists between recommended and actual clinical practices for pediatric CAP.
- Local evaluation of inpatient care for pediatric CAP is necessary.
Purpose of the Study:
- To assess adherence to established guidelines for inpatient pediatric community-acquired pneumonia (CAP) care.
- To identify factors influencing adherence to hospitalization indications, antibiotic selection, treatment duration, and length of stay.
- To evaluate local clinical practices against best-practice recommendations for pediatric CAP.
Main Methods:
- Retrospective review of 122 pediatric patients hospitalized with CAP between 2014-2017.
- Evaluation of adherence to guidelines concerning hospitalization indication, antibiotic choice, treatment duration, and hospital stay.
- Bivariate analysis to identify clinical factors associated with adherence rates.
Main Results:
- Hospital admission was indicated in only 47.5% of cases, often influenced by serum CRP levels and prolonged fever.
- Median hospital stay was 4 days, with justification in 23.8% of patients.
- Antibiotic choice was appropriate in 91.8% of cases; however, treatment duration aligned with recommendations in only 58.3% of patients.
Conclusions:
- Antibiotic selection for pediatric CAP aligns well with current guidelines.
- Significant improvements are needed in the indication for hospitalization and the duration of antimicrobial therapy.
- Further optimization of inpatient care pathways for pediatric CAP is recommended to enhance guideline adherence.
Abstract:
Objectives: To evaluate adherence to guidelines for inpatient care of pediatric patients with community-acquired pneumonia (CAP). Background: Pediatric CAP is one of the most common acute infections requiring hospital admission. Discrepancies between recommended care and effective management are reported, raising the necessity to evaluate our local clinical practices. Patients and Methods: Retrospective data review of all children hospitalized for CAP at our institution was conducted between 2014 and 2017. Adherence to inpatient care guidelines was evaluated with a focus on indication of hospitalization, initial antibiotic choice, treatment duration, and hospital stay. A bivariate analysis was performed to identify clinical factors influencing adherence rates. Results: A total of 122 children (median age of 3.5 years) were identified. Hospital admission was indicated in 47.5% of patients and was driven by the value of serum CRP as well as prolonged fever. Median hospital stay was 4 days and was justified in 23.8% of patients. The choice of antibiotics was relevant in 91.8% of cases and amoxicillin-clavulanate was the most prescribed drug. The drugs dose, interval, and route of administration were respected in all cases. Antimicrobial therapy lasted for a median of 10 days and was in accordance with recommendations in 58.3% of patients. No clinical parameter was found to be significantly associated with length of stay or choice and duration of treatment. Conclusions: The choice of antibiotics was consistent with guidelines but treatment duration, indication and length of hospitalization still need to be improved.
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