International Practice Patterns of Antibiotic Therapy and Laboratory Testing in Bronchiolitis
Amy Zipursky1, Nathan Kuppermann2, Yaron Finkelstein1,3
1Division of Pediatric Emergency Medicine and.
Insights
Antibiotic use for infant bronchiolitis was low and consistent across international emergency departments. However, nonindicated laboratory testing varied significantly, being more common in North America and Portugal than in the UK and Ireland.
Area of Science:
- Pediatrics
- Infectious Diseases
- Health Services Research
Background:
- Bronchiolitis is a common viral illness in infants, often managed in emergency departments.
- International variations in antibiotic use and diagnostic testing for bronchiolitis are not well understood.
- Understanding these patterns is crucial for optimizing evidence-based care and resource allocation.
Purpose of the Study:
- To evaluate international variations in antibiotic administration and nonindicated laboratory testing for infants diagnosed with bronchiolitis.
- To identify patient characteristics and clinical factors associated with antibiotic use and testing.
- To compare these practices across multiple pediatric emergency research networks globally.
Main Methods:
- A retrospective cohort study was conducted using data from 38 emergency departments across Canada, the US, Australia, New Zealand, the UK, Ireland, Spain, and Portugal.
- Previously healthy infants aged 2-12 months with a bronchiolitis diagnosis were included.
- Outcomes assessed included systemic antibiotic administration and utilization of urine, blood, or viral testing, and chest radiography (CXR).
Main Results:
- Antibiotic administration was low (7.6%) and did not significantly vary across networks, but was associated with chest radiography (CXR), apnea, and fever.
- Nonindicated testing occurred in 32.6% of infants and showed significant variation across networks, being highest in Spain/Portugal and the US.
- Testing was associated with suspected bacterial infections and respiratory distress parameters, with viral testing and CXR being most frequent.
Conclusions:
- Antibiotic prescribing for infant bronchiolitis is generally low and consistent internationally.
- Significant international variation exists in nonindicated diagnostic testing, independent of patient clinical factors.
- Further research is needed to understand the drivers of testing variation and promote standardized, evidence-based diagnostic approaches.
Background And Objectives:
International patterns of antibiotic use and laboratory testing in bronchiolitis in emergency departments are unknown. Our objective is to evaluate variation in the use of antibiotics and nonindicated tests in infants with bronchiolitis in 38 emergency departments in Pediatric Emergency Research Networks in Canada, the United States, Australia and New Zealand, the United Kingdom and Ireland, and Spain and Portugal. We hypothesized there would be significant variation, adjusted for patient characteristics.
Methods:
We analyzed a retrospective cohort study of previously healthy infants aged 2 to 12 months with bronchiolitis. Variables examined included network, poor feeding, dehydration, nasal flaring, chest retractions, apnea, saturation, respiratory rate, fever, and suspected bacterial infection. Outcomes included systemic antibiotic administration and urine, blood, or viral testing or chest radiography (CXR).
Results:
In total, 180 of 2359 (7.6%) infants received antibiotics, ranging from 3.5% in the United Kingdom and Ireland to 11.1% in the United States. CXR (adjusted odds ratio [aOR] 2.3; 95% confidence interval 1.6-3.2), apnea (aOR 2.2; 1.1-3.5), and fever (aOR 2.4; 1.7-3.4) were associated with antibiotic use, which did not vary across networks (P = .15). In total, 768 of 2359 infants (32.6%) had ≥1 nonindicated test, ranging from 12.7% in the United Kingdom and Ireland to 50% in Spain and Portugal. Compared to the United Kingdom and Ireland, the aOR (confidence interval) results for testing were Canada 5.75 (2.24-14.76), United States 4.14 (1.70-10.10), Australia and New Zealand 2.25 (0.86-5.74), and Spain and Portugal 3.96 (0.96-16.36). Testing varied across networks (P < .0001) and was associated with suspected bacterial infections (aOR 2.12; 1.30-2.39) and most respiratory distress parameters. Viral testing (591 of 768 [77%]) and CXR (507 of 768 [66%]) were obtained most frequently.
Conclusions:
The rate of antibiotic use in bronchiolitis was low across networks and was associated with CXR, fever, and apnea. Nonindicated testing was common outside of the United Kingdom and Ireland and varied across networks irrespective of patient characteristics.
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