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Risk Factors and Outcomes Associated With Antibiotic Therapy in Children Hospitalized With Asthma Exacerbation
Jamie M Pinto1, Sarita Wagle1, Lauren J Navallo1
1Department of Pediatrics (JMP, SW, LJN), Jersey Shore University Medical Center, Neptune, NJ.
Insights
Antibiotics are frequently overused in pediatric asthma exacerbations, even without bacterial infection. This unnecessary antibiotic use in children was linked to longer hospital stays.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Health Services Research
Background:
- Antibiotic overuse is a significant concern in managing pediatric asthma exacerbations.
- Current guidelines recommend against routine antibiotic use in asthma unless a bacterial infection is present.
Purpose of the Study:
- To identify factors associated with antibiotic use in children hospitalized with asthma.
- To determine the outcomes, specifically length of stay, related to antibiotic administration in this population.
Main Methods:
- Retrospective analysis of administrative data from 2012-2015 for children hospitalized with asthma.
- Factors analyzed included demographics, clinical presentation, and disposition (pediatric floor vs. PICU).
- Outcomes assessed were antibiotic use, presence of bacterial infection/fever, and length of stay (LOS).
Main Results:
- Over half (53.8%) of hospitalized pediatric asthma patients received antibiotics, often without clear indication.
- Antibiotic use was higher in pediatric intensive care unit (PICU) admissions and associated with older age, female sex, and respiratory distress.
- Antibiotic treatment correlated with a 13-19 hour increase in LOS for patients without bacterial infection or fever.
Conclusions:
- A substantial proportion of pediatric asthma exacerbations are treated with antibiotics without a clear indication.
- Unnecessary antibiotic use in pediatric asthma is associated with prolonged hospital stays, highlighting a need for guideline adherence.
Objective:
Despite lack of benefit, antibiotics are overused in management of asthma exacerbation in children. In this study, data from a single children's hospital were analyzed to identify factors and outcomes associated with antibiotic use in children hospitalized with asthma.
Methods:
The study population was identified by using administrative data from 2012 to 2015, with subsequent verification of asthma. We analyzed factors associated with antibiotic use (demographic, seasonal, clinical) and outcome (length of stay [LOS]) with respect to: 1) disposition to pediatric floor (PF) or pediatric intensive care unit (PICU); and 2) evidence of coexisting bacterial infection and/or fever. Statistical analysis included univariate and controlled regression models. Data are presented as median and IQR for continuous variables and OR and regression coefficient (β) with 95% CIs for regression analyses.
Results:
Of 600 patients, 28.8% were admitted to PICU, 14.8% had verified bacterial infection, and 53.8% received antibiotic, mainly azithromycin. Nearly all PICU patients were treated with antibiotic, irrespective of coexisting bacterial infection or fever. Among PF patients, nearly 30% without bacterial infection or fever and 40% with fever alone received antimicrobials. Overall risk for antibiotic treatment was associated with older age, female sex, desaturation events, oxygen supplementation, and PICU admission. Additionally, antibiotic treatment was associated with 13- to 19-hour increased LOS for PF patients without bacterial infection and/or fever.
Conclusions:
Almost half of pediatric patients admitted with asthma exacerbation received antibiotic therapy with no clear indication, which was associated with prolonged LOS.
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