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Factors Associated With Antibiotic Use for Children Hospitalized With Pneumonia
Jillian M Cotter1, Todd A Florin2,3, Angela Moss4
1Section of Hospital Medicine, Children's Hospital Colorado, Department of Pediatrics.
Insights
Antibiotic use in hospitalized children with community-acquired pneumonia (CAP) is linked to emergency department (ED) decisions. Reducing ED antibiotic prescriptions may decrease overall inpatient antibiotic use, especially in non-radiographic CAP cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Community-acquired pneumonia (CAP) in children is often viral, yet antibiotics are frequently prescribed.
- Understanding factors influencing antibiotic use in hospitalized children with suspected CAP is crucial.
Purpose of the Study:
- To identify factors associated with antibiotic prescription in children hospitalized for suspected CAP.
- To investigate the relationship between emergency department (ED) antibiotic decisions and inpatient antibiotic use.
Main Methods:
- A prospective cohort study of 477 children hospitalized for suspected CAP.
- Multivariable Poisson regression was used to estimate risk factors for antibiotic receipt.
- Subgroup analysis focused on children with non-radiographic CAP.
Main Results:
- 60% of children received inpatient antibiotics; 53% received a full course.
- ED antibiotic use, fever, and supplemental oxygen were associated with inpatient antibiotic receipt.
- Nearly one-third of children with non-radiographic CAP received inpatient antibiotics.
Conclusions:
- Inpatient antibiotic use is influenced by ED antibiotic decisions, chest radiograph findings, and clinical factors.
- High rates of antibiotic use in non-radiographic CAP suggest potential overuse.
- ED antibiotic decisions represent a modifiable target to reduce inpatient antibiotic utilization.
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.
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