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Drivers of Prolonged Outpatient Antibiotic Therapy for Urinary Tract Infections and Community-Acquired Pneumonia
Rohan M Shah1, Shan Sun1, Emily Shteynberg1
1Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Infectious Diseases, Chicago, Illinois, USA.
Insights
Treatment duration for pediatric community-acquired pneumonia (CAP) and urinary tract infections (UTI) varies. Younger children, Medicaid insurance, and certain care settings were linked to longer antibiotic courses, while trainees prescribed shorter durations.
Area of Science:
- Pediatric Infectious Diseases
- Health Services Research
- Antibiotic Stewardship
Background:
- Significant variability exists in antibiotic treatment durations for pediatric community-acquired pneumonia (CAP) and urinary tract infections (UTI).
- This variability may be influenced by non-clinical factors, impacting patient care and antibiotic resistance.
- Understanding these factors is crucial for optimizing treatment guidelines.
Purpose of the Study:
- To identify non-clinical predictors of prolonged antibiotic therapy (≥10 days) for outpatient CAP and UTI in children.
- To analyze the association of patient demographics, insurance status, and care setting with antibiotic treatment duration.
- To evaluate the role of healthcare provider type in prescribing long-duration antibiotic therapies.
Main Methods:
- A retrospective analysis of 2124 CAP and 1116 UTI prescriptions from a children's hospital network (2016-2019).
- Multivariable logistic regression was employed to determine predictors of antibiotic durations of 10 days or longer.
- Subsequent 30-day hospitalizations were tracked as a clinical outcome.
Main Results:
- Longer antibiotic durations (≥10 days) were prescribed in 59.9% of CAP and 47.6% of UTI cases.
- Convenient care settings for CAP and emergency departments for UTI were associated with longer treatment durations.
- Younger children, Medicaid insurance, and care provided by attending physicians (vs. residents/fellows) were linked to prolonged antibiotic therapy.
Conclusions:
- Non-clinical factors such as younger age, Medicaid insurance, and specific care settings (ED, convenient care) significantly influence antibiotic treatment duration for pediatric CAP and UTI.
- Trainee physicians (residents and fellows) were less likely to prescribe extended antibiotic courses compared to attending physicians.
- These findings highlight opportunities for standardizing treatment protocols and improving antibiotic stewardship in pediatric care.
Background:
Variability exists in treatment duration for community-acquired pneumonia (CAP) and urinary tract infection (UTI) in children and may be associated with non-clinical factors.
Methods:
A retrospective study was conducted of patients treated for outpatient CAP and UTI in a children's hospital network from 2016 to 2019. Multivariable logistic regression was performed to identify predictors of long antibiotic duration (≥10 days). Hospitalization within 30 days was determined.
Results:
Overall, 2124 prescriptions for CAP and 1116 prescriptions for UTI were included. Prescriptions were ≥10 days in 59.9% and 47.6% for CAP and UTI, respectively. Long durations were more common in the emergency department (ED) than in clinics for UTI's (P = .0082), and more common in convenient care for CAP (P = .045). In UTI's, Asian and Hispanic patients received shorter durations than white patients. Younger children had greater odds of long duration for both diagnoses. Medicaid insurance was associated with long therapy for UTI (OR: 1.660, P = .0042) and CAP (OR: 1.426, P = .0169). Residents and fellows were less likely to give long durations than attending physicians (P < .0001). APNs were more likely to administer long therapies in CAP (P = .0062). Subsequent hospitalizations were uncommon for UTI (n = 10) and CAP (n = 20).
Conclusions:
Younger age, Medicaid insurance, ED, and convenient care visits were associated with a long duration of therapy. Residents and fellows were less likely to give long durations.
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