Determinants of expert-advised antibiotic indication in pediatric emergency department, data from a cross-sectional...

Antibiotic resistance and inappropriate antibiotic use are critical global public health issues, but research on the determinants of expert-advised antibiotic prescribing in pediatric emergency departments (EDs) remains limited. This study aimed to quantify variability in expert antibiotic recommendatios for pediatric ED patients.

A cross-sectional survey was conducted in a Chinese pediatric hospital ED in 2020. Two days/quarter (one weekday/weekend day, avoiding infectious disease outbreaks) were selected and 1000 cases were randomly extracted for secondary analysis. Clinical data (without treatment details) were reviewed by two pediatric experts who provided retrospective antibiotic recommendations. Cases were enrolled upon their consensus. Factors influencing expert-advised antibiotic prescriptions in ED were analyzed.

Expert consensus was achieved in 819/1000 cases. Among these, 174 (21.3%) cases were advised antibiotics by experts (57 cases not prescribed clinically), and 645 (78.7%) cases were not advised for antibiotics (53 cases prescribed clinically). Common diagnoses were upper respiratory tract infections (52.3%), gastroenteritis (18.1%), and lower respiratory tract infections (9.5%) with antibiotic advice rates 24.5%, 14.9%, and 38.5%, respectively. The median age of the antibiotic-advised group was 36 months [interquartile range (IQR): 12, 60], older than the not-advised group[12 months (IQR: 11, 36)]. Median white blood cell count (WBC) and C-reactive protein (CRP) in advised group were 12.9 × 10⁶/µL(IQR: 12.0, 13.8) and 28.5 mg/L (IQR: 23.4, 33.5), which were higher than non-advised group (7.2 × 10⁶/µL, IQR: 6.9, 7.5; 3.5 mg/L, IQR: 3.0, 4.0) Age, WBC and CRP were different between groups (P < 0.001).,Multivariate analysis showed older age (Odds ratio (OR) = 1.012, Confidence Interval (95%CI): 1.002-1.022), fever (OR = 8.644, 95%CI: 2.321-32.188), elevated WBC (OR = 1.455, 95%CI: 1.300-1.629), neutrophil ratio (OR = 1.034, 95%CI: 1.010-1.058) and CRP (OR = 1.210, 95%CI: 1.144-1.281) were independant determinants.

Older age, fever, and elevated inflammatory markers (WBC, CRP, neutrophil ratio) are key determinants of expert antibiotic recommendations. Inappropriate antibiotic prescriptions highlighted the need for strengthened antibiotic stewardship in pediatric EDs.