Factors Associated With Antibiotic Prescribing and Outcomes for Pediatric Pneumonia in the Emergency Department.
Journal
Pediatric emergency care
ISSN: 1535-1815
Titre abrégé: Pediatr Emerg Care
Pays: United States
ID NLM: 8507560
Informations de publication
Date de publication:
01 Dec 2021
01 Dec 2021
Historique:
pubmed:
11
7
2019
medline:
18
12
2021
entrez:
11
7
2019
Statut:
ppublish
Résumé
Chest radiographs (CXRs) are often performed in children with respiratory illness to inform the decision to prescribe antibiotics. Our objective was to determine the factors associated with clinicians' plans to treat with antibiotics prior to knowledge of CXR results and the associations between preradiograph plans with antibiotic prescription and return to medical care. Previously healthy children aged 3 months to 18 years with a CXR for suspected pneumonia were enrolled in a prospective cohort study in the emergency department. Our primary outcomes were antibiotic prescription or administration in the emergency department and medical care sought within 7 to 15 days after discharge. Inverse probability treatment weighting was used to limit bias due to treatment selection. Inverse probability treatment weighting was included in a logistic regression model estimating the association between the intention to give antibiotics and outcomes. Providers planned to prescribe antibiotics prior to CXR in 68 children (34.9%). There was no difference in the presence of radiographic pneumonia between those with and without a plan for antibiotics. Children who had a plan for antibiotics were more likely to receive antibiotics than those without (odds ratio [OR], 6.39; 95% confidence interval [CI], 3.7-11.0). This association was stronger than the association between radiographic pneumonia and antibiotic receipt (OR, 3.49; 95% CI, 1.98-6.14). Children prescribed antibiotics were more likely to seek care after discharge than children who were not (OR, 1.85; 95% CI, 1.13-3.05). Intention to prescribe antibiotics based on clinical impression was the strongest predictor of antibiotic prescription in our study. Prescribing antibiotics may lead to subsequent medical care after controlling for radiographic pneumonia.
Identifiants
pubmed: 31290801
pii: 00006565-202112000-00060
doi: 10.1097/PEC.0000000000001892
pmc: PMC6946906
mid: NIHMS1530482
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1033-e1038Subventions
Organisme : NIAID NIH HHS
ID : K01 AI125413
Pays : United States
Organisme : NIAID NIH HHS
ID : K23 AI121325
Pays : United States
Organisme : NHLBI NIH HHS
ID : T35 HL113229
Pays : United States
Informations de copyright
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Disclosure: The authors declare no conflict of interest.
Références
Alpern ER, Stanley RM, Gorelick MH, et al. Epidemiology of a Pediatric Emergency Medicine Research Network: the PECARN Core Data Project. Pediatr Emerg Care . 2006;22:689–699.
Handy LK, Bryan M, Gerber JS, et al. Variability in antibiotic prescribing for community-acquired pneumonia. Pediatrics . 2017;139.
Launay E, Levieux K, Levy C, et al. Compliance with the current recommendations for prescribing antibiotics for paediatric community-acquired pneumonia is improving: data from a prospective study in a French network. BMC Pediatr . 2016;16:126.
Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis . 2011;53:e25–e76.
Rambaud-Althaus C, Althaus F, Genton B, et al. Clinical features for diagnosis of pneumonia in children younger than 5 years: a systematic review and meta-analysis. Lancet Infect Dis . 2015;15:439–450.
Shah SN, Bachur RG, Kim D, et al. Lack of predictive value of tachypnea in the diagnosis of pneumonia in children. Pediatr Infect Dis J . 2010;29:406–409.
Shah SN, Bachur RG, Simel DL, et al. Does this child have pneumonia?: The rational clinical examination systematic review. JAMA . 2017;318:462–471.
Florin TA, Ambroggio L, Brokamp C, et al. Reliability of examination findings in suspected community-acquired pneumonia. Pediatrics . 2017;140.
Grossman LK, Caplan SE. Clinical, laboratory, and radiological information in the diagnosis of pneumonia in children. Ann Emerg Med . 1988;17:43–46.
Alario AJ, McCarthy PL, Markowitz R, et al. Usefulness of chest radiographs in children with acute lower respiratory tract disease. J Pediatr . 1987;111:187–193.
Nelson KA, Morrow C, Wingerter SL, et al. Impact of chest radiography on antibiotic treatment for children with suspected pneumonia. Pediatr Emerg Care . 2016;32:514–519.
Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med . 2015;373:415–427.
Feudtner C, Feinstein JA, Zhong W, et al. Pediatric Complex Chronic Conditions Classification System version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr . 2014;14:199.
Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika . 1983;70:41–55.
Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med . 2015;34:3661–3679.
Swingler GH, Hussey GD, Zwarenstein M. Randomised controlled trial of clinical outcome after chest radiograph in ambulatory acute lower-respiratory infection in children. Lancet . 1998;351:404–408.
Jain S, Williams DJ, Arnold SR, et al. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med . 2015;372:835–845.
Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA . 2016;315:1864–1873.
Zimmerman DR, Kovalski N, Fields S, et al. Diagnosis of childhood pneumonia: clinical assessment without radiological confirmation may lead to overtreatment. Pediatr Emerg Care . 2012;28:646–649.
Lipsett SC, Monuteaux MC, Bachur RG, et al. Negative chest radiography and risk of pneumonia. Pediatrics . 2018;142.
Hamano-Hasegawa K, Morozumi M, Nakayama E, et al. Comprehensive detection of causative pathogens using real-time PCR to diagnose pediatric community-acquired pneumonia. J Infect Chemother . 2008;14:424–432.
Turck D, Bernet JP, Marx J, et al. Incidence and risk factors of oral antibiotic-associated diarrhea in an outpatient pediatric population. J Pediatr Gastroenterol Nutr . 2003;37:22–26.
Lovegrove MC, Geller AI, Fleming-Dutra KE, et al. US emergency department visits for adverse drug events from antibiotics in children, 2011–2015. J Pediatr Infect Dis Soc . 2018. Available at: https://academic.oup.com/jpids/advance-article/doi/10.1093/jpids/piy066/5063274 . Accessed June 28, 2019.
doi: 10.1093/jpids/piy066/5063274