Longer Hospital Stay, Higher Costs With Unwarranted Antibiotics in Asthma Exacerbations

This article is part of Pulmonology Advisor‘s coverage of the American Thoracic Society’s International Conference, taking place in San Diego, California. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from ATS 2018.

SAN DIEGO — Increased length of hospital stay and costs were seen when antibiotics were given to adults admitted for an asthma exacerbation without documented indication of lung infection, according to researchers from Baystate Medical Center in Springfield, Massachusetts.¹

At the American Thoracic Society 2018 International Conference, lead author Mihaela S. Stefan, MD, PhD, reiterated that clinical guidelines state there is no place for antibiotics in asthma exacerbation “unless there is strong evidence of lung infection.” Previous findings from a study conducted by Dr Stefan and colleagues revealed that antibiotics were administered to 60% of patients without indication of a lung infection.²

For this analysis, the researchers conducted an observational comparative effectiveness study of patients hospitalized for asthma during a 2-year period at more than 550 US hospitals. Patients diagnosed with a sinus infection, pneumonia, bronchitis, sepsis, or any condition that would potentially involve antibiotics were excluded.

The data showed 46.1% of the remaining patients were given antibiotics within their first 2 days of being hospitalized. Propensity-matched analysis indicated that patients receiving antibiotics had longer hospital length of stay (4.4 vs 3.4 days; P <.0001), greater hospitalization costs ($6427 vs $5387), as well as a 55% increased risk for antibiotic-related diarrhea (odds ratio, 1.55; 95% CI, 1.16-2.08) compared with those who did not receive antibiotics.

No difference, however, was observed regarding risk for treatment failure between the compared groups (odds ratio, 1.02; 95% CI, 0.88-1.17). Treatment failure was defined as the start of invasive or noninvasive mechanical ventilation, transfer to the intensive care unit after day 2, and in-hospital mortality or readmission for asthma exacerbation within 30 days of discharge.

Dr Stefan added that the study’s findings further confirmed that “antibiotics should not be prescribed routinely in adult patients hospitalized with asthma.” She called for greater antibiotic stewardship in hospitals and reassessment of patient care for those hospitalized with asthma. A future qualitative study is anticipated to better understand why physicians administer antibiotics in asthma.

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References

1. Stefan MS, Lindenauer PK, Shieh M, Pekow P. High antibiotics prescribing in patients hospitalized with asthma exacerbation — but are antibiotics associated with better outcomes? Presented at:  American Thoracic Society 2018 International Conference; May 18-23, 2018; San Diego, CA. Abstract 16204.
2. Lindenauer PK, Stefan MS, Feemster LC, et al. Use of antibiotics among patients hospitalized for exacerbations of asthma. JAMA Intern Med. 2016;176(9):1397-1400.