Does CAP Antibiotic Prescribing Differ in Children's vs Non-Children's Hospitals?
At both types of hospitals the trajectory of guideline-concordant antibiotic prescribing changed following the release of the pediatric CAP guidelines in 2011.
Although guideline-concordant antibiotic prescribing in pediatric patients with community-acquired pneumonia (CAP) has increased in both children's and non-children's hospitals, prescribing trends in non-children's hospitals appear to be falling behind children's hospitals.
A retrospective analysis was conducted using 2 hospital billing databases of inpatient discharges from across the United States: Pediatric Health Information System (PHIS; children's hospitals only) and Premier Perspectives (both children's and non-children's hospitals). Results of the study were published in JAMA Pediatrics.
Investigators sought to compare antibiotic prescribing habits in pediatric patients with CAP between hospital types prior to and following guideline publication in 2011. The study participants included children who were admitted for CAP and were discharged between January 1, 2009, and September 30, 2015 based on the following criteria: a primary diagnosis of pneumonia, receipt of a systemic antibiotic potentially prescribed for CAP (eg, penicillins with or without beta-lactamase inhibitors, cephalosporins, carbapenems, macrolides, doxycycline, fluoroquinolones, vancomycin, linezolid, clindamycin, or trimethoprim-sulfamethoxazole), and an overnight stay.
A total of 120,238 children were identified; 62,923 were boys. Median patient age was 3 years (interquartile range, 1-6 years). All patients with CAP had been discharged from 51 children's hospitals (46 PHIS hospitals and 5 Premier Perspectives hospitals; 54.2% [n=65,029]) and from 471 non-children's hospitals (45.8% [n=55,029]).
At both types of hospitals, the trajectory of guideline-concordant prescribing changed following the release of the pediatric CAP guidelines. In children's hospitals, the modeled probability of guideline-concordant prescribing increased from 0.25 (95% CI, 0.15-0.34) immediately prior to guideline release to 0.61 (95% CI, 0.56-0.66) at the end of the study. If the pre-guideline trend had been maintained without the observed change after guideline release, the probability of prescribing according to guidelines would have been 0.31 (95% CI, 0.15-0.47; P =.001) at study conclusion.
In non-children's hospitals, the probability of guideline-concordant prescribing increased from 0.06 (95% CI, 0.04-0.08) immediately prior to guideline release to 0.27 (95% CI, 0.20-0.35) at the end of the study. If the pre-guideline trend had continued, prescribing according to guidelines would have been 0.08 (95% CI, 0.01-0.14; P =.004) at the study conclusion.
Post-guideline paths were similar from the beginning to the end of the final study year: 0.08 absolute increase (95% CI, 0.05-0.10) at children's hospitals vs 0.07 absolute increase (95% CI, 0.04-0.10) at non-children's hospitals (P =.56).
The findings demonstrated that 4 years after publication of national pediatric CAP guidelines, only 27% of pediatric patients admitted to non-children's hospitals receive guideline-concordant therapy compared with 61% of patients in children's hospitals.
The investigators concluded that addressing the discrepancy in antibiotic prescribing habits may represent an important goal for antimicrobial stewardship efforts.
Tribble AC, Ross RK, Gerber JS. Comparison of antibiotic prescribing for pediatric community-acquired pneumonia in children's and non-children's hospitals [published online December 10, 2018]. JAMA Pediatr. doi:10.1001/jamapediatrics.2018.4270