1273. Comparison of Antibiotic Prescribing for Pediatric Community-Acquired Pneumonia Between Children’s and Non-Children’s Hospitals
Session: Oral Abstract Session: Pediatric Antimicrobial Stewardship
Friday, October 9, 2015: 2:00 PM
Room: 5--AB
Background: Children treated for community-acquired pneumonia (CAP) with penicillin, amoxicillin, or ampicillin have outcomes similar to those treated with broad-spectrum agents, and 2011 IDSA/PIDS guidelines recommend these agents as first-line therapy for pediatric CAP. Use of recommended agents has improved in children’s hospitals following guideline release. A substantial proportion of pediatric CAP hospitalizations, however, occur in non-children’s hospitals, where post-guideline antibiotic use has not been evaluated.

Methods: Retrospective analysis of children 1-17 years admitted in 2013 to 323 hospitals, captured via the Pediatric Health Information System and Premier Perspective databases. Children’s hospitals were identified as having >75% pediatric admissions (n=49). Children with CAP were identified using a validated ICD-9 code-based algorithm, excluding those with complicated pneumonia, complex chronic conditions, receipt of intensive care, and MRSA infection or colonization. Antibiotic use was assessed as: 1) ever received penicillin, ampicillin, or amoxicillin (“guideline”), 2) ever received a macrolide, fluoroquinolone, or tetracycline (“atypical”), and 3) received any non-guideline antibiotic. Standardized probability of exposure to select antibiotics was compared between children’s and non-children’s hospitals, adjusting for age, sex, and insurance provider.

Results: Of 15,222 children hospitalized with CAP, 60% were admitted to children’s hospitals. Median age was 3 years (IQR 2-6 years); 51% were male and 56% had public insurance. After adjustment, children admitted to non-children’s hospitals received guideline therapy less often than those in children’s hospitals, and received atypical coverage and non-guideline therapy more often than those in children’s hospitals (Table, p<0.001 for all comparisons).

Conclusion: Significant disparities exist in antibiotic prescribing for pediatric CAP between children’s and non-children’s hospitals. Further study is needed to understand these differences and improve guideline adherence for all children hospitalized with CAP.

 

 

Children’s

Non-Children’s

Guideline

46 (39-54)

14 (11-18)

Atypical

36 (32-40)

50 (45-55)

Non-guideline

77 (71-84)

 94 (92-96) 

Table. Standardized % (95% CI) of children receiving select antibiotics for CAP, by hospital type

Alison Tribble, MD1,2, Rachael Ross, MPH1,3, Neika Vendetti, MPH1,3 and Jeffrey S. Gerber, MD, PhD1,2,3, (1)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, (3)Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA

Disclosures:

A. Tribble, None

R. Ross, None

N. Vendetti, Merck: Investigator , Research support

J. S. Gerber, Pfizer: Grant Investigator , Research grant

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