Methods: Diagnosis codes were used to identify patients from 4 months to 18 years old with a diagnosis of CAP between January 2012 and December 2015. Hospital records were reviewed to confirm the diagnosis of CAP and to determine patient demographics, risk factors, clinical characteristics, and treatment outcomes. Patients who were immunocompromised for any reason, had cystic fibrosis, a current tracheostomy, or other concurrent bacterial illnesses were excluded. Factors for children who were treated according to guideline recommendations and those who were not were compared using Fisher’s exact test or Mann-Whitney test. A multivariable logistic regression analysis evaluated the relationship between patient factors, clinical characteristics, and guideline adherence. Data analysis was performed using Stata 14.
Results: Of the 154 children with CAP, 90 (58%) were treated according to the guidelines. In non-adherent cases, antibiotic coverage was too broad in 23 (36%) patients, included unnecessary MRSA coverage in 11 (17%), and was of prolonged duration in 20 (31%) patients. Only 10 (16%) had antibiotic coverage that was too narrow. The adherent group had a 1-day shorter length of stay (LOS) (P=0.05) and 2-day shorter duration of antibiotic therapy (P<0.01). There was no significant difference in the number of chest X-rays performed, complications, duration of fever, supplemental oxygen use, and need for intensive care unit admission. On regression analysis, older age and age-appropriate immunization status were significantly associated with decreased adjusted odds of guideline adherence, odds ratio (OR) = 0.8, 95% confidence interval (CI) [0.66, 0.95], and 0.09, [0.01, 0.59], respectively.
Conclusion: Guideline adherence is associated with similar outcomes, shorter LOS, and duration of treatment compared to non-adherence. Further studies should investigate why older children are less likely to receive recommended antibiotic therapy for CAP.