1449. Comparison of Emergency Department versus Inpatient Pediatric Treatment for Empiric Community Acquired Pneumonia in Infants and Children over 3 months of age
Session: Poster Abstract Session: Respiratory Infections: CAP
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • Comparison of Emergency Department versus Inpatient Pediatric Treatment for Empiric Community Acquired Pneumonia in Infants and Children over 3 months of age.pdf (866.8 kB)
  • Background: The Infectious Diseases Society of America (IDSA) made guidelines for management of community acquired pneumonia (CAP) in healthy infants and children older than 3 month of age. These were made to assist clinicians in choosing appropriate antimicrobial therapy in order to decrease morbidity and mortality and minimize antimicrobial resistance. Accordingly, narrow spectrum antibiotics as first line treatment but inappropriate selection of broad spectrum antibiotics remains high. Our study investigates the concordance between emergency department (ED) and in-patient prescribers in choosing appropriate antibiotic therapy for CAP.

    Methods: This retrospective chart review the aforementioned population who were admitted to the inpatient pediatric service via the ED from January 1, 2015 – December 1. 2017. Data collection included patient demographics, prior antibiotic use from an outside prescriber, the antimicrobial prescribed in the ED, and the antimicrobial used in the pediatric unit. The primary outcome determined the consistency between the prescribing pattern in the ED and the inpatient. A descriptive statistical analysis was conducted afterward.

    Results: 210 patients were admitted to the inpatient pediatric service. The ED prescribed an aminopenicillin to 2.9% of patients or a cephalosporin as monotherapy to 70.9%; 0.9% of patients were started on both types. Once under the hospitalist’s service, the hospitalist continued the cephalosporin in 72.4%, switched to an aminopenicillin in 10.6%, switched to a macrolide in 5.4%, and 8.1% discontinued antimicrobrials altogether. If an aminopenicillin was started in the ED, it was continued by the hospitalist in 83.3% of the cases, with none switching to a cephalosporin, and 1 patient being switched to a macrolide.

    Conclusion: At our local pediatric hospital, there is poor compliance with IDSA guidelines for CAP. There is high concordance between ED and in-patient prescribers since hospitalists were more likely to continue the antimicrobial started in the ED. Guideline adherence might be improved by focus on antibiotic stewardship and creating order sets that adhere to IDSA guidelines. Future studies could investigate if these suggestions improve overall adherence rates.

    Jan Fune, MD, Pediatrics, Jersey Shore University Medical Center, Neptune, NJ

    Disclosures:

    J. Fune, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.