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Hospital outcomes associated with guideline‐recommended antibiotic therapy for pediatric pneumonia
Author(s) -
Thomson Joanna,
Ambroggio Lilliam,
Murtagh Kurowski Eileen,
Statile Angela,
Graham Camille,
Courter Joshua D.,
Sheehan Brieanne,
Iyer Srikant,
White Christine M.,
Shah Samir S.
Publication year - 2015
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.2265
Subject(s) - medicine , guideline , interquartile range , pharmacy , pneumonia , emergency medicine , retrospective cohort study , pneumonia severity index , confidence interval , intensive care medicine , community acquired pneumonia , family medicine , pathology
BACKGROUND Recent national guidelines recommend use of narrow‐spectrum antibiotic therapy as empiric treatment for children hospitalized with community‐acquired pneumonia (CAP). However, clinical outcomes associated with adoption of this recommendation have not been studied. METHODS This retrospective cohort study included children age 3 months to 18 years, hospitalized with CAP from May 2, 2011 through July 30, 2012. Primary exposure of interest was empiric antibiotic therapy, classified as guideline recommended or not. Primary outcomes were length of stay (LOS), total hospital costs, and inpatient pharmacy costs. Secondary outcomes included broadened antibiotic therapy, emergency department revisits, and readmissions. Multivariable linear regression and Fisher exact test were performed to determine the association of guideline‐recommended antibiotic therapy on outcomes. RESULTS Empiric guideline‐recommended therapy was prescribed to 168 (76%) of 220 patients. Median hospital LOS was 1.3 days (interquartile range [IQR]: 0.9–1.9 days), median total cost of index hospitalization was $4097 (IQR: $2657–$6054), and median inpatient pharmacy cost was $91 (IQR: $40–$183). Between patients who did and did not receive guideline‐recommended therapy, there were no differences in LOS (adjusted −5.8% change; 95% confidence interval [CI]: −22.1 to 12.8), total costs (adjusted −10.9% change; 95% CI: −27.4 to 9.4), or inpatient pharmacy costs (adjusted 14.8% change; 95% CI: −43.4 to 27.1). Secondary outcomes were rare, with no difference in unadjusted analysis between patients who did and did not receive guideline‐recommended therapy. CONCLUSIONS Use of guideline‐recommended antibiotic therapy was not associated with unintended negative consequences; there were no changes in LOS, total costs, or inpatient pharmacy costs. Journal of Hospital Medicine 2015;10:13–18. © 2014 Society of Hospital Medicine