Variation in Resource Utilization for the Management of Uncomplicated Community-Acquired Pneumonia across Community and Children's Hospitals

Abstract

Objective To describe patterns of diagnostic testing and antibiotic management of uncomplicated pneumonia in general community hospitals and children's hospitals within hospitals, and to determine the association between diagnostic testing and length of hospital stay. Study design We conducted a retrospective cohort study of children 1-17 years of age hospitalized with the diagnosis of pneumonia from 2007-2010 to hospitals contributing data to Perspective Database Warehouse, assessing patterns of diagnostic testing and antibiotic management. We constructed logistic regression models of log-transformed length of stay and grouped treatment models to ascertain whether performance of blood cultures and viral respiratory testing were associated with length of stay. Results 17299 pneumonia cases occurred at 125 hospitals, with considerable variability in pneumonia management. Only 40 (0.2%) received ampicillin/penicillin G alone or in combination with other antibiotics, and 1318 (7.4%) received macrolide monotherapy as initial antibiotic management. Performance of blood culture and testing for respiratory viruses was associated with a statistically significant longer length of stay, but these differences did not persist in grouped treatment models. Conclusions We observed higher rates of diagnostic testing in this cohort of structurally diverse hospitals than previously reported at freestanding children's hospitals, with extremely low rates of narrow-spectrum antibiotic use. Tailored antibiotic stewardship initiatives at these hospitals are needed to achieve adherence to national guideline recommendations.

Risk factors for hospitalizations due to bacterial respiratory tract infections after tracheotomy

“…Increased risk of hospital readmission for a bRTI and poorer outcomes in children with younger age, Hispanic ethnicity and government payer status complements findings of previous studies and highlight potential opportunities to optimize outpatient care access and management of this complex patient population. For example, because frequent hospitalizations may impact attendance at outpatient preventative care visits for vaccinations, opportunities may exist to increase vaccination coverage rates by giving age‐appropriate vaccinations on the inpatient setting or at subspecialty outpatient appointments.…”

Advances in the diagnosis of pneumonia in children

“…Serological testing of blood specimens may be useful for epidemiological studies of the cause of pneumonia, where comparison of acute and convalescent titers may help identify the causative agent, [93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110][111][112] although the diagnostic value of a single specimen collected in the acute phase of the illness is generally limited. Pertussis serology may be a useful complementary diagnostic tool in older children and during the later phases of illness.…”

Utility of blood cultures in children admitted to hospital with community‐acquired pneumonia

“…Data from the United States suggest that most patients admitted with CAP receive third‐generation cephalosporin despite the fact that most cases are caused by penicillin‐sensitive Strep. pneumoniae . Current NSW Health guidelines recommend treating mild to moderate disease with amoxicillin, and moderate CAP with intravenous benzylpenicillin if oral antibiotics are not tolerated.…”