1449. Comparison of Emergency Department vs. Inpatient Pediatric Treatment for Empiric Community Acquired Pneumonia in Infants and Children over 3 Months of Age

Abstract

BackgroundThe Infectious Diseases Society of America (IDSA) made guidelines for management of community acquired pneumonia (CAP) in healthy infants and children older than 3 months 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.MethodsThis retrospective chart reviews 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.ResultsA total of 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 one patient being switched to a macrolide.ConclusionAt 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.Disclosures All authors: No reported disclosures.