Abstract
BackgroundCommunity-acquired pneumonia (CAP) is a common childhood infection. CAP complications, such as parapneumonic empyema (PPE), are increasing and are frequently caused by antibiotic-resistant organisms. No clinical guidelines currently exist for management of pediatric CAP and no published data exist about variations in antibiotic prescribing patterns. Our objectives were to describe variation in CAP clinical management for hospitalized children by pediatric infectious disease consultants and to examine associations between recommended antibiotic regimens and local antibiotic resistance levels.MethodsWe surveyed pediatric members of the Emerging Infections Network, which consists of 259 pediatric infectious disease physicians. Participants responded regarding their recommended empiric antibiotic regimens for hospitalized children with CAP with and without PPE and their recommendations for duration of therapy. Participants also provided information about the prevalence of penicillin non-susceptible S. pneumoniae and methicillin-resistant S. aureus (MRSA) in their community.ResultsWe received 148 responses (57%). For uncomplicated CAP, respondents were divided between recommending beta-lactams alone (55%) versus beta-lactams in combination with another class (40%). For PPE, most recommended a combination of a beta-lactam plus an anti-MRSA agent, however, they were divided between clindamycin (44%) and vancomycin (57%). The relationship between reported antibiotic resistance and empiric regimen was mixed. We found no relationship between aminopenicillin use and prevalence of penicillin non-suscepetible S. pneumoniae or clindamycin use and clindamycin resistance, however, respondents were more likely to recommend an anti-MRSA agent when MRSA prevalence increased.ConclusionsSubstantial variability exists in recommendations for CAP management. Development of clinical guidelines via antimicrobial stewardship programs and dissemination of data about local antibiotic resistance patterns represent opportunities to improve care.
Highlights
Community acquired pneumonia (CAP) is a common serious infection in childhood, accounting for over 150,000 hospitalizations each year in the US [1]
The extent to which antibiotic recommendations for pneumonia reflect local resistance patterns for these organisms is unknown. It is unknown whether clindamycin and vancomycin, which have activity against methicillin-resistant S. aureus (MRSA), are recommended more frequently for parapneumonic empyema (PPE) in communities where MRSA prevalence is higher
We found no associations between treatment duration and antibiotic regimens, reported MRSA prevalence, the presence of a clinical guideline or ASP or years of experience for either uncomplicated Community-acquired pneumonia (CAP) or PPE
Summary
Community acquired pneumonia (CAP) is a common serious infection in childhood, accounting for over 150,000 hospitalizations each year in the US [1]. Antibiotic-resistant organisms, especially Staphylococcus aureus and Streptococcus pneumoniae are important causes of CAP and PPE. Resistance patterns for these organisms vary widely throughout the United States [5,6,7,8]. CAP complications, such as parapneumonic empyema (PPE), are increasing and are frequently caused by antibiotic-resistant organisms. No clinical guidelines currently exist for management of pediatric CAP and no published data exist about variations in antibiotic prescribing patterns. Our objectives were to describe variation in CAP clinical management for hospitalized children by pediatric infectious disease consultants and to examine associations between recommended antibiotic regimens and local antibiotic resistance levels
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