International Practice Patterns of Antibiotic Therapy and Laboratory Testing in Bronchiolitis

Author:

Zipursky Amy1,Kuppermann Nathan2,Finkelstein Yaron13,Zemek Roger4,Plint Amy C.4,Babl Franz E.5,Dalziel Stuart R.6,Freedman Stephen B.7,Steele Dale W.8,Fernandes Ricardo M.9,Florin Todd A.10,Stephens Derek3,Kharbanda Anupam11,Roland Damian1213,Lyttle Mark D.1415,Johnson David W.16,Schnadower David17,Macias Charles G.18,Benito Javier19,Schuh Suzanne13,

Affiliation:

1. Division of Pediatric Emergency Medicine and

2. Departments of Emergency Medicine and Pediatrics, School of Medicine, University of California Davis and University of California Davis Health, Sacramento, California;

3. Research Institute, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada;

4. Division of Pediatric Emergency Medicine, Faculty of Medicine, University of Ottawa and Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada;

5. Emergency Department, Murdoch Children’s Research Institute, The Royal Children’s Hospital and The University of Melbourne, Melbourne, Australia;

6. Emergency Department, Starship Children’s Hospital and the Departments of Surgery and Paediatrics: Child and Youth Health, School of Medicine, The University of Auckland, Auckland, New Zealand;

7. Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children’s Hospital and

8. Department of Pediatric Emergency Medicine, Hasbro Children’s Hospital and Departments of Emergency Medicine and Pediatrics, Warren Alpert Medical School and Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, Rhode Island;

9. Department of Pediatrics, Hospital de Santa Maria and Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal;

10. Department of Pediatrics, Feinberg School of Medicine, Northwestern University and Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois;

11. Department of Pediatric Emergency Medicine, Children’s Hospital of Minnesota, Minneapolis, Minnesota;

12. Paediatric Emergency Medicine Leicester Academic Group, Children’s Emergency Department, Leicester Royal Infirmary, Leicester, United Kingdom;

13. Social Science Applied to Healthcare Improvement Research Group, Department of Health Sciences, University of Leicester, Leicester, United Kingdom;

14. Paediatric Emergency Department, Bristol Royal Hospital for Children, Bristol, United Kingdom;

15. Faculty of Health and Applied Life Sciences, University of the West of England, Bristol, United Kingdom;

16. Departments of Pediatrics, Emergency Medicine, and Physiology and Pharmacology, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, Calgary, Alberta, Canada;

17. Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;

18. Division of Pediatric Emergency Medicine, University Hospitals Rainbow Babies and Children’s Hospital and Case Western Reserve University, Cleveland, Ohio; and

19. Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Bizkaia, Spain

Abstract

BACKGROUND AND OBJECTIVES: International patterns of antibiotic use and laboratory testing in bronchiolitis in emergency departments are unknown. Our objective is to evaluate variation in the use of antibiotics and nonindicated tests in infants with bronchiolitis in 38 emergency departments in Pediatric Emergency Research Networks in Canada, the United States, Australia and New Zealand, the United Kingdom and Ireland, and Spain and Portugal. We hypothesized there would be significant variation, adjusted for patient characteristics. METHODS: We analyzed a retrospective cohort study of previously healthy infants aged 2 to 12 months with bronchiolitis. Variables examined included network, poor feeding, dehydration, nasal flaring, chest retractions, apnea, saturation, respiratory rate, fever, and suspected bacterial infection. Outcomes included systemic antibiotic administration and urine, blood, or viral testing or chest radiography (CXR). RESULTS: In total, 180 of 2359 (7.6%) infants received antibiotics, ranging from 3.5% in the United Kingdom and Ireland to 11.1% in the United States. CXR (adjusted odds ratio [aOR] 2.3; 95% confidence interval 1.6–3.2), apnea (aOR 2.2; 1.1–3.5), and fever (aOR 2.4; 1.7–3.4) were associated with antibiotic use, which did not vary across networks (P = .15). In total, 768 of 2359 infants (32.6%) had ≥1 nonindicated test, ranging from 12.7% in the United Kingdom and Ireland to 50% in Spain and Portugal. Compared to the United Kingdom and Ireland, the aOR (confidence interval) results for testing were Canada 5.75 (2.24–14.76), United States 4.14 (1.70–10.10), Australia and New Zealand 2.25 (0.86–5.74), and Spain and Portugal 3.96 (0.96–16.36). Testing varied across networks (P < .0001) and was associated with suspected bacterial infections (aOR 2.12; 1.30–2.39) and most respiratory distress parameters. Viral testing (591 of 768 [77%]) and CXR (507 of 768 [66%]) were obtained most frequently. CONCLUSIONS: The rate of antibiotic use in bronchiolitis was low across networks and was associated with CXR, fever, and apnea. Nonindicated testing was common outside of the United Kingdom and Ireland and varied across networks irrespective of patient characteristics.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

Cited by 23 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3