Limits...
Variability in pediatric infectious disease consultants' recommendations for management of community-acquired pneumonia.

Hersh AL, Shapiro DJ, Newland JG, Polgreen PM, Beekmann SE, Shah SS - PLoS ONE (2011)

Bottom Line: 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.Substantial 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.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah, United States of America. adam.hersh@hsc.utah.edu

ABSTRACT

Background: Community-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.

Methods: We 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.

Results: We 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.

Conclusions: Substantial 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.

Show MeSH

Related in: MedlinePlus

Recommended duration of therapy for uncomplicated CAP (N = 140) and PPE (N = 138).CAP, community-acquired pneumonia; PPE, parapneumonic empyema.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3105054&req=5

pone-0020325-g001: Recommended duration of therapy for uncomplicated CAP (N = 140) and PPE (N = 138).CAP, community-acquired pneumonia; PPE, parapneumonic empyema.

Mentions: Overall, respondents generally recommended longer duration for PPE than for uncomplicated cases (Figure 1). For uncomplicated cases, 140 respondents provided data for duration and only 10% (14/140) recommended a duration of 7 days or less. The most common duration was 8–10 days, recommended by 56% (78/140). For PPE, 138 respondents provided data and 35% (48/138) recommended 11–14 days, 41% (57/138) recommended 15–21 days and 17% (24/138) recommended >21 days. 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 CAP or PPE.


Variability in pediatric infectious disease consultants' recommendations for management of community-acquired pneumonia.

Hersh AL, Shapiro DJ, Newland JG, Polgreen PM, Beekmann SE, Shah SS - PLoS ONE (2011)

Recommended duration of therapy for uncomplicated CAP (N = 140) and PPE (N = 138).CAP, community-acquired pneumonia; PPE, parapneumonic empyema.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3105054&req=5

pone-0020325-g001: Recommended duration of therapy for uncomplicated CAP (N = 140) and PPE (N = 138).CAP, community-acquired pneumonia; PPE, parapneumonic empyema.
Mentions: Overall, respondents generally recommended longer duration for PPE than for uncomplicated cases (Figure 1). For uncomplicated cases, 140 respondents provided data for duration and only 10% (14/140) recommended a duration of 7 days or less. The most common duration was 8–10 days, recommended by 56% (78/140). For PPE, 138 respondents provided data and 35% (48/138) recommended 11–14 days, 41% (57/138) recommended 15–21 days and 17% (24/138) recommended >21 days. 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 CAP or PPE.

Bottom Line: 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.Substantial 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.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah, United States of America. adam.hersh@hsc.utah.edu

ABSTRACT

Background: Community-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.

Methods: We 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.

Results: We 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.

Conclusions: Substantial 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.

Show MeSH
Related in: MedlinePlus