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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.

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Related in: MedlinePlus

Percentage of respondents who recommended an anti-MRSA agent for uncomplicated CAP (N = 135) and PPE (N = 134) across a range of reported MRSA prevalence levels in their community.MRSA, methicillin-resistant S. aureus; CAP, community-acquired pneumonia; PPE, parapneumonic empyema.
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pone-0020325-g002: Percentage of respondents who recommended an anti-MRSA agent for uncomplicated CAP (N = 135) and PPE (N = 134) across a range of reported MRSA prevalence levels in their community.MRSA, methicillin-resistant S. aureus; CAP, community-acquired pneumonia; PPE, parapneumonic empyema.

Mentions: There were 135 respondents who provided data on MRSA prevalence and empiric antibiotic recommendations for uncomplicated CAP and 134 for PPE. In contrast to penicillin non-susceptible pneumococci, we observed an increasing percentage of respondents who recommended anti-MRSA agents across the increasing levels of reported MRSA prevalence for uncomplicated CAP and PPE (Figure 2). For uncomplicated CAP, the percentage increased from 0% of respondents recommending anti-MRSA agents who reported MRSA prevalence <10% to 26% of those who reported MRSA prevalence >50% (p trend = 0.14). For PPE, the percentage increased from 50% of respondents who reported MRSA prevalence <10% to 94% of respondents who reported MRSA prevalence >50% (p trend = 0.01).


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)

Percentage of respondents who recommended an anti-MRSA agent for uncomplicated CAP (N = 135) and PPE (N = 134) across a range of reported MRSA prevalence levels in their community.MRSA, methicillin-resistant S. aureus; CAP, community-acquired pneumonia; PPE, parapneumonic empyema.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0020325-g002: Percentage of respondents who recommended an anti-MRSA agent for uncomplicated CAP (N = 135) and PPE (N = 134) across a range of reported MRSA prevalence levels in their community.MRSA, methicillin-resistant S. aureus; CAP, community-acquired pneumonia; PPE, parapneumonic empyema.
Mentions: There were 135 respondents who provided data on MRSA prevalence and empiric antibiotic recommendations for uncomplicated CAP and 134 for PPE. In contrast to penicillin non-susceptible pneumococci, we observed an increasing percentage of respondents who recommended anti-MRSA agents across the increasing levels of reported MRSA prevalence for uncomplicated CAP and PPE (Figure 2). For uncomplicated CAP, the percentage increased from 0% of respondents recommending anti-MRSA agents who reported MRSA prevalence <10% to 26% of those who reported MRSA prevalence >50% (p trend = 0.14). For PPE, the percentage increased from 50% of respondents who reported MRSA prevalence <10% to 94% of respondents who reported MRSA prevalence >50% (p trend = 0.01).

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