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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 clindamycin as an anti-MRSA agent for uncomplicated CAP (N = 27) and PPE (N = 117) across a range of reported clindamycin resistance levels.MRSA, methicillin-resistant S. aureus; CAP, community-acquired pneumonia; PPE, parapneumonic empyema.
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pone-0020325-g003: Percentage of respondents who recommended clindamycin as an anti-MRSA agent for uncomplicated CAP (N = 27) and PPE (N = 117) across a range of reported clindamycin resistance levels.MRSA, methicillin-resistant S. aureus; CAP, community-acquired pneumonia; PPE, parapneumonic empyema.

Mentions: There were 27 respondents who selected an anti-MRSA agent for uncomplicated CAP and provided data on clindamycin resistance and 117 for PPE. Overall, we found no direct relationship between the selection of clindamycin as an anti-MRSA agent and the reported level of clindamycin resistance (Figure 3). For uncomplicated CAP, examining this relationship is somewhat limited due to the fact that clindamycin was the anti-MRSA agent recommended by 86% of respondents. There was a trend towards a decline in the percentage of respondents who selected clindamycin as reported clindamycin resistance increased, declining from 100% among those reporting clindamycin resistance <10% to 67% among those reporting clindamycin resistance 25–50% (p trend = 0.06), however, selection of clindamycin remained high overall. For PPE, the percentage recommending clindamycin as the anti-MRSA agent was unchanged as reported clindamycin resistance increased, ranging from 38%–41% across all levels (p trend = 0.86).


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 clindamycin as an anti-MRSA agent for uncomplicated CAP (N = 27) and PPE (N = 117) across a range of reported clindamycin resistance levels.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-g003: Percentage of respondents who recommended clindamycin as an anti-MRSA agent for uncomplicated CAP (N = 27) and PPE (N = 117) across a range of reported clindamycin resistance levels.MRSA, methicillin-resistant S. aureus; CAP, community-acquired pneumonia; PPE, parapneumonic empyema.
Mentions: There were 27 respondents who selected an anti-MRSA agent for uncomplicated CAP and provided data on clindamycin resistance and 117 for PPE. Overall, we found no direct relationship between the selection of clindamycin as an anti-MRSA agent and the reported level of clindamycin resistance (Figure 3). For uncomplicated CAP, examining this relationship is somewhat limited due to the fact that clindamycin was the anti-MRSA agent recommended by 86% of respondents. There was a trend towards a decline in the percentage of respondents who selected clindamycin as reported clindamycin resistance increased, declining from 100% among those reporting clindamycin resistance <10% to 67% among those reporting clindamycin resistance 25–50% (p trend = 0.06), however, selection of clindamycin remained high overall. For PPE, the percentage recommending clindamycin as the anti-MRSA agent was unchanged as reported clindamycin resistance increased, ranging from 38%–41% across all levels (p trend = 0.86).

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