David G Bundy1, Troy E Richardson2, Matthew Hall2, Jean L Raphael3, David C Brousseau4, Staci D Arnold5, Ram V Kalpatthi6, Angela M Ellison7, Suzette O Oyeku8, Samir S Shah9,10,11. 1. Department of Pediatrics, Medical University of South Carolina, Charleston. 2. Department of Research and Statistics, Children's Hospital Association, Lenexa, Kansas. 3. Department of Pediatrics, Baylor College of Medicine, Houston, Texas. 4. Department of Pediatrics, Medical College of Wisconsin, Milwaukee. 5. Department of Pediatrics, Emory University, Atlanta, Georgia. 6. Department of Pediatrics, University of Missouri-Kansas City School of Medicine. 7. Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 8. Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York. 9. Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 10. Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 11. Section editor.
Abstract
Importance: Acute chest syndrome (ACS) is a common, serious complication of sickle cell disease (SCD) and a leading cause of hospitalization and death in both children and adults with SCD. Little is known about the effectiveness of guideline-recommended antibiotic regimens for the care of children hospitalized with ACS. Objectives: To use a large, national database to describe patterns of antibiotic use for children with SCD hospitalized for ACS and to determine whether receipt of guideline-adherent antibiotics was associated with lower readmission rates. Design, Setting, and Participants: Retrospective cohort study including 14 480 hospitalizations in 7178 children (age 0-22 years) with a discharge diagnosis of SCD and either ACS or pneumonia. Information was obtained from 41 children's hospitals submitting data to the Pediatric Health Information System from January 1, 2010, to December 31, 2016. Exposures: National Heart, Lung, and Blood Institute guideline-adherent (macrolide with parenteral cephalosporin) vs non-guideline-adherent antibiotic regimens. Main Outcomes and Measures: Acute chest syndrome-related and all-cause 7- and 30-day readmissions. Results: Of the 14 480 hospitalizations, 6562 (45.3%) were in girls; median (interquartile range) age was 9 (4-14) years. Guideline-adherent antibiotics were provided in 10 654 of 14 480 hospitalizations for ACS (73.6%). Hospitalizations were most likely to include guideline-adherent antibiotics for children aged 5 to 9 years (3230 of 4047 [79.8%]) and declined to the lowest level for children 19 to 22 years (697 of 1088 [64.1%]). Between-hospital variation in antibiotic regimens was wide, with use of guideline-adherent antibiotics ranging from 24% to 90%. Children treated with guideline-adherent antibiotics had lower 30-day ACS-related (odds ratio [OR], 0.71; 95% CI, 0.50-1.00) and all-cause (OR, 0.50; 95% CI, 0.39-0.64) readmission rates vs children who received other regimens (cephalosporin and macrolide vs neither drug class). Conclusions and Relevance: Current approaches to antibiotic treatment in children with ACS vary widely, but guideline-adherent therapy appears to result in fewer readmissions compared with non-guideline-adherent therapy. Efforts to increase the dissemination and implementation of SCD treatment guidelines are warranted as is comparative effectiveness research to strengthen the underlying evidence base.
Importance: Acute chest syndrome (ACS) is a common, serious complication of sickle cell disease (SCD) and a leading cause of hospitalization and death in both children and adults with SCD. Little is known about the effectiveness of guideline-recommended antibiotic regimens for the care of children hospitalized with ACS. Objectives: To use a large, national database to describe patterns of antibiotic use for children with SCD hospitalized for ACS and to determine whether receipt of guideline-adherent antibiotics was associated with lower readmission rates. Design, Setting, and Participants: Retrospective cohort study including 14 480 hospitalizations in 7178 children (age 0-22 years) with a discharge diagnosis of SCD and either ACS or pneumonia. Information was obtained from 41 children's hospitals submitting data to the Pediatric Health Information System from January 1, 2010, to December 31, 2016. Exposures: National Heart, Lung, and Blood Institute guideline-adherent (macrolide with parenteral cephalosporin) vs non-guideline-adherent antibiotic regimens. Main Outcomes and Measures: Acute chest syndrome-related and all-cause 7- and 30-day readmissions. Results: Of the 14 480 hospitalizations, 6562 (45.3%) were in girls; median (interquartile range) age was 9 (4-14) years. Guideline-adherent antibiotics were provided in 10 654 of 14 480 hospitalizations for ACS (73.6%). Hospitalizations were most likely to include guideline-adherent antibiotics for children aged 5 to 9 years (3230 of 4047 [79.8%]) and declined to the lowest level for children 19 to 22 years (697 of 1088 [64.1%]). Between-hospital variation in antibiotic regimens was wide, with use of guideline-adherent antibiotics ranging from 24% to 90%. Children treated with guideline-adherent antibiotics had lower 30-day ACS-related (odds ratio [OR], 0.71; 95% CI, 0.50-1.00) and all-cause (OR, 0.50; 95% CI, 0.39-0.64) readmission rates vs children who received other regimens (cephalosporin and macrolide vs neither drug class). Conclusions and Relevance: Current approaches to antibiotic treatment in children with ACS vary widely, but guideline-adherent therapy appears to result in fewer readmissions compared with non-guideline-adherent therapy. Efforts to increase the dissemination and implementation of SCD treatment guidelines are warranted as is comparative effectiveness research to strengthen the underlying evidence base.
Authors: Samir K Ballas; Susan Lieff; Lennette J Benjamin; Carlton D Dampier; Matthew M Heeney; Carolyn Hoppe; Cage S Johnson; Zora R Rogers; Kim Smith-Whitley; Winfred C Wang; Marilyn J Telen Journal: Am J Hematol Date: 2010-01 Impact factor: 10.047
Authors: Jay G Berry; Sara L Toomey; Alan M Zaslavsky; Ashish K Jha; Mari M Nakamura; David J Klein; Jeremy Y Feng; Shanna Shulman; Vincent W Chiang; Vincent K Chiang; William Kaplan; Matt Hall; Mark A Schuster Journal: JAMA Date: 2013-01-23 Impact factor: 56.272
Authors: F M Gill; L A Sleeper; S J Weiner; A K Brown; R Bellevue; R Grover; C H Pegelow; E Vichinsky Journal: Blood Date: 1995-07-15 Impact factor: 22.113
Authors: Susan Claster; Amanda Termuhlen; Sheree M Schrager; Julie A Wolfson; Ellen Iverson Journal: Pediatr Blood Cancer Date: 2013-08-26 Impact factor: 3.167
Authors: Alyssa H Silver; Nora Esteban-Cruciani; Gabriella Azzarone; Lindsey C Douglas; Diana S Lee; Sheila Liewehr; Joanne M Nazif; Ilir Agalliu; Susan Villegas; Hai Jung H Rhim; Michael L Rinke; Katherine O'Connor Journal: Pediatrics Date: 2015-11-09 Impact factor: 7.124