Management of Community-Acquired Pneumonia in Pediatrics: Adherence to Clinical Guidelines

Abstract

Objectives: To evaluate adherence to guidelines for inpatient care of pediatric patients with community-acquired pneumonia (CAP). Background: Pediatric CAP is one of the most common acute infections requiring hospital admission. Discrepancies between recommended care and effective management are reported, raising the necessity to evaluate our local clinical practices. Patients and Methods: Retrospective data review of all children hospitalized for CAP at our institution was conducted between 2014 and 2017. Adherence to inpatient care guidelines was evaluated with a focus on indication of hospitalization, initial antibiotic choice, treatment duration, and hospital stay. A bivariate analysis was performed to identify clinical factors influencing adherence rates. Results: A total of 122 children (median age of 3.5 years) were identified. Hospital admission was indicated in 47.5% of patients and was driven by the value of serum CRP as well as prolonged fever. Median hospital stay was 4 days and was justified in 23.8% of patients. The choice of antibiotics was relevant in 91.8% of cases and amoxicillin-clavulanate was the most prescribed drug. The drugs dose, interval, and route of administration were respected in all cases. Antimicrobial therapy lasted for a median of 10 days and was in accordance with recommendations in 58.3% of patients. No clinical parameter was found to be significantly associated with length of stay or choice and duration of treatment. Conclusions: The choice of antibiotics was consistent with guidelines but treatment duration, indication and length of hospitalization still need to be improved.

Assessment of Difference in the Clinical and Microbial Spectrum of Community-Acquired Pneumonia among Egyptian Children

“…Patients' mean age was 1.79 years and it ranged from 2 month to 7 years, and weight ranged from 3 to 21 Kg with a mean of 9.61 Kg. These findings were in agreement with the study of Hatem et al (8) , and Tannous et al (9) who showed that 60.4% of patients were males and 39.5% were females. On the contrary, Mathew et al (10) found that there were no major differences in gender.…”

“…As regard blood culture, 66.7% were -ve, 11.1% were contaminated and 22.2% were +ve (most frequent organism was Staph 13%). The study of Hatem et al (9) revealed that most of the identified microbes were isolated from culture of respiratory specimens and blood. They found that S. aureus 35.4% was the most common pathogen detected in sputum regardless the age group, candida was 12.5%, Klebsiella was 8.33%, and Pseudomonus was 4.16%.…”

Aetiology of acute respiratory infection in preschool children requiring hospitalisation in Europe—results from the PED-MERMAIDS multicentre case–control study

“… 36 In terms of disease severity, the group of cases in our study does not seem to differ from children included in other studies on hospitalisations for ARI (including, but not exclusively, CAP) in comparable settings. 37 Although overall case severity showed a good representation of the intended group, it is nonetheless possible that convenience sampling biased associations between detected pathogens and hospitalisation in either direction.…”

Impact of reducing the duration of antibiotic treatment on the long-term prognosis of community acquired pneumonia

“…On the one hand, it reduces antimicrobial resistance, possible adverse effects and costs, while, on the other hand, it improves adherence to treatment [ 6 – 9 ]. However, despite current evidence avoiding unnecessarily prolonged treatments remains an arduous task, likely due to a false sense of security provided by longer-term treatments [ 21 ]. In fact, a retrospective study carried out in the United States in patients admitted for CAP, observed that the average duration of antibiotic treatment exceeded the recommended time by 74 and 71% for patients aged 18–64 years and ≥ 65 years, respectively [ 22 ].…”