Risk Factors and Outcomes Associated With Antibiotic Therapy in Children Hospitalized With Asthma Exacerbation

Abstract

OBJECTIVE Despite lack of benefit, antibiotics are overused in management of asthma exacerbation in children. In this study, data from a single children's hospital were analyzed to identify factors and outcomes associated with antibiotic use in children hospitalized with asthma. METHODS The study population was identified by using administrative data from 2012 to 2015, with subsequent verification of asthma. We analyzed factors associated with antibiotic use (demographic, seasonal, clinical) and outcome (length of stay [LOS]) with respect to: 1) disposition to pediatric floor (PF) or pediatric intensive care unit (PICU); and 2) evidence of coexisting bacterial infection and/or fever. Statistical analysis included univariate and controlled regression models. Data are presented as median and IQR for continuous variables and OR and regression coefficient (β) with 95% CIs for regression analyses. RESULTS Of 600 patients, 28.8% were admitted to PICU, 14.8% had verified bacterial infection, and 53.8% received antibiotic, mainly azithromycin. Nearly all PICU patients were treated with antibiotic, irrespective of coexisting bacterial infection or fever. Among PF patients, nearly 30% without bacterial infection or fever and 40% with fever alone received antimicrobials. Overall risk for antibiotic treatment was associated with older age, female sex, desaturation events, oxygen supplementation, and PICU admission. Additionally, antibiotic treatment was associated with 13- to 19-hour increased LOS for PF patients without bacterial infection and/or fever. CONCLUSIONS Almost half of pediatric patients admitted with asthma exacerbation received antibiotic therapy with no clear indication, which was associated with prolonged LOS.

Effect of Disease Severity, Age of Child, and Clinic No-Shows on Unscheduled Healthcare Use for Childhood Asthma at an Academic Medical Center

“…Correspondingly, while DV3 could be helpful in planning and developing strategies for long-term asthma management, DV2 may be an ideal indicator (among the three DVs) of unscheduled healthcare use for childhood asthma, particularly with respect to use and re-use of emergency and inpatient healthcare services for childhood asthma. It would also be more consistent with the existing literature on asthma healthcare use, which has mostly relied on 12- or 18-month periods for assessing unscheduled healthcare use for childhood asthma [ 1 , 2 , 16 , 17 ].…”

“…While existing studies have examined the influence of “asthma severity” or “clinic no-shows” on healthcare utilization for childhood asthma at the community (regional, state, or national) level, there are few organizational (hospital or clinic)-based studies that have concurrently examined the influence of individual biologic, demographic, and behavioral risk factors on unscheduled healthcare use for childhood asthma [ 14 , 15 ]. Moreover, while most existing studies have utilized 12-month timeframes to examine unscheduled healthcare use (emergency or inpatient visits) for childhood asthma, this study examines unscheduled healthcare use for childhood asthma over 12-, 18-, and 24-month timeframes [ 1 , 2 , 16 , 17 ].…”

Protective effect of inhaled corticosteroid on children with asthma with Mycoplasma pneumoniae pneumonia

“…Therefore, long-term treatment of ICS in children with asthma can reduce the severity of acute attacks, and exposure to allergens should be avoided. Antibiotic use ( 28 ) and family history of asthma ( 29 ) are risk factors for recurrent hospitalization for acute attacks in children with asthma. Children with asthma require chronic treatment and medium- and high-dose ICS should be used in the acute stage and low-dose ICS should be used in the remission stage after the acute stage.…”