Factors Associated with the Use of Antibiotic Therapy in Previously Healthy Children Under 2 Years Old Hospitalized for Bronchiolitis
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v3i2.3796
Abstract
Objective: To profile patient characteristics and factors leading to antibiotic prescription in all previously healthy children under 2 years of age hospitalized with a diagnosis of bronchiolitis over a 12-month period at a specialized pediatric hospital. Methods: This was a descriptive observational study of the clinical and epidemiological characteristics of previously healthy children under 2 years of age hospitalized with a diagnosis of bronchiolitis from January 1 to December 31, 2018, at the "Dr. Carlos Sáenz Herrera" National Children's Hospital of the Costa Rican Social Security Fund. This study included a comparative analysis of factors associated with the use or non-use of antibiotics during their hospitalization. Results: A total of 261 previously healthy children hospitalized with bronchiolitis were included. The mean age was 7.3 months and the male gender predominated (n = 160, 61.3%). Exposure to passive smoking was reported in 24.5% of patients. 66.1% of patients had no history of wheezing prior to admission, and 52.2% had a family history of bronchial asthma. It was reported that 17.2% (n = 45) received antibiotics during their hospitalization. Factors associated with antibiotic prescription were the presence of pulmonary opacities (p = 0.001, OR: 32.2) and bronchopneumonic infiltrates (p = 0.002, OR: 2.72) on chest X-ray, escalation to high-flow cannula therapy (p < 0.001, OR: 4.43), and assisted mechanical ventilation (p = 0.001, OR: 7.17). Conclusion: The two factors that lead physicians to prescribe antibiotics to healthy patients with BQL are a deteriorating respiratory pattern that requires intubation and ventilation, and the presence of pulmonary opacities and bronchopneumonic infiltrates.
Keywords
bronchiolitis; respiratory syncytial virus; infants; antibiotics
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[1] Cody Meissner H. Viral bronchiolitis in children. N Engl J Med. 2016;374:62-72. DOI: 10.1056/NEJMra1413456
[2] Papenburg J, Fontela PS, Freitas RR, Burstein B. Inappropriate antibiotic prescribing for acute bronchiolitis in US Emergency Departments, 2007-2015. J Pediatric Infect Dis Soc. 2019;8:567-570. DOI: 10.1093/jpids/piy131
[3] Nair, H.; Nokes, D.J.; Gessner, B.D.; Dherani, M.; Madhi, S.A.; Singleton, R.J.; Chandran, A. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010;375:1545-1555. DOI: 10.1016/S0140-6736(10)60206-1
[4] Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Balet JE, Gadomski AM, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134:e1474-e1502. DOI: 10.1542/peds.2015-2862
[5] Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2014;6:1-61 CD001266. DOI: 10.1002/14651858. CD001266.pub4
[6] Ralston S, Hill V, Waters A. Occult serious bacterial infection in infants younger than 60 to 90 days with bronchiolitis: a systematic review. Arch Pediatr Adolesc Med. 2011;165:951-956. DOI: 10.1001/archpediatrics.2011.155
[7] Wang EE, Law BJ, Boucher FD, Stephens D, Robinson JL, Dobson S, et al. Pediatric investigators collaborative network on infections in Canada (PICNIC) study of admission and management variation in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. J Pediatr. 1996;129:390-395. DOI: 10.1016/s0022-3476(96)70071-9
[8] Stang P, Brandenburg N, Carter B. The economic burden of respiratory syncytial virus-associated bronchiolitis hospitalizations. Arch Pediatr Adolesc Med. 2001;155:95-96. DOI: 10.1001/archpedi.155.1.95
[9] ML Nonoyama, V Kukreti, E Papaconstantinou, R Raymond D'cruz. Assessing physical and respiratory distress in children with bronchiolitis admitted to a community hospital emergency department: a retrospective chart review. Can J Respir Ther. 2019;55:16-20. DOI:10.29390/cjrt-2018-021. eCollection 2019
[10] Farley R, Spurling GK, Eriksson L, Del Mar CB. Antibiotics for bronchiolitis in children under two years of age. Cochrane Database Syst Rev. 2014;10:1-34 CD005189. DOI: 10.1002/14651858. CD005189.pub4
[11] Vogel AM, Lennon DR, Harding JE, Pinnock RE, Graham DA, Grimwood K, et al. Variations in bronchiolitis management between Five New Zealand Hospitals: can we do better? J of Paediatr Child Health. 2003;39:40-45. DOI: 10.1046/j.1440-1754.2003.00069.x
[12] Ruvinsky S, Mónaco A, Pérez G, Taicz M, Inda L, Kijko I, et al. Motivos de la prescripción inadecuada de antibióticos en un hospital pediátrico de alta complejidad. Rev Panam Salud Pública. 2011; 30:580-585
[13] Ochoa C, Anglada L, Eiros JM, Solís G, Vallano A, Guerra L et al. Appropriateness of antibiotic prescriptions in community - acquired acute pediatric respiratory infections in Spanish Emergency Rooms. Pediatr Infect Dis J. 2001; 20:751-758. DOI: 10.1097/00006454-200108000-00007
[14] McKay R, Mah A, Law MR, McGrail K, Patrick DM. 2016. Systematic review of factors associated with antibiotic prescribing for respiratory tract infections. Antimicrob Agents Chemother. 2016;60:4106-4118. DOI: 10.1128/AAC.00209-16
[15] Wrotek A, Czajkowska M, Jackowska T. Antibiotic treatment in patients with bronchiolitis. Adv Exp Med Biol. 2019;1211:111-119. DOI: 10.1007/5584_2019_391
[16] Plint AC, Taljaard M, McGahern C, Scott SD, Grimshaw JM, Klassen TP, et al. Management of bronchiolitis in Community Hospitals in Ontario: a multicentre cohort study. CJEM. 2016;18:443- 452. DOI: 10.1017/cem.2016.7
[17] Florin TA, Byczkowski T, Ruddy RM, Zorc JJ, Test M, Shah SS. Variation in the management of infants hospitalized for bronchiolitis persists after the 2006 American Academy of Pediatric Bronchiolitis Guidelines. J Pediatr. 2014;165:782-792. DOI: 10.1016/j.jpeds.2014.05.057
[18] Elenius V, Bergroth E, Koponen P, Remes S, Piedra PA, Espinola JA, et al. Marked variability observed in inpatient management of bronchiolitis in Three Finnish Hospitals. Acta Paediatr. 2017;106:1512- 1518. DOI: 10.1111/apa.13931
[19] Patra S, Singh V, Pemde HK, Chandra J. Antibiotic prescribing pattern in paediatric in patients with first time wheezing. Ital J Pediatr. 2011;37:40. DOI: 10.1186/1824-7288-37-40
[20] Breakell R, Thorndyke B, Clennett J, Harkensee C. Reducing Unnecessary Chest X-Rays, Antibiotics and bronchodilators through implementation of the NICE Bronchiolitis Guideline. Eur J Pediatr. 2018;177:47-51. DOI: 10.1007/s00431- 017-3034-5
[21] Schuh S, Lalani A, Allen U, Manson D, Babyn P, Stephens D, et al. Evaluation of the utility of radiography in acute bronchiolitis. J Pediatr. 2007;150:429-433. DOI: 10.1016/j.jpeds.2007.01.005
[22] Librizzi J, McCulloh R, Koehn K, Alverson B. Appropriateness of testing for serious bacterial infection in children hospitalized with bronchiolitis. Hospital Pediatrics. 2014;4:33-38. DOI: 10.1542/hpeds.2013-0073
[23] Alejandre C, Balaguer M, Guitart C, et al. Procalcitoninguided antibiotic stewardship in paediatric patients with severe bronchiolitis. Acta Paediatr. 2020;109:1190-1195. DOI: 10.1111/apa.15148
[24] Esposito A, Elias A, Archanjo A, de Paulis M, Vieira S. Etiological diagnosis reduces the use of antibiotics in infants with bronchiolitis. Clinics. 2012;67:1001-1006. DOI: 10.6061/clinics/2012(09)03
[25] Levine DA, Platt SL, Dayan PS, Macias CG, Zorc JJ, Krief W, et al. Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics. 2004;113:1728-1734. DOI: 10.1542/peds.113.6.1728
[26] Pierce HC, Mansbach JM, Fisher ES, Macias CG, Pate BM, Piedra PA, et al. Variability of intensive care management for children with bronchiolitis. Hosp Pediatr. 2015;5:175-184. DOI: 10.1542/hpeds.2014-0125
[27] Kneyber M, van Oud-Alblas H, van Vliet M, Uiterwaal C, Kimpen J, van Vught A. Concurrent bacterial infection and prolonged mechanical ventilation in infants with respiratory syncytial virus lower respiratory tract disease. Intensive Care Med. 2005;31:680-685. DOI: 10.1007/s00134-005- 2614-4
[28] Ruvinsky S, Mónaco A, Pérez G, Taicz M, Inda L, Kijko I, et al. Motivos de la prescripción inadecuada de antibióticos en un hospital pediátrico de alta complejidad. Rev Panam Salud Pública. 2011;30:580-585
[29] Bradshaw ML, Deragon A, Puligandla P, Emeriaud G, Canakis AM, Fontela PS. Treatment of severe bronchiolitis: a survey of Canadian pediatric intensivists. Pediatr Pulmonol. 2018;53:613-618. DOI: 10.1002/ppul.23974
[2] Papenburg J, Fontela PS, Freitas RR, Burstein B. Inappropriate antibiotic prescribing for acute bronchiolitis in US Emergency Departments, 2007-2015. J Pediatric Infect Dis Soc. 2019;8:567-570. DOI: 10.1093/jpids/piy131
[3] Nair, H.; Nokes, D.J.; Gessner, B.D.; Dherani, M.; Madhi, S.A.; Singleton, R.J.; Chandran, A. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010;375:1545-1555. DOI: 10.1016/S0140-6736(10)60206-1
[4] Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Balet JE, Gadomski AM, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134:e1474-e1502. DOI: 10.1542/peds.2015-2862
[5] Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2014;6:1-61 CD001266. DOI: 10.1002/14651858. CD001266.pub4
[6] Ralston S, Hill V, Waters A. Occult serious bacterial infection in infants younger than 60 to 90 days with bronchiolitis: a systematic review. Arch Pediatr Adolesc Med. 2011;165:951-956. DOI: 10.1001/archpediatrics.2011.155
[7] Wang EE, Law BJ, Boucher FD, Stephens D, Robinson JL, Dobson S, et al. Pediatric investigators collaborative network on infections in Canada (PICNIC) study of admission and management variation in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. J Pediatr. 1996;129:390-395. DOI: 10.1016/s0022-3476(96)70071-9
[8] Stang P, Brandenburg N, Carter B. The economic burden of respiratory syncytial virus-associated bronchiolitis hospitalizations. Arch Pediatr Adolesc Med. 2001;155:95-96. DOI: 10.1001/archpedi.155.1.95
[9] ML Nonoyama, V Kukreti, E Papaconstantinou, R Raymond D'cruz. Assessing physical and respiratory distress in children with bronchiolitis admitted to a community hospital emergency department: a retrospective chart review. Can J Respir Ther. 2019;55:16-20. DOI:10.29390/cjrt-2018-021. eCollection 2019
[10] Farley R, Spurling GK, Eriksson L, Del Mar CB. Antibiotics for bronchiolitis in children under two years of age. Cochrane Database Syst Rev. 2014;10:1-34 CD005189. DOI: 10.1002/14651858. CD005189.pub4
[11] Vogel AM, Lennon DR, Harding JE, Pinnock RE, Graham DA, Grimwood K, et al. Variations in bronchiolitis management between Five New Zealand Hospitals: can we do better? J of Paediatr Child Health. 2003;39:40-45. DOI: 10.1046/j.1440-1754.2003.00069.x
[12] Ruvinsky S, Mónaco A, Pérez G, Taicz M, Inda L, Kijko I, et al. Motivos de la prescripción inadecuada de antibióticos en un hospital pediátrico de alta complejidad. Rev Panam Salud Pública. 2011; 30:580-585
[13] Ochoa C, Anglada L, Eiros JM, Solís G, Vallano A, Guerra L et al. Appropriateness of antibiotic prescriptions in community - acquired acute pediatric respiratory infections in Spanish Emergency Rooms. Pediatr Infect Dis J. 2001; 20:751-758. DOI: 10.1097/00006454-200108000-00007
[14] McKay R, Mah A, Law MR, McGrail K, Patrick DM. 2016. Systematic review of factors associated with antibiotic prescribing for respiratory tract infections. Antimicrob Agents Chemother. 2016;60:4106-4118. DOI: 10.1128/AAC.00209-16
[15] Wrotek A, Czajkowska M, Jackowska T. Antibiotic treatment in patients with bronchiolitis. Adv Exp Med Biol. 2019;1211:111-119. DOI: 10.1007/5584_2019_391
[16] Plint AC, Taljaard M, McGahern C, Scott SD, Grimshaw JM, Klassen TP, et al. Management of bronchiolitis in Community Hospitals in Ontario: a multicentre cohort study. CJEM. 2016;18:443- 452. DOI: 10.1017/cem.2016.7
[17] Florin TA, Byczkowski T, Ruddy RM, Zorc JJ, Test M, Shah SS. Variation in the management of infants hospitalized for bronchiolitis persists after the 2006 American Academy of Pediatric Bronchiolitis Guidelines. J Pediatr. 2014;165:782-792. DOI: 10.1016/j.jpeds.2014.05.057
[18] Elenius V, Bergroth E, Koponen P, Remes S, Piedra PA, Espinola JA, et al. Marked variability observed in inpatient management of bronchiolitis in Three Finnish Hospitals. Acta Paediatr. 2017;106:1512- 1518. DOI: 10.1111/apa.13931
[19] Patra S, Singh V, Pemde HK, Chandra J. Antibiotic prescribing pattern in paediatric in patients with first time wheezing. Ital J Pediatr. 2011;37:40. DOI: 10.1186/1824-7288-37-40
[20] Breakell R, Thorndyke B, Clennett J, Harkensee C. Reducing Unnecessary Chest X-Rays, Antibiotics and bronchodilators through implementation of the NICE Bronchiolitis Guideline. Eur J Pediatr. 2018;177:47-51. DOI: 10.1007/s00431- 017-3034-5
[21] Schuh S, Lalani A, Allen U, Manson D, Babyn P, Stephens D, et al. Evaluation of the utility of radiography in acute bronchiolitis. J Pediatr. 2007;150:429-433. DOI: 10.1016/j.jpeds.2007.01.005
[22] Librizzi J, McCulloh R, Koehn K, Alverson B. Appropriateness of testing for serious bacterial infection in children hospitalized with bronchiolitis. Hospital Pediatrics. 2014;4:33-38. DOI: 10.1542/hpeds.2013-0073
[23] Alejandre C, Balaguer M, Guitart C, et al. Procalcitoninguided antibiotic stewardship in paediatric patients with severe bronchiolitis. Acta Paediatr. 2020;109:1190-1195. DOI: 10.1111/apa.15148
[24] Esposito A, Elias A, Archanjo A, de Paulis M, Vieira S. Etiological diagnosis reduces the use of antibiotics in infants with bronchiolitis. Clinics. 2012;67:1001-1006. DOI: 10.6061/clinics/2012(09)03
[25] Levine DA, Platt SL, Dayan PS, Macias CG, Zorc JJ, Krief W, et al. Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics. 2004;113:1728-1734. DOI: 10.1542/peds.113.6.1728
[26] Pierce HC, Mansbach JM, Fisher ES, Macias CG, Pate BM, Piedra PA, et al. Variability of intensive care management for children with bronchiolitis. Hosp Pediatr. 2015;5:175-184. DOI: 10.1542/hpeds.2014-0125
[27] Kneyber M, van Oud-Alblas H, van Vliet M, Uiterwaal C, Kimpen J, van Vught A. Concurrent bacterial infection and prolonged mechanical ventilation in infants with respiratory syncytial virus lower respiratory tract disease. Intensive Care Med. 2005;31:680-685. DOI: 10.1007/s00134-005- 2614-4
[28] Ruvinsky S, Mónaco A, Pérez G, Taicz M, Inda L, Kijko I, et al. Motivos de la prescripción inadecuada de antibióticos en un hospital pediátrico de alta complejidad. Rev Panam Salud Pública. 2011;30:580-585
[29] Bradshaw ML, Deragon A, Puligandla P, Emeriaud G, Canakis AM, Fontela PS. Treatment of severe bronchiolitis: a survey of Canadian pediatric intensivists. Pediatr Pulmonol. 2018;53:613-618. DOI: 10.1002/ppul.23974
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