Institute of Healthcare Delivery and Population Science, Baystate Medical Center, Springfield, Massachusetts, USA
Department of Pediatrics and The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
BMJ Qual Saf. 2021 Apr;30(4):292-299. doi: 10.1136/bmjqs-2019-010792. Epub 2020 May 18.
Antibiotic resistance represents a worldwide public health threat. Characterising prescribing patterns for conditions for which antibiotics have no role can inform antimicrobial stewardship efforts. Asthma is among the most common non-infectious diseases in children and results in 100 000 hospitalisations annually in the USA. We sought to identify the rate of antibiotic prescribing in children hospitalised for asthma exacerbations, and to characterise patient and hospital factors associated with receipt of antibiotics.
Children and adolescents aged 2-17 years admitted to hospital between 1 October 2015 and 30 June 2018 with an asthma exacerbation were identified from the Premier Alliance Database. After excluding hospitalisations for which antibiotics appeared to have been justified, we assessed receipt and duration of antibiotic treatments during the hospital stay. We developed a hierarchical logistic regression model to identify patient and hospital factors associated with antibiotic treatment. For each hospital with at least 10 asthma cases we computed the percentage of cases receiving antibiotic treatment.
23 129 hospital stays met inclusion criteria; in 3329 (14%) of these, antibiotics were prescribed without clear indication. Hospital prescribing rates varied widely (range 0%-95%), with 25% of hospitals prescribing antibiotics at a rate of 27.5% or more. Patient factors most strongly associated with receipt of antibiotics included the presence of a complex chronic condition (OR: 2.4, 95% CI 2.1 to 2.9; p<0.0001) and admission to the intensive care unit compared with a general medical-surgical bed (OR: 1.6, 95% CI 1.5 to 1.9; p<0.0001). Hospitalisation at general hospitals with minimum paediatric specialty support conferred a nearly threefold higher odds of antibiotic treatment (OR: 2.9, 95% CI 1.5 to 5.6; p<0.0001).
These findings illustrate an opportunity to reduce unnecessary exposure to antibiotics in children hospitalised with asthma, particularly in general hospitals where three-quarters of children in the USA receive their hospital-based care.
抗生素耐药性是全球公共卫生面临的威胁。描述抗生素治疗无效的病症的处方模式，可以为抗菌药物管理提供信息。哮喘是儿童中最常见的非传染性疾病之一，每年在美国导致 10 万例住院治疗。我们旨在确定因哮喘加重而住院的儿童中抗生素的处方率，并确定与抗生素使用相关的患者和医院因素。
从 Premier 联盟数据库中确定了 2015 年 10 月 1 日至 2018 年 6 月 30 日期间因哮喘加重住院的 2-17 岁儿童和青少年患者。在排除了抗生素治疗有明确指征的住院病例后，我们评估了住院期间抗生素治疗的使用和持续时间。我们开发了一个分层逻辑回归模型来确定与抗生素治疗相关的患者和医院因素。对于每家至少有 10 例哮喘病例的医院，我们计算了接受抗生素治疗的病例比例。
23129 例住院符合纳入标准；其中 3329 例（14%）的患者没有明确的抗生素治疗指征。医院的处方率差异很大（范围为 0%-95%），其中 25%的医院开具抗生素的比例为 27.5%或更高。与接受抗生素治疗最相关的患者因素包括存在复杂的慢性疾病（比值比：2.4，95%置信区间 2.1 至 2.9；p<0.0001）和入住重症监护病房与普通医疗-外科病床相比（比值比：1.6，95%置信区间 1.5 至 1.9；p<0.0001）。在普通医院（儿科专科支持最少）住院的儿童接受抗生素治疗的可能性几乎高出三倍（比值比：2.9，95%置信区间 1.5 至 5.6；p<0.0001）。
这些发现表明，有机会减少因哮喘住院的儿童中不必要的抗生素暴露，尤其是在美国，四分之三的儿童在普通医院接受医院治疗。
