Shah Rohan M, Sun Shan, Shteynberg Emily, Scardina Tonya, Whitmer Grant, Patel Sameer J
Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Infectious Diseases, Chicago, Illinois, USA.
Feinberg School of Medicine, Chicago, Illinois, USA.
J Pediatric Infect Dis Soc. 2022 Dec 28;11(12):543-549. doi: 10.1093/jpids/piac083.
Variability exists in treatment duration for community-acquired pneumonia (CAP) and urinary tract infection (UTI) in children and may be associated with non-clinical factors.
A retrospective study was conducted of patients treated for outpatient CAP and UTI in a children's hospital network from 2016 to 2019. Multivariable logistic regression was performed to identify predictors of long antibiotic duration (≥10 days). Hospitalization within 30 days was determined.
Overall, 2124 prescriptions for CAP and 1116 prescriptions for UTI were included. Prescriptions were ≥10 days in 59.9% and 47.6% for CAP and UTI, respectively. Long durations were more common in the emergency department (ED) than in clinics for UTI's (P = .0082), and more common in convenient care for CAP (P = .045). In UTI's, Asian and Hispanic patients received shorter durations than white patients. Younger children had greater odds of long duration for both diagnoses. Medicaid insurance was associated with long therapy for UTI (OR: 1.660, P = .0042) and CAP (OR: 1.426, P = .0169). Residents and fellows were less likely to give long durations than attending physicians (P < .0001). APNs were more likely to administer long therapies in CAP (P = .0062). Subsequent hospitalizations were uncommon for UTI (n = 10) and CAP (n = 20).
Younger age, Medicaid insurance, ED, and convenient care visits were associated with a long duration of therapy. Residents and fellows were less likely to give long durations.
儿童社区获得性肺炎（CAP）和尿路感染（UTI）的治疗时长存在差异，且可能与非临床因素有关。
对2016年至2019年在一家儿童医院网络中接受门诊CAP和UTI治疗的患者进行回顾性研究。采用多变量逻辑回归来确定抗生素治疗时长≥10天的预测因素。确定30天内的住院情况。
总体而言，共纳入2124份CAP处方和1116份UTI处方。CAP和UTI处方治疗时长≥10天的比例分别为59.9%和47.6%。UTI在急诊科的长疗程比在诊所更常见（P = 0.0082），而CAP在便捷护理中更常见（P = 0.045）。在UTI中，亚裔和西班牙裔患者的治疗时长比白人患者短。年龄较小的儿童在这两种诊断中长疗程的几率更高。医疗补助保险与UTI（OR：1.660，P = 0.0042）和CAP（OR：1.426，P = 0.0169）的长疗程治疗相关。住院医师和研究员给予长疗程治疗的可能性低于主治医师（P < 0.0001）。高级执业护士在CAP中给予长疗程治疗的可能性更大（P = 0.0062）。UTI（n = 10）和CAP（n = 20）随后的住院情况并不常见。
年龄较小、医疗补助保险、急诊科就诊和便捷护理就诊与长疗程治疗相关。住院医师和研究员给予长疗程治疗的可能性较小。
