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Adherence to antimicrobial guidelines varied by hospital site
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SAN FRANCISCO — Trends in antimicrobial prescribing have changed with published guidelines, but the reduction in the use of broad-spectrum antimicrobial therapy for children with community-acquired pneumonia was not consistent among hospitals, according to study results presented at ID Week 2013.
In August 2011, the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America jointly published guidelines recommending narrow-spectrum antimicrobial prescribing for hospitalized children with community-acquired pneumonia.
Derek J. Williams
“Guidelines alone may be insufficient to induce rapid practice change,” study researcher Derek J. Williams, MD, MPH, of the Vanderbilt University School of Medicine, told Infectious Disease News. “Local efforts which address barriers to guideline adherence — including educational campaigns, local practice guidelines, computerized orders sets and stewardship programs — are likely key for guideline adoption.”
Williams and colleagues evaluated data from 2,628 hospitalized children between 2010 and 2012. They assessed for treatment with broad-spectrum antimicrobials — third-generation cephalosporins with or without macrolide — and narrow-spectrum antimicrobials — aminopenicillins with or without macrolide — within the first 2 days of hospital stay.
Before the 2011 guidelines, the monthly median use of broad-spectrum therapy was stabilized at 45% (interquartile range, 42-50).
Nine months after the guideline was published, findings indicated an overall 10% (95% CI, 2-20) increase in narrow-spectrum therapy and a –15% (95% CI, –24 to –7) reduction in the use of broad-spectrum therapy.
However, the researchers noted the reductions in broad-spectrum therapy varied from –26% (95% CI, –40 to –12) to –10% (95% CI, –25 to 7) depending on site.
When adjusting for patient age, chronic conditions, season, study site, length of stay and ICU admission, the results were not affected.
“National consensus guidelines appear to improve recommended antimicrobial prescribing for childhood [community-acquired pneumonia],” Williams said. “In addition, faster and more substantial changes were observed at institutions that proactively disseminated the guidelines. However, further research is needed to determine the most effective interventions for improving guideline adherence and antimicrobial prescribing.”
For more information:
Williams DJ. Abstract #877. Presented at: ID Week 2013; Oct. 2-6, 2013; San Francisco.
Disclosure: The researchers report no relevant financial disclosures.