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American Academy of Pediatrics National Conference and Exhibition
October 13, 2014
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ICU physicians had stronger compliance to IDSA CAP guidelines

SAN DIEGO — Research presented at the 2014 AAP National Conference and Exhibition show children admitted to the ICU with community-acquired pneumonia were more likely to have a complete blood count and blood culture taken, suggesting that physicians in the ICU have better adherence to guidelines.

Researchers reviewed records for children aged 3 months to 18 years who were hospitalized for community-acquired pneumonia (CAP) at 4 tertiary children’s hospitals from 2011 through 2012. Of the 1,142 patients who met study criteria, 763 were confirmed to have pneumonia at admission or discharge and were included in the study cohort.

Overall, 78% of study participants (559 of 763) had a complete blood count obtained. Ninety-two of the 109 children who required ICU-level care had complete blood counts obtained (84.4%).

Approximately 60.6% of all study participants (462 of 763) had blood cultures drawn, compared with 77.1% of children in the ICU (84 of 109; P=0.0.001).

Regarding chest x-rays, 96.1% of all patients had an x-ray compared with 99.1% of all ICU patients (P=0.22).

Thirty-two percent of vaccinated patients received amoxicillin, ampicillin, or penicillin in an inpatient setting; and 43.8% received a third generation cephalosporin. Approximately 34.5% of unvaccinated or under-vaccinated children received amoxicillin, ampicillin, or penicillin in an inpatient setting; and 48.3% received a third generation cephalosporin.

“In terms of blood cultures and chest x-rays, which are recommended, we found that the ICU had better adherence to those guidelines than non-ICU,” study researcher Jordan Sack told Infectious Diseases in Children. “It’s interesting that only 32% of vaccinated children received first-line [antibiotics], indicating two-thirds did not receive the ideal antibiotics.”

Jordan Sack

Jordan Sack

The study findings indicate there is not ideal compliance to the IDSA guidelines and that the ICU tended to have better adherence to those guidelines, according to Sack.

“The question is whether this is because the patient [in the ICU] is sicker or is it because physicians in the ICU are looking at the guidelines and following them,” he said.

For more information:

Sack J. Abstract #26824. Presented at: 2014 AAP National Conference and Exhibition; Oct. 11-14; San Diego.

Disclosure: Sack reports no relevant financial disclosures.