Are guideline-adherent antibiotics associated with reduced readmission rates among children with sickle cell disease hospitalized with acute chest syndrome?
In this cohort study of 14 480 hospitalizations in children with acute chest syndrome, guideline-adherent antibiotic regimens (macrolide with parenteral cephalosporin) were associated with statistically significantly lower 30-day acute chest syndrome and all-cause readmission rates compared with non–guideline-adherent regimens.
Efforts to increase the dissemination and implementation of sickle cell disease treatment guidelines, in particular as they relate to the antibiotic treatment of children hospitalized with acute chest syndrome, are warranted.
Acute chest syndrome (ACS) is a common, serious complication of sickle cell disease (SCD) and a leading cause of hospitalization and death in both children and adults with SCD. Little is known about the effectiveness of guideline-recommended antibiotic regimens for the care of children hospitalized with ACS.
To use a large, national database to describe patterns of antibiotic use for children with SCD hospitalized for ACS and to determine whether receipt of guideline-adherent antibiotics was associated with lower readmission rates.
Design, Setting, and Participants
Retrospective cohort study including 14 480 hospitalizations in 7178 children (age 0-22 years) with a discharge diagnosis of SCD and either ACS or pneumonia. Information was obtained from 41 children’s hospitals submitting data to the Pediatric Health Information System from January 1, 2010, to December 31, 2016.
National Heart, Lung, and Blood Institute guideline-adherent (macrolide with parenteral cephalosporin) vs non–guideline-adherent antibiotic regimens.
Main Outcomes and Measures
Acute chest syndrome–related and all-cause 7- and 30-day readmissions.
Of the 14 480 hospitalizations, 6562 (45.3%) were in girls; median (interquartile range) age was 9 (4-14) years. Guideline-adherent antibiotics were provided in 10 654 of 14 480 hospitalizations for ACS (73.6%). Hospitalizations were most likely to include guideline-adherent antibiotics for children aged 5 to 9 years (3230 of 4047 [79.8%]) and declined to the lowest level for children 19 to 22 years (697 of 1088 [64.1%]). Between-hospital variation in antibiotic regimens was wide, with use of guideline-adherent antibiotics ranging from 24% to 90%. Children treated with guideline-adherent antibiotics had lower 30-day ACS-related (odds ratio [OR], 0.71; 95% CI, 0.50-1.00) and all-cause (OR, 0.50; 95% CI, 0.39-0.64) readmission rates vs children who received other regimens (cephalosporin and macrolide vs neither drug class).
Conclusions and Relevance
Current approaches to antibiotic treatment in children with ACS vary widely, but guideline-adherent therapy appears to result in fewer readmissions compared with non–guideline-adherent therapy. Efforts to increase the dissemination and implementation of SCD treatment guidelines are warranted as is comparative effectiveness research to strengthen the underlying evidence base.
Bundy DG, Richardson TE, Hall M, Raphael JL, Brousseau DC, Arnold SD, Kalpatthi RV, Ellison AM, Oyeku SO, Shah SS. Association of Guideline-Adherent Antibiotic Treatment With Readmission of Children With Sickle Cell Disease Hospitalized With Acute Chest Syndrome. JAMA Pediatr. Published online September 11, 2017. doi:10.1001/jamapediatrics.2017.2526