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Original Investigation
September 11, 2017

Association of Guideline-Adherent Antibiotic Treatment With Readmission of Children With Sickle Cell Disease Hospitalized With Acute Chest Syndrome

Author Affiliations
  • 1Department of Pediatrics, Medical University of South Carolina, Charleston
  • 2Department of Research and Statistics, Children’s Hospital Association, Lenexa, Kansas
  • 3Department of Pediatrics, Baylor College of Medicine, Houston, Texas
  • 4Department of Pediatrics, Medical College of Wisconsin, Milwaukee
  • 5Department of Pediatrics, Emory University, Atlanta, Georgia
  • 6Department of Pediatrics, University of Missouri–Kansas City School of Medicine
  • 7Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 8Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
  • 9Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 10Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 11Section editor, JAMA Pediatrics
JAMA Pediatr. Published online September 11, 2017. doi:10.1001/jamapediatrics.2017.2526
Key Points

Question  Are guideline-adherent antibiotics associated with reduced readmission rates among children with sickle cell disease hospitalized with acute chest syndrome?

Findings  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.

Meaning  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.

Abstract

Importance  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.

Objectives  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.

Exposures  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.

Results  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.

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