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. 2023 Nov 30;77(11):1604-1611.
doi: 10.1093/cid/ciad385.

Management of Pediatric Pneumonia: A Decade After the Pediatric Infectious Diseases Society and Infectious Diseases Society of America Guideline

Lilliam Ambroggio  1 , Jillian Cotter  1 , Matthew Hall  2 , Daniel J Shapiro  3   4 , Susan C Lipsett  3   4 , Adam L Hersh  5 , Samir S Shah  6   7 , Thomas V Brogan  8   9 , Jeffrey S Gerber  10   11 , Derek J Williams  12 , Anne J Blaschke  5 , Jonathan D Cogen  13 , Mark I Neuman  3   4
Affiliations

Management of Pediatric Pneumonia: A Decade After the Pediatric Infectious Diseases Society and Infectious Diseases Society of America Guideline

Lilliam Ambroggio et al. Clin Infect Dis. .

Abstract

Background: Incomplete uptake of guidelines can lead to nonstandardized care, increased expenditures, and adverse clinical outcomes. The objective of this study was to evaluate the impact of the 2011 Pediatric Infectious Diseases Society and Infectious Diseases Society of America (PIDS/IDSA) pediatric community-acquired pneumonia (CAP) guideline that emphasized aminopenicillin use and de-emphasized the use of chest radiographs (CXRs) in certain populations.

Methods: This quasi-experimental study queried a national administrative database of children's hospitals to identify children aged 3 months-18 years with CAP who visited 1 of 28 participating hospitals from 2009 to 2021. PIDS/IDSA pediatric CAP guideline recommendations regarding antibiotic therapy, diagnostic testing, and imaging were evaluated. Segmented regression interrupted time series was used to measure guideline-concordant practices with interruptions for guideline publication and the Coronavirus Disease 2019 (COVID-19) pandemic.

Results: Of 315 384 children with CAP, 71 804 (22.8%) were hospitalized. Among hospitalized children, there was a decrease in blood culture performance (0.5% per quarter) and increase in aminopenicillin prescribing (1.1% per quarter). Among children discharged from the emergency department (ED), there was an increase in aminopenicillin prescription (0.45% per quarter), whereas the rate of obtaining CXRs declined (0.12% per quarter). However, use of CXRs rebounded during the COVID-19 pandemic (increase of 1.56% per quarter). Hospital length of stay, ED revisit rates, and hospital readmission rates remained stable.

Conclusions: Guideline publication was associated with an increase of aminopenicillin prescribing. However, rates of diagnostic testing did not materially change, suggesting the need to consider implementation strategies to meaningfully change clinical practice for children with CAP.

Keywords: antibiotics; diagnostic testing; pediatric; pneumonia.

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Conflict of interest statement

Potential conflicts of interest. L. A.'s institution receives funding from Pfizer Inc on her behalf for an unrelated study and also reports support from the National Institute of Allergy and Infectious Diseases, unrelated to this work (grant numbers K01AI125413 and R21AI154239). D. J. S. reports a grant or contract from the Agency for Healthcare Quality and Research, unrelated to this work (T32HS000063-28). J. C. reports grants or contracts unrelated to this work from Pfizer Inc. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Graphical Abstract
Graphical Abstract
This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/management-of-pediatric-pneumonia-a-decade-after-the-pids-idsa-guideline-b2c95d43-6cbe-43f2-8882-af73aff79aeb
Figure 1.
Figure 1.
Quarterly trends in guideline recommendations. *“Aminopenicillin” is used to indicate receipt of either amoxicillin or ampicillin. Abbreviations: COVID-19, Coronavirus Disease 2019; ED, emergency department; PIDS/IDSA, Pediatric Infectious Diseases Society and Infectious Diseases Society of America; Q4, quarter 4.
See this image and copyright information in PMC

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