title: Hospital outcomes associated with guideline-recommended antibiotic therapy for pediatric pneumonia.
abstract: BACKGROUND
  Recent national guidelines recommend use of narrow-spectrum antibiotic therapy as empiric treatment for children hospitalized with community-acquired pneumonia (CAP). However, clinical outcomes associated with adoption of this recommendation have not been studied.
  
  
  METHODS
  This retrospective cohort study included children age 3 months to 18 years, hospitalized with CAP from May 2, 2011 through July 30, 2012. Primary exposure of interest was empiric antibiotic therapy, classified as guideline recommended or not. Primary outcomes were length of stay (LOS), total hospital costs, and inpatient pharmacy costs. Secondary outcomes included broadened antibiotic therapy, emergency department revisits, and readmissions. Multivariable linear regression and Fisher exact test were performed to determine the association of guideline-recommended antibiotic therapy on outcomes.
  
  
  RESULTS
  Empiric guideline-recommended therapy was prescribed to 168 (76%) of 220 patients. Median hospital LOS was 1.3 days (interquartile range [IQR]: 0.9-1.9 days), median total cost of index hospitalization was $4097 (IQR: $2657-$6054), and median inpatient pharmacy cost was $91 (IQR: $40-$183). Between patients who did and did not receive guideline-recommended therapy, there were no differences in LOS (adjusted -5.8% change; 95% confidence interval [CI]: -22.1 to 12.8), total costs (adjusted -10.9% change; 95% CI: -27.4 to 9.4), or inpatient pharmacy costs (adjusted 14.8% change; 95% CI: -43.4 to 27.1). Secondary outcomes were rare, with no difference in unadjusted analysis between patients who did and did not receive guideline-recommended therapy.
  
  
  CONCLUSIONS
  Use of guideline-recommended antibiotic therapy was not associated with unintended negative consequences; there were no changes in LOS, total costs, or inpatient pharmacy costs.
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Joanna
authors.initials: J
authors.lastname: Thomson
authors.forename: Lilliam
authors.initials: L
authors.lastname: Ambroggio
authors.forename: Eileen
authors.initials: E
authors.lastname: Murtagh Kurowski
authors.forename: Angela
authors.initials: A
authors.lastname: Statile
authors.forename: Camille
authors.initials: C
authors.lastname: Graham
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Courter
authors.forename: Brieanne
authors.initials: B
authors.lastname: Sheehan
authors.forename: Srikant
authors.initials: S
authors.lastname: Iyer
authors.forename: Christine M
authors.initials: CM
authors.lastname: White
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000639:trends*; D006801:Humans; D007223:Infant; D008297:Male; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D017410:Practice Guidelines as Topic / Q000592:standards*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents