Objective: To determine the influence of pneumococcal penicillin non-susceptibility patterns on individual antibiotic prescription among 33 children’s hospitals using a multi-level, random intercept, logistic regression analysis. Design: Multi-level cross-sectional study Setting: 33 children’s hospitals Participants: Children, 1–18 years of age, with CAP discharged in 2006. Hospital antibiotic susceptibility data were collected from surveys and patient data was obtained from an administrative database. Main Exposures: The primary exposure was the proportion of penicillin non-susceptible pneumococcal isolates reported in 2005 by each hospital. A secondary exposure included using the proportion of penicillin-resistant pneumococcal isolates to determine if a threshold of susceptibility existed. Main Outcome Measures: Receipt of broad spectrum empiric antibiotic therapy in 2006 (i.e., antibiotics other than penicillins or aminopenicillins). Results: 4,888 children diagnosed with community-acquired pneumonia (CAP) were eligible. The proportion of penicillin non-susceptible isolates ranged from 9%−70% across hospitals while the proportion of penicillin resistant isolates ranged from 0%−60%. Broad spectrum antibiotics were prescribed to 93% of patients; 45% of patients received cephalosporin class antibiotics alone. There was no significant association between the proportion of pencillin nonsusceptible pneumococcal isolates at individual hospitals and narrow spectrum prescribing. However, every 10% increase in penicillin-resistant pneumococcal isolates was associated with a 39% increase in broad spectrum antibiotic prescribing (adjusted odds ratio, 1.39; 95% confidence interval: 1.08–1.69). Conclusion: There was substantial variability in empiric antibiotic prescribing for CAP among children’s hospitals in the U.S. High- (i.e., resistant) but not modest-levels (i.e., intermediate susceptibility) of penicillin resistance were associated with broad spectrum antibiotic prescribing.
【저자키워드】 Pneumonia, pediatric, hospitals, Child, Bacterial, Drug-resistance, Streptococcus pneumoniae,