Folasade Odeniyi

Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections

Importance Acute respiratory tract infections account for the majority of antibiotic exposure in children, and broad-spectrum antibiotic prescribing for acute respiratory tract infections is increasing. It is not clear whether broad-spectrum treatment is associated with improved outcomes compared with narrow-spectrum treatment. Objective To compare the effectiveness of broad-spectrum and narrow-spectrum antibiotic treatment for acute respiratory tract infections in children. Design, Setting, and Participants A retrospective cohort study assessing clinical outcomes and a prospective cohort study assessing patient-centered outcomes of children between the ages of 6 months and 12 years diagnosed with an acute respiratory tract infection and prescribed an oral antibiotic between January 2015 and April 2016 in a network of 31 pediatric primary care practices in Pennsylvania and New Jersey. Stratified and propensity score–matched analyses to account for confounding by clinician and by patient-level characteristics, respectively, were implemented for both cohorts. Exposures Broad-spectrum antibiotics vs narrow-spectrum antibiotics. Main Outcomes and Measures In the retrospective cohort, the primary outcomes were treatment failure and adverse events 14 days after diagnosis. In the prospective cohort, the primary outcomes were quality of life, other patient-centered outcomes, and patient-reported adverse events. Results Of 30 159 children in the retrospective cohort (19 179 with acute otitis media; 6746, group A streptococcal pharyngitis; and 4234, acute sinusitis), 4307 (14%) were prescribed broad-spectrum antibiotics including amoxicillin-clavulanate, cephalosporins, and macrolides. Broad-spectrum treatment was not associated with a lower rate of treatment failure (3.4% for broad-spectrum antibiotics vs 3.1% for narrow-spectrum antibiotics; risk difference for full matched analysis, 0.3% [95% CI, −0.4% to 0.9%]). Of 2472 children enrolled in the prospective cohort (1100 with acute otitis media; 705, group A streptococcal pharyngitis; and 667, acute sinusitis), 868 (35%) were prescribed broad-spectrum antibiotics. Broad-spectrum antibiotics were associated with a slightly worse child quality of life (score of 90.2 for broad-spectrum antibiotics vs 91.5 for narrow-spectrum antibiotics; score difference for full matched analysis, −1.4% [95% CI, −2.4% to −0.4%]) but not with other patient-centered outcomes. Broad-spectrum treatment was associated with a higher risk of adverse events documented by the clinician (3.7% for broad-spectrum antibiotics vs 2.7% for narrow-spectrum antibiotics; risk difference for full matched analysis, 1.1% [95% CI, 0.4% to 1.8%]) and reported by the patient (35.6% for broad-spectrum antibiotics vs 25.1% for narrow-spectrum antibiotics; risk difference for full matched analysis, 12.2% [95% CI, 7.3% to 17.2%]). Conclusions and Relevance Among children with acute respiratory tract infections, broad-spectrum antibiotics were not associated with better clinical or patient-centered outcomes compared with narrow-spectrum antibiotics, and were associated with higher rates of adverse events. These data support the use of narrow-spectrum antibiotics for most children with acute respiratory tract infections.

Surveillance for Healthcare-Associated Influenza-Like Illness in Pediatric Clinics: Validity of Diagnosis Codes for Case Identification.

Compared to chart review, a definition based on the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for healthcare-associated influenza-like illness (HA-ILI) among young children in a large pediatric network demonstrated high positive and negative predictive values. This finding suggests that electronic health record-based definitions for surveillance can accurately identify medically attended outpatient HA-ILI cases for research and surveillance. Infect Control Hosp Epidemiol 2016;1-4.

Clinician Perspectives on Preparing for and Conducting Family Meetings (S773)

T13 and T18 over a 20-year period; 2) To evaluate the association between interventions and survival. Methods. Using linked Ontario health administrative databases that capture all hospitalizations in the single-payer healthcare system, we created a retrospective cohort of children born between April 1, 1991 and March 31, 2012 with a diagnosis code for T13 or T18 on a discharge record. Demographic data and procedure codes were extracted from hospitalization discharges through March 31, 2013. Survival times were calculated from listed birth and death dates; patients without death dates were censored at the most recent hospital discharge date. Results. The trisomy 13 cohort included 195 individuals; 161 (82.6%) died during follow-up. Of the 268 children with trisomy 18, 232 (86.6%) died. Median ages at death were 7 days and 5.5 days, respectively; the oldest children in the cohorts were 17 years in trisomy 13 and 15 years in trisomy 18. 80 children with trisomy 13 and 100 children with trisomy 18 received a total of 2141 procedures. Interventions per year increased over time from 10 in 1991 to 58 in 2012. Details about specific procedure types and association with survival will be forthcoming. Conclusions. Children with T13 and T18 in Ontario are receiving increasing numbers of interventions over time. Implications. Interventional outcomes will help guide family and clinician decision-making for care of children with T13 and T18.