Provider-ordered viral testing and antibiotic administration practices among children with acute respiratory infections across healthcare settings in Nashville, Tennessee.

Autor:	Rankin DA; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.; Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN, USA., Katz SE; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA., Amarin JZ; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA., Hayek H; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA., Stewart LS; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA., Slaughter JC; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA., Deppen S; Department of Thoracic Surgery and Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA., Yanis A; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA., Romero YH; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA., Chappell JD; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA., Khankari NK; Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA., Halasa NB; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
Jazyk:	angličtina
Zdroj:	Antimicrobial stewardship & healthcare epidemiology : ASHE [Antimicrob Steward Healthc Epidemiol] 2024 Mar 06; Vol. 4 (1), pp. e29. Date of Electronic Publication: 2024 Mar 06 (Print Publication: 2024).
DOI:	10.1017/ash.2024.24
Abstrakt:	Objective: Evaluate the association between provider-ordered viral testing and antibiotic treatment practices among children discharged from an ED or hospitalized with an acute respiratory infection (ARI). Design: Active, prospective ARI surveillance study from November 2017 to February 2020. Setting: Pediatric hospital and emergency department in Nashville, Tennessee. Participants: Children 30 days to 17 years old seeking medical care for fever and/or respiratory symptoms. Methods: Antibiotics prescribed during the child's ED visit or administered during hospitalization were categorized into (1) None administered; (2) Narrow-spectrum; and (3) Broad-spectrum. Setting-specific models were built using unconditional polytomous logistic regression with robust sandwich estimators to estimate the adjusted odds ratios and 95% confidence intervals between provider-ordered viral testing (ie, tested versus not tested) and viral test result (ie, positive test versus not tested and negative test versus not tested) and three-level antibiotic administration. Results: 4,107 children were enrolled and tested, of which 2,616 (64%) were seen in the ED and 1,491 (36%) were hospitalized. In the ED, children who received a provider-ordered viral test had 25% decreased odds (aOR: 0.75; 95% CI: 0.54, 0.98) of receiving a narrow-spectrum antibiotic during their visit than those without testing. In the inpatient setting, children with a negative provider-ordered viral test had 57% increased odds (aOR: 1.57; 95% CI: 1.01, 2.44) of being administered a broad-spectrum antibiotic compared to children without testing. Conclusions: In our study, the impact of provider-ordered viral testing on antibiotic practices differed by setting. Additional studies evaluating the influence of viral testing on antibiotic stewardship and antibiotic prescribing practices are needed. Competing Interests: N.H. receives grant support from Sanofi, Quidel, and speaker compensation from an education grant supported by Genentech. All other co-authors have no conflicts of interest relevant to this article to disclose. (© The Author(s) 2024.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu