Guideline-Adherent Antibiotics Decrease Readmission for Acute Chest Syndrome

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The diagnosis of acute chest syndrome is made in 10% of children whom are febrile with a diagnosis of sickle cell disease presenting to the emergency department.
The diagnosis of acute chest syndrome is made in 10% of children whom are febrile with a diagnosis of sickle cell disease presenting to the emergency department.

Among children with acute chest syndrome and sickle cell disease, guideline-adherent treatment reduced hospital readmission rates, according to recent research published in JAMA Pediatrics.

In this retrospective study, researchers evaluated hospitalization (n=14,480) of children (median age 9; range 0-22) from a national database with a discharge diagnosis of sickle cell disease and acute chest syndrome or pneumonia (n=7178). Treatment was considered National Heart, Lung, and Blood Institute guideline-adherent (macrolide with parenteral cephalosporin) vs non-guideline-adherent antibiotic therapy.

Approximately three-quarters of children hospitalized were treated with guideline-adherent antibiotics for acute chest syndrome (73.6%). Age range affected the rate of guideline-adherent treatment, with children age 5 to 9 years receiving a higher rate of guideline-adherent treatment (79.8%) compared with children 19 to 22 (64.1%). 

The use of guideline-adherent antibiotics varied among hospitals, with rates ranging from 24% to 90%.

Treatment with guideline-adherent antibiotics reduced the risk for acute chest syndrome-related readmission (odds ratio [OR]: .71; 95% CI, .50-1) and all-cause readmission (OR: .50; 95% CI, .39-.64) within 30 days.

Dr David Bundy, lead author on the study, noted that there have been no randomized controlled trials on antibiotic use for acute chest syndrome. Therefore, he concluded that “until randomized control trial data exist, following existing treatment guidelines seems prudent. Our study suggests doing so will yield the lowest readmission rates following episodes of [acute chest syndrome].”

Reference

Bundy DG, Richardson TE, Hall M, et al. Association of guideline-adherent antibiotic treatment with readmission of children with sickle cell disease hospitalized with acute chest syndrome [published online September 11, 2017]. JAMA Pediatr. doi:10.1001/jamapediatrics.2017.2526

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