Provider-ordered viral testing and antibiotic administration practices among children with acute respiratory infections across healthcare settings in Nashville, Tennessee
Abstract 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...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2024-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X2400024X/type/journal_article |
| _version_ | 1797272249099616256 |
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| author | Danielle A. Rankin Sophie E. Katz Justin Z. Amarin Haya Hayek Laura S. Stewart James C. Slaughter Stephen Deppen Ahmad Yanis Yesenia Herazo Romero James D. Chappell Nikhil K. Khankari Natasha B. Halasa |
| author_facet | Danielle A. Rankin Sophie E. Katz Justin Z. Amarin Haya Hayek Laura S. Stewart James C. Slaughter Stephen Deppen Ahmad Yanis Yesenia Herazo Romero James D. Chappell Nikhil K. Khankari Natasha B. Halasa |
| author_sort | Danielle A. Rankin |
| collection | DOAJ |
| description |
Abstract
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.
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| first_indexed | 2024-03-07T14:24:42Z |
| format | Article |
| id | doaj.art-da1b21302903409c8f0ec2152e123d13 |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-03-07T14:24:42Z |
| publishDate | 2024-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-da1b21302903409c8f0ec2152e123d132024-03-06T08:55:57ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2024-01-01410.1017/ash.2024.24Provider-ordered viral testing and antibiotic administration practices among children with acute respiratory infections across healthcare settings in Nashville, TennesseeDanielle A. Rankin0https://orcid.org/0000-0003-3018-3373Sophie E. Katz1https://orcid.org/0000-0003-4611-6861Justin Z. Amarin2https://orcid.org/0000-0002-4484-1077Haya Hayek3https://orcid.org/0000-0003-0087-4392Laura S. Stewart4https://orcid.org/0000-0001-6867-2223James C. Slaughter5https://orcid.org/0000-0002-8770-980XStephen Deppen6https://orcid.org/0000-0002-3661-662XAhmad Yanis7https://orcid.org/0000-0003-2333-9050Yesenia Herazo Romero8James D. Chappell9https://orcid.org/0000-0002-7382-7864Nikhil K. Khankari10https://orcid.org/0000-0002-8802-4431Natasha B. Halasa11https://orcid.org/0000-0002-6381-1826Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, TN, USADepartment of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USADepartment of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USADepartment of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USADepartment of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USADepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USADepartment of Thoracic Surgery and Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USADepartment of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USADepartment of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USADepartment of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USADivision of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USADepartment of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA Abstract 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. https://www.cambridge.org/core/product/identifier/S2732494X2400024X/type/journal_article |
| spellingShingle | Danielle A. Rankin Sophie E. Katz Justin Z. Amarin Haya Hayek Laura S. Stewart James C. Slaughter Stephen Deppen Ahmad Yanis Yesenia Herazo Romero James D. Chappell Nikhil K. Khankari Natasha B. Halasa Provider-ordered viral testing and antibiotic administration practices among children with acute respiratory infections across healthcare settings in Nashville, Tennessee Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Provider-ordered viral testing and antibiotic administration practices among children with acute respiratory infections across healthcare settings in Nashville, Tennessee |
| title_full | Provider-ordered viral testing and antibiotic administration practices among children with acute respiratory infections across healthcare settings in Nashville, Tennessee |
| title_fullStr | Provider-ordered viral testing and antibiotic administration practices among children with acute respiratory infections across healthcare settings in Nashville, Tennessee |
| title_full_unstemmed | Provider-ordered viral testing and antibiotic administration practices among children with acute respiratory infections across healthcare settings in Nashville, Tennessee |
| title_short | Provider-ordered viral testing and antibiotic administration practices among children with acute respiratory infections across healthcare settings in Nashville, Tennessee |
| title_sort | provider ordered viral testing and antibiotic administration practices among children with acute respiratory infections across healthcare settings in nashville tennessee |
| url | https://www.cambridge.org/core/product/identifier/S2732494X2400024X/type/journal_article |
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