Antibiotic treatment of signs and symptoms of pulmonary exacerbations: A comparison by care site

Michael S. Schechter, Warren E. Regelmann, Gregory S. Sawicki, Lawrence Rasouliyan, Donald R. Vandevanter, Margaret Rosenfeld, David Pasta, Wayne J Morgan, Michael W. Konstan

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background Antibiotic treatment of cystic fibrosis pulmonary exacerbations is inconsistent. Previous research has indicated that intravenous antibiotics are used more frequently at sites with better pulmonary function but it is not clear under what circumstances they are prescribed. Method Pediatric care sites enrolled in the Epidemiologic Study of Cystic Fibrosis were ranked by median FEV<inf>1</inf> % predicted of children they followed. Reported presence of new signs and symptoms of a pulmonary exacerbation (PEx) and antibiotic treatment within 21 days were compared between those in the highest vs. those in the other quartiles, and adjusted for sociodemographic and clinical characteristics of patients. Result Highest quartile sites had a total of 2,454 children eligible for this analysis; lower quartile sites had a total of 5,487. The odds of having a PEx at highest vs. lower sites varied with how the PEx was defined, but high quartile sites were uniformly more likely to treat PEx with antibiotics. The adjusted odds ratio for treatment with any antibiotics of a PEx defined by the occurrence of one or two new signs and symptoms was 1.24 (95% CI 1.10, 1.40); for treatment of a PEx defined by the occurrence of three or four new signs and symptoms was 1.50 (95% CI 1.06, 2.11); and for treatment of a PEx defined by a drop of FEV<inf>1</inf> by ≥-15% was 1.33 (1.10, 1.60). The adjusted OR for treatment of these PEx with IV antibiotics was 1.11 (0.94, 1.32), 1.90 (1.32, 2.72), and 1.33 (1.10, 1.60), respectively. Conclusion ESCF care sites in the highest quartile for FEV<inf>1</inf> were more likely to prescribe antibiotics when patients present with either mild or overt evidence of PEx. While this may not be the only reason that their patients have superior median FEV1, it is likely an important contributor.

Original languageEnglish (US)
Pages (from-to)431-440
Number of pages10
JournalPediatric Pulmonology
Volume50
Issue number5
DOIs
StatePublished - May 1 2015

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Signs and Symptoms
Anti-Bacterial Agents
Lung
Therapeutics
Cystic Fibrosis
Epidemiologic Studies
Odds Ratio
Pediatrics
Research

Keywords

  • antibiotic therapy
  • benchmarking
  • Cystic Fibrosis (CF)
  • epidemiology

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

Cite this

Schechter, M. S., Regelmann, W. E., Sawicki, G. S., Rasouliyan, L., Vandevanter, D. R., Rosenfeld, M., ... Konstan, M. W. (2015). Antibiotic treatment of signs and symptoms of pulmonary exacerbations: A comparison by care site. Pediatric Pulmonology, 50(5), 431-440. https://doi.org/10.1002/ppul.23147

Antibiotic treatment of signs and symptoms of pulmonary exacerbations : A comparison by care site. / Schechter, Michael S.; Regelmann, Warren E.; Sawicki, Gregory S.; Rasouliyan, Lawrence; Vandevanter, Donald R.; Rosenfeld, Margaret; Pasta, David; Morgan, Wayne J; Konstan, Michael W.

In: Pediatric Pulmonology, Vol. 50, No. 5, 01.05.2015, p. 431-440.

Research output: Contribution to journalArticle

Schechter, MS, Regelmann, WE, Sawicki, GS, Rasouliyan, L, Vandevanter, DR, Rosenfeld, M, Pasta, D, Morgan, WJ & Konstan, MW 2015, 'Antibiotic treatment of signs and symptoms of pulmonary exacerbations: A comparison by care site', Pediatric Pulmonology, vol. 50, no. 5, pp. 431-440. https://doi.org/10.1002/ppul.23147
Schechter MS, Regelmann WE, Sawicki GS, Rasouliyan L, Vandevanter DR, Rosenfeld M et al. Antibiotic treatment of signs and symptoms of pulmonary exacerbations: A comparison by care site. Pediatric Pulmonology. 2015 May 1;50(5):431-440. https://doi.org/10.1002/ppul.23147
Schechter, Michael S. ; Regelmann, Warren E. ; Sawicki, Gregory S. ; Rasouliyan, Lawrence ; Vandevanter, Donald R. ; Rosenfeld, Margaret ; Pasta, David ; Morgan, Wayne J ; Konstan, Michael W. / Antibiotic treatment of signs and symptoms of pulmonary exacerbations : A comparison by care site. In: Pediatric Pulmonology. 2015 ; Vol. 50, No. 5. pp. 431-440.
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abstract = "Background Antibiotic treatment of cystic fibrosis pulmonary exacerbations is inconsistent. Previous research has indicated that intravenous antibiotics are used more frequently at sites with better pulmonary function but it is not clear under what circumstances they are prescribed. Method Pediatric care sites enrolled in the Epidemiologic Study of Cystic Fibrosis were ranked by median FEV1 {\%} predicted of children they followed. Reported presence of new signs and symptoms of a pulmonary exacerbation (PEx) and antibiotic treatment within 21 days were compared between those in the highest vs. those in the other quartiles, and adjusted for sociodemographic and clinical characteristics of patients. Result Highest quartile sites had a total of 2,454 children eligible for this analysis; lower quartile sites had a total of 5,487. The odds of having a PEx at highest vs. lower sites varied with how the PEx was defined, but high quartile sites were uniformly more likely to treat PEx with antibiotics. The adjusted odds ratio for treatment with any antibiotics of a PEx defined by the occurrence of one or two new signs and symptoms was 1.24 (95{\%} CI 1.10, 1.40); for treatment of a PEx defined by the occurrence of three or four new signs and symptoms was 1.50 (95{\%} CI 1.06, 2.11); and for treatment of a PEx defined by a drop of FEV1 by ≥-15{\%} was 1.33 (1.10, 1.60). The adjusted OR for treatment of these PEx with IV antibiotics was 1.11 (0.94, 1.32), 1.90 (1.32, 2.72), and 1.33 (1.10, 1.60), respectively. Conclusion ESCF care sites in the highest quartile for FEV1 were more likely to prescribe antibiotics when patients present with either mild or overt evidence of PEx. While this may not be the only reason that their patients have superior median FEV1, it is likely an important contributor.",
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AU - Vandevanter, Donald R.

AU - Rosenfeld, Margaret

AU - Pasta, David

AU - Morgan, Wayne J

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N2 - Background Antibiotic treatment of cystic fibrosis pulmonary exacerbations is inconsistent. Previous research has indicated that intravenous antibiotics are used more frequently at sites with better pulmonary function but it is not clear under what circumstances they are prescribed. Method Pediatric care sites enrolled in the Epidemiologic Study of Cystic Fibrosis were ranked by median FEV1 % predicted of children they followed. Reported presence of new signs and symptoms of a pulmonary exacerbation (PEx) and antibiotic treatment within 21 days were compared between those in the highest vs. those in the other quartiles, and adjusted for sociodemographic and clinical characteristics of patients. Result Highest quartile sites had a total of 2,454 children eligible for this analysis; lower quartile sites had a total of 5,487. The odds of having a PEx at highest vs. lower sites varied with how the PEx was defined, but high quartile sites were uniformly more likely to treat PEx with antibiotics. The adjusted odds ratio for treatment with any antibiotics of a PEx defined by the occurrence of one or two new signs and symptoms was 1.24 (95% CI 1.10, 1.40); for treatment of a PEx defined by the occurrence of three or four new signs and symptoms was 1.50 (95% CI 1.06, 2.11); and for treatment of a PEx defined by a drop of FEV1 by ≥-15% was 1.33 (1.10, 1.60). The adjusted OR for treatment of these PEx with IV antibiotics was 1.11 (0.94, 1.32), 1.90 (1.32, 2.72), and 1.33 (1.10, 1.60), respectively. Conclusion ESCF care sites in the highest quartile for FEV1 were more likely to prescribe antibiotics when patients present with either mild or overt evidence of PEx. While this may not be the only reason that their patients have superior median FEV1, it is likely an important contributor.

AB - Background Antibiotic treatment of cystic fibrosis pulmonary exacerbations is inconsistent. Previous research has indicated that intravenous antibiotics are used more frequently at sites with better pulmonary function but it is not clear under what circumstances they are prescribed. Method Pediatric care sites enrolled in the Epidemiologic Study of Cystic Fibrosis were ranked by median FEV1 % predicted of children they followed. Reported presence of new signs and symptoms of a pulmonary exacerbation (PEx) and antibiotic treatment within 21 days were compared between those in the highest vs. those in the other quartiles, and adjusted for sociodemographic and clinical characteristics of patients. Result Highest quartile sites had a total of 2,454 children eligible for this analysis; lower quartile sites had a total of 5,487. The odds of having a PEx at highest vs. lower sites varied with how the PEx was defined, but high quartile sites were uniformly more likely to treat PEx with antibiotics. The adjusted odds ratio for treatment with any antibiotics of a PEx defined by the occurrence of one or two new signs and symptoms was 1.24 (95% CI 1.10, 1.40); for treatment of a PEx defined by the occurrence of three or four new signs and symptoms was 1.50 (95% CI 1.06, 2.11); and for treatment of a PEx defined by a drop of FEV1 by ≥-15% was 1.33 (1.10, 1.60). The adjusted OR for treatment of these PEx with IV antibiotics was 1.11 (0.94, 1.32), 1.90 (1.32, 2.72), and 1.33 (1.10, 1.60), respectively. Conclusion ESCF care sites in the highest quartile for FEV1 were more likely to prescribe antibiotics when patients present with either mild or overt evidence of PEx. While this may not be the only reason that their patients have superior median FEV1, it is likely an important contributor.

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