Dataset Information

Aspiration and Non-Aspiration Pneumonia in Hospitalized Children With Neurologic Impairment.

ABSTRACT:

Background and objective

Children with neurologic impairment (NI) are commonly hospitalized for different types of pneumonia, including aspiration pneumonia. We sought to compare hospital management and outcomes of children with NI diagnosed with aspiration versus nonaspiration pneumonia.

Methods

A retrospective study of 27?455 hospitalized children aged 1 to 18 years with NI diagnosed with pneumonia from 2007 to 2012 at 40 children's hospitals in the Pediatric Health Information System database. The primary exposure was pneumonia type, classified as aspiration or nonaspiration. Outcomes were complications (eg, acute respiratory failure) and hospital utilization (eg, length of stay, 30-day readmission). Multivariable regression was used to assess the association between pneumonia type and outcomes, adjusting for NI type, comorbid conditions, and other characteristics.

Results

In multivariable analysis, the 9.7% of children diagnosed with aspiration pneumonia experienced more complications than children with nonaspiration pneumonia (34.0% vs 15.2%, adjusted odds ratio [aOR] 1.2 (95% confidence interval [CI] 1.1-1.3). Children with aspiration pneumonia had significantly longer length of stay (median 5 vs 3 days; ratio of means 1.2; 95% CI 1.2-1.3); more ICU transfers (4.3% vs 1.5%; aOR 1.4; 95% CI 1.1-1.9); greater hospitalization costs (median $11?594 vs $5162; ratio of means 1.2; 95% CI 1.2-1.3); and more 30-day readmissions (17.4% vs 6.8%; aOR 1.3; 95% CI 1.2-1.5).

Conclusions

Hospitalized children with NI diagnosed with aspiration pneumonia have more complications and use more hospital resources than when diagnosed with nonaspiration pneumonia. Additional investigation is needed to understand the reasons for these differences.

SUBMITTER: Thomson J

PROVIDER: S-EPMC6322541 | biostudies-literature | 2016 Feb

REPOSITORIES: biostudies-literature

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Publications

Aspiration and Non-Aspiration Pneumonia in Hospitalized Children With Neurologic Impairment.

Thomson Joanna J Hall Matt M Ambroggio Lilliam L Stone Bryan B Srivastava Rajendu R Shah Samir S SS Berry Jay G JG

Pediatrics 20160119 2

<h4>Background and objective</h4>Children with neurologic impairment (NI) are commonly hospitalized for different types of pneumonia, including aspiration pneumonia. We sought to compare hospital management and outcomes of children with NI diagnosed with aspiration versus nonaspiration pneumonia.<h4>Methods</h4>A retrospective study of 27 455 hospitalized children aged 1 to 18 years with NI diagnosed with pneumonia from 2007 to 2012 at 40 children's hospitals in the Pediatric Health Information ...[more]

PMID: 26787045

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Project description:Background:Bed-ridden state, dysphagia, altered mental state, or respiratory muscle weakness are common in neurologic patients and increase the risk of pneumonia. The major causes of pneumonia in neurologic patients may differ from those in the general population, resulting in a different pathogen distribution. We investigated the trends of pathogen distribution in culture-positive pneumonia in hospitalized neurologic patients and the related antibiotic resistance in those with hospital-acquired pneumonia (HAP). Methods:A retrospective study was performed at Seoul National University Hospital, South Korea. Patients admitted to the Department of Neurology with a positive respiratory specimen culture between 2007 and 2016 were included. Pneumonia events in patients were screened by chronologically associating the date of respiratory specimen acquisition for culture studies and the date of antibiotics administration. Subgroup analyses regarding multidrug resistance in HAP were performed in different pneumonia categories, by presence of ≥1 risk factor and by time period (first half vs. second half of study period). Microbial resistance profiles of isolates from patients with pneumonia were analyzed. Results:We identified 351 pneumonia cases in 227 patients involving 36 different pathogens. 232 cases were HAP, of which 70 cases were intensive care unit (ICU)-HAP. The leading pathogens were Stapylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Streptococcus pneumoniae, and Enterobacter aerogenes, which were isolated in 133 (37.9%), 72 (20.5%), 55 (15.7%), 44 (12.5%), 33 (9.4%), and 27 (7.7%) cases, respectively. Cases with HAP showed a higher proportion of P. aeruginosa and a lower proportion of S. pneumoniae (both, p < 0.05) than those with non-HAP. ICU-HAP isolates showed a higher multidrug resistance (MDR) rate than non-ICU-HAP isolates (p < 0.005) in those with ≥1 MDR risk factor. Non-susceptibility to imipenem (p < 0.0005), piperacillin-tazobactam (p < 0.001), cefepime (p < 0.005), and trimethoprim-sulfamethoxazole (p < 0.05) in Gram-negative pathogens increased over time in both ICU and non-ICU settings. Conclusions:S. aureus, K. pneumoniae, A. baumannii, P. aeruginosa, S. pneumoniae, and E. aerogenes were the leading isolates in culture-positive pneumonia in hospitalized neurologic patients. Antimicrobial resistance of Gram-negative pathogens in neurologic patients with culture-positive HAP has recently increased.

Project description:Background and objectivesPneumonia is a leading cause of hospitalization and readmission in children. Understanding the patient characteristics associated with pneumonia readmissions is necessary to inform interventions to reduce avoidable hospitalizations and related costs. The objective of this study was to characterize readmission rates, and identify factors and costs associated with readmission among children previously hospitalized with pneumonia.MethodsRetrospective cohort study of children hospitalized with pneumonia at the 43 hospitals included in the Pediatric Health Information System between January 1, 2008, and December 31, 2011. The primary outcome was all-cause readmission within 30 days after hospital discharge, and the secondary outcome was pneumonia-specific readmission. We used multivariable regression models to identify patient and hospital characteristics and costs associated with readmission.ResultsA total of 82?566 children were hospitalized with pneumonia (median age, 3 years; interquartile range 1-7). Thirty-day all-cause and pneumonia-specific readmission rates were 7.7% and 3.1%, respectively. Readmission rates were higher among children <1 year of age, as well as in patients with previous hospitalizations, longer index hospitalizations, and complicated pneumonia. Children with chronic medical conditions were more likely to experience all-cause (odds ratio 3.0; 95% confidence interval 2.8-3.2) and pneumonia-specific readmission (odds ratio 1.8; 95% confidence interval 1.7-2.0) compared with children without chronic medical conditions. The median cost of a readmission ($11?344) was higher than that of an index admission ($4495; P = .01). Readmissions occurred in 8% of pneumonia hospitalizations but accounted for 16.3% of total costs for all pneumonia hospitalizations.ConclusionsReadmissions are common after hospitalization for pneumonia, especially among young children and those with chronic medical conditions, and are associated with substantial costs.

Project description:BACKGROUND/OBJECTIVES:Off-label use of antipsychotics is common in hospitals, most often for delirium management. Antipsychotics have been associated with aspiration pneumonia in community and nursing home settings, but the association in hospitalized individuals is unexplored. We aimed to investigate the association between antipsychotic exposure and aspiration pneumonia during hospitalization. DESIGN:Retrospective cohort study. SETTING:Large academic medical center. PARTICIPANTS:All adult hospitalizations between January 2007 and July 2013. We excluded outside hospital transfers, hospitalizations shorter than 48 hours, and psychiatric hospitalizations. MEASUREMENTS:Antipsychotic use defined as any pharmacy charge for an antipsychotic medication. Aspiration pneumonia was defined according to a discharge diagnosis code for aspiration pneumonia not present on admission and validated using chart review. A generalized estimating equation was used to control for 43 potential confounders. RESULTS:Our cohort included 146,552 hospitalizations (median age 56; 39% male). Antipsychotics were used in 10,377 (7.1%) hospitalizations (80% atypical, 35% typical, 15% both). Aspiration pneumonia occurred in 557 (0.4%) hospitalizations. The incidence of aspiration pneumonia was 0.3% in unexposed individuals and 1.2% in those with antipsychotic exposure (odds ratio (OR) = 3.9, 95% confidence interval (CI) = 3.2-4.8). After adjustment, antipsychotic exposure was significantly associated with aspiration pneumonia (adjusted OR = (aOR) = 1.5, 95% CI = 1.2-1.9). Similar results were demonstrated in a propensity-matched analysis and in an analysis restricted to those with delirium or dementia. The magnitude of the association was similar for typical (aOR = 1.4, 95% CI = 0.94-2.2) and atypical (aOR = 1.5, 95% CI = 1.1-2.0) antipsychotics. CONCLUSION:Antipsychotics were associated with greater odds of aspiration pneumonia after extensive adjustment for participant characteristics. This risk should be considered when prescribing antipsychotics in the hospital.

Dataset Information

Aspiration and Non-Aspiration Pneumonia in Hospitalized Children With Neurologic Impairment.

Background and objective

Methods

Results

Conclusions

Publications

Aspiration and Non-Aspiration Pneumonia in Hospitalized Children With Neurologic Impairment.

Similar Datasets

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