Association of Antibiotic Choice With Hospital Length of Stay and Risk Factors for Readmission in Patients With Sickle Cell Disease and Acute Chest Syndrome: An Observational Cohort Study.

Abstract

STUDY OBJECTIVE:

We determine the association between use of specific cephalosporins and macrolides and hospital length of stay in patients with sickle cell disease (SCD) who are admitted with acute chest syndrome, and determine treatment risk factors for acute chest syndrome-related 30-day readmission.

METHODS:

Patients admitted to 48 US hospitals within the Pediatric Health Information System between January 2008 and December 2016 with associated International Classification of Diseases, Ninth Revision (ICD-9) or ICD-10 diagnoses of SCD and acute chest syndrome were included. Primary outcomes were hospital length of stay and acute chest syndrome-related and all-cause 30-day readmission. Data were analyzed with t tests, ANOVA, and bivariable and multivariable linear and logistic regressions.

RESULTS:

In 21,126 visits (representing 8,856 patients), median age was 11.2 years (interquartile range 6.1 to 16.5 years), 53.5% were male patients, and 77.2% had hemoglobin SS genotype. Median length of stay was 4 days (interquartile range 2 to 6 days; mean 4.76 days [SD 4.62 days]). Ceftriaxone alone (length of stay 4.75 days [SD 4.66 days]; P<.001) or the combination of ceftriaxone and azithromycin (length of stay 4.84 days [SD 4.74 days]; P<.001) was associated with the shortest length of stay and a reduced risk of acute chest syndrome-related readmission (ceftriaxone odds ratio [OR] 0.31; 95% confidence interval [CI] 0.27 to 0.35; ceftriaxone+azithromycin OR 0.20; 95% CI 0.17 to 0.24). Albuterol (OR 0.97; 95% CI 0.96 to 0.98) and RBC transfusion (OR 0.60; 95% CI 0.43 to 0.83) were also associated with decreased rates of acute chest syndrome-related 30-day readmission. All-cause 30-day readmission rate was 16.7% (95% CI 16.2% to 17.3%).

CONCLUSION:

Guideline-compliant therapy for acute chest syndrome could preferentially include ceftriaxone and azithromycin. All-cause 30-day readmission for acute chest syndrome is lower than that reported for all-cause readmissions for SCD and more consistent with rates of readmission for pneumonia in the general population.

• Authors: Oluwakemi Badaki-Makun, James F Casella, Sean Tackett, Xueting Tao, James M Chamberlain
• Journal: Annals of emergency medicine (Ann Emerg Med) Vol. 76 Issue 3S Pg. S37-S45 (09 2020) ISSN: 1097-6760 [Electronic] United States
• PMID: 32928460 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Cephalosporins
• Macrolides

Topics

• Acute Chest Syndrome (drug therapy, etiology)
• Adolescent
• Anemia, Sickle Cell (complications, drug therapy)
• Anti-Bacterial Agents (therapeutic use)
• Cephalosporins (therapeutic use)
• Child
• Female
• Humans
• Length of Stay (statistics & numerical data)
• Linear Models
• Logistic Models
• Macrolides (therapeutic use)
• Male
• Patient Readmission (statistics & numerical data)
• Retrospective Studies
• Risk Factors
• United States