Factors Associated With Antibiotic Exposure in Children Less Than 3 Years Old Hospitalized With Bronchiolitis
Bibliographic record
Abstract
Background. Children hospitalized with bronchiolitis, a leading cause of pediatric admissions, are frequently treated with antibiotics despite recommendations to limit their use in this viral syndrome. To inform strategies to curb antibiotic overuse in this population, we sought to identify determinants of antibiotic exposure among inpatients with bronchiolitis. Methods. We performed a prospective cohort study of children 29 days to 35 months old hospitalized from 2006 to 2010 for acute respiratory infection (ARI) in Quebec City, Canada. We collected clinical data and a nasopharyngeal aspirate for multiplex viral testing at enrollment and reviewed patient charts to record management. We assessed factors associated with antibiotic use by logistic regression. Results. Among 681 children admitted for ARI, 472 (69.3%) were diagnosed with bronchiolitis. We identified ≥1 respiratory virus in 435/472 (92.2%) patients, most frequently respiratory syncytial virus (RSV; 366 [77.5%]). Chest x-ray (CXR) and blood culture were performed in 450 (95.3%) and 247 (52.3%) subjects, respectively. Antibiotics were prescribed to 300/472 (63.6%) children. In a multivariate analysis, the strongest independent risk factors for antibiotic exposure were a concurrent clinical diagnosis of acute otitis media (adjusted odds ratio [aOR] 17.8; 95% CI 8.9-35.3) and pneumonia (aOR 8.4; 95% CI 2.7-25.9). Other risk factors included having a blood culture (aOR 7.6; 95% CI 4.1-14.0), fever ≥38.5 °C (aOR 3.1; 95% CI 1.7-5.7), underlying comorbidity (aOR 3.1; 95% CI 1.1-8.1), infiltrate on CXR (aOR 3.1; 95% CI 1.05-8.9), longer hospital stay in days (aOR 1.2; 95% CI 1.1-1.4), and older age (6-11 months [aOR 1.1; 95% CI 0.5-2.2]; 12-23 months [aOR 3.1; 95% CI 1.3-7.5]; 24-35 months [aOR 6.7; 95% CI 0.95-47.8]). RSV rapid test result, infecting virus, and disease severity (need for O2 therapy or intensive care) were not associated with antibiotic use. Conclusion. Antibiotic exposure occurred in nearly two-thirds of children admitted with bronchiolitis, almost all of whom had an identifiable viral etiology. More reliable methods to diagnose concurrent bacterial pneumonia and otitis could greatly reduce unnecessary antibiotic use in bronchiolitis hospitalizations. Disclosures. G. Boivin, BioCryst: Investigator, Research grant. Merck: Investigator, Research grant; J. Papenburg, Becton, Dickenson & Co.: Investigator, Research grant. RPS Diagnostics: Scientific Advisor, n/a. AbbVie: Scientific Advisor, n/a
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".