Time to antibiotics and outcomes for children hospitalized with community acquired pneumonia

BACKGROUND: It is unclear whether time to antibiotics changes outcomes for hospitalized children with community-acquired pneumonia (CAP) and whether observation is safe. OBJECTIVE: Our objective was to compare outcomes among children with CAP admitted to the hospital who did and who did not receive antibiotics within 4 h of presentation to the Emergency Department. METHODS: We conducted a multicenter, retrospective cohort study using data from four hospitals obtained from the Pediatric Health Information System. Children aged 3 months to 18 years, with a chest X-ray, admitted to the hospital from the ED with suspected CAP who received antibiotics were enrolled. Our primary outcome was a composite of escalation of care (escalation in respiratory support, transfer to the intensive care unit, vasopressor use, or chest tube placement). Secondary outcomes were length of stay, duration of oxygen use, and cost of stay. Inverse propensity weighted logistic regression and log gamma regression to evaluate the association of early versus late antibiotics and outcome. RESULTS: There were 758 children hospitalized with CAP who met inclusion criteria, of which 451 (59%) received antibiotics within 4 h. There was no statistical difference in escalation of care between those who received early versus late antibiotics (3% vs. 2%; odds ratio [OR]: 1.46 [95% confidence interval [CI]: 0.57,3.73]). There were no statistical associations with secondary outcomes. CONCLUSION: This study provides an opportunity for antibiotic stewardship by showing that more time to observe patients with CAP without antibiotics does not change outcomes. This time may identify patients who will improve without antibiotics, limiting side effects.