Background: Community-acquired pneumonia (CAP) in pediatric patients is a common and potentially serious respiratory infection that affects children in community settings. Vaccination, particularly with Streptococcus pneumonia and Haemophilus influenzae type b, plays a vital role in preventing CAP and in the treatment approach in pediatric patients. Currently, the American Academy of Pediatrics guidelines recommend treating patients admitted to the hospital with mild CAP who are fully vaccinated with ampicillin or penicillin G and patients who are not fully vaccinated with ceftriaxone. Because guideline-directed therapy for mild CAP was not consistently followed at Loyola University Medical Center (LUMC), a pathway was developed to aid healthcare providers in classifying and managing pediatric patients with CAP. Methods: This study is a single-center, observational, retrospective, cohort study conducted on patients admitted to the general pediatric and pediatric intensive care units (PICUs) with a diagnosis of CAP from January 2022 to December 2023 at LUMC Children’s Hospital. The purpose of this study is to evaluate the implementation of the inpatient clinical pathway for CAP in infants >60 days to pediatric patients <18 years old at LUMC Children’s Hospital. The primary outcome was the effectiveness of the pathway in the reduction of ceftriaxone prescribing in pediatric patients with CAP. Results: A total of 146 patients were included, with 87 in the prepathway group and 59 in the postpathway group. While there were notable shifts in racial demographics postpathway, with a significant increase in Hispanic representation (39.1% to 67.8%, P = 0.001) and a significant decrease in Caucasian representation (39.1% to 15.3%, P = 0.003), there were no significant differences observed between gender distribution, vaccination status, or prevalence of penicillin allergies in the two groups. Notably, there was an increase in the utilization of infectious disease consultation (1.1% prepathway vs. 10.2% postpathway, P = 0.018) and Methicillin-resistant Staphylococcus aureus nares screening (3.4% prepathway vs. 61% postpathway, P < 0.01). Additionally, there was a statistically significant decrease in the empirical use of ceftriaxone upon admission to the inpatient units (86.2% prepathway vs. 54.2% postpathway, P < 0.01). Adherence to clinical pathways, particularly on admission to the general pediatric (37.9% prepathway vs. 89.7% postpathway, P < 0.01) and PICU (13.8% prepathway vs. 33.3% postpathway, P = 0.031) also improved postpathway implementation. Conclusion: The implementation of the inpatient clinical pathway for CAP at LUMC Children’s Hospital has demonstrated significant enhancements in patient management practices, particularly in the realm of antibiotic stewardship. The observed improvements in the utilization of infectious disease consultation and adherence to the pathway reduced empirical use of ceftriaxone, which highlights the pathway’s pivotal role in promoting judicious antibiotic prescribing. By providing a standardized approach to CAP management, this pathway not only improves clinical outcomes but also contributes to antibiotic stewardship efforts, ensuring optimal treatment while minimizing antibiotic resistance and associated risks. These findings emphasize the importance of integrating clinical pathways, specifically tailored for CAP, in healthcare settings to advance antibiotic stewardship practices and enhance overall patient care.
Craven et al. (Tue,) studied this question.