Marcella Jewell is a first-year MD/PhD student in the Population-based Urban and Rural Community Health program at the University of Massachusetts Medical School–Baystate and a Research Associate in the Institute for Healthcare Delivery and Population Science. Her recent paper in BMJ Quality & Safety reports on a retrospective cohort study of children aged 2-17 years hospitalized for asthma exacerbation over a 3 year period at a geographically and structurally diverse sample of US hospitals.
Unnecessary Antibiotics in Children Hospitalized for Asthma Exacerbation Risks Antibiotics Resistance
Jewell and her co-authors found that more than 14% of children received antibiotic therapy during a hospital stay for asthma without an apparent indication for treatment.
Hospital prescribing rates varied widely (range 0%-95%). Large, urban, teaching hospitals with extensive pediatric specialty support were more likely to have lower prescribing rates. Hospitalization at general hospitals with minimum pediatric specialty support conferred a nearly threefold higher odds of antibiotic treatment.
Children with multiple chronic conditions and those treated at general hospitals were at the highest risk of receiving inappropriate treatment. This misuse contributes to antibiotic-related adverse events, and the growing threat of antibiotic resistance.
Implications for Baystate Health and Its Communities
"As a first-year medical student in the UMass-Baystate PURCH track, we are taught to think critically from day one about how the health of our community and environment uniquely affect each of our patients," said Jewell.
The greater Springfield community was identified again in 2019 by the Asthma and Allergy Foundation as the most challenging city in which to live with asthma, based on related-ED visits and prevalence among adults and children. Nearly 20% of Springfield school children have asthma, which is 2.5 times the national average of 8%.
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Jewell MJ, Leyenaar J, Shieh MS, Pekow PS, Stefan M, Lindenauer PK. Unnecessary antibiotic prescribing in children hospitalised for asthma exacerbation: a retrospective national cohort study. BMJ Qual Saf. 2020 May 18; [Epub ahead of print] PMID: 32423905.