313 - Antibiotic Use Among Hospitalized Children With Status Asthmaticus: A Community Hospital Experience

Publication Number: 2302.313

Carl G. Julien, The Brooklyn Hospital Center, Brooklyn, NY, United States; Ankita Nanda, The Brooklyn Hospital Center, Brooklyn, NY, United States; Noah P. Kondamudi, The Brooklyn, Brooklyn, NY, United States

Background: Despite clear national guidelines, (Global Initiative for asthma (GINA 2024) and National asthma Education and Prevention Program (NAEPP) 2020) regarding appropriate antibiotic use for status asthmaticus, their use remains widespread. National data suggest that up to 40% of pediatric asthma hospitalizations involve antibiotic exposure despite limited evidence of benefit, raising concerns for adverse reactions, resistance, and higher costs.

Objective: To quantify antibiotic use in hospitalized children with status asthmaticus, assess adherence to guideline-based indications, and identify clinical factors associated with prescribing.

Design/Methods: Retrospective study conducted at a community-hospital inpatient unit between January 2022 and December 2024. Included were children aged 2-18 years admitted for status asthmaticus and excluded were children with immunocompromised condition, children with chronic diseases and those on antibiotics at admission. Data on demographics, illness severity, radiographic and laboratory findings, and antibiotic use abstracted. Appropriateness determined when concordance with guidelines. Bivariate tests and multivariable logistic regression for identified predictors of antibiotic using SPSS for windows version 26.

Results: 190 encounters met inclusion criteria among 139 children. The mean age was 7.8± 4.6 years; 63.2% male, 62 encounters (32.6%) received antibiotics. The most commonly used antibiotics were Azithromycin in 79% (n=49) and Ceftriaxone in 26% (n=16). Chest x-rays performed in119 encounters with 16.8% (n=20) diagnosed with findings of bacterial pneumonia. Of those without findings of bacterial pneumonia (n=99), 41.4% (n=41) of patients received antibiotics for presumed pneumonia. A significant association detected between chest X-ray performance (p= < 0.001) and asthma severity (p= < 0.009) with antibiotics use. Mean length of stay was longer in antibiotic-treated vs non-treated patients (3.47 ± 1.70 vs 2.55 ± 0.84 days, p < .001). Clinical factors associated with antibiotics use shown in table 2. Those factors remained consistent in the multivariable logistic regression analysis.

Conclusion(s): A third of children hospitalized for status asthmaticus received antibiotics, many without evidence of bacterial infection. Performance of chest ray is strongly associated with antibiotic use and be related to over diagnosis of pneumonia in the interpretation of radiological findings. Prudent use of chest-ray and lab data consistent with national guidelines (GINA and NAEPP) can prevent unnecessary antibiotic use and help with antibiotic stewardship.

Table 1. Distribution of Antibiotic Agents Administered Among Hospitalized Children With Status Asthmaticus (n = 62)
Azithromycin accounted for the majority of antibiotic prescriptions (79%), followed by ceftriaxone (25.8%) and amoxicillin (17.7%).

Table 2. Clinical Factors Associated With Antibiotic Use in Children Hospitalized for Status Asthmaticus
Tachypnea, high-flow nasal cannula (HFNC) use, low-flow oxygen requirement, illness severity, and presence of fever were significantly associated with antibiotic administration (p < 0.05). Percentages reflect within-group proportions.