Importance Acute chest syndrome (ACS) is a common, serious complication of sickle cell disease (SCD) and a leading cause of hospitalization and death in both children and adults with SCD. Little is known about the effectiveness of guideline-recommended antibiotic regimens for the care of children hospitalized with ACS. Objectives To use a large, national database to describe patterns of antibiotic use for children with SCD hospitalized for ACS and to determine whether receipt of guideline-adherent antibiotics was associated with lower readmission rates. Design, Setting, and Participants Retrospective cohort study including 14 480 hospitalizations in 7178 children (age 0-22 years) with a discharge diagnosis of SCD and either ACS or pneumonia. Information was obtained from 41 children’s hospitals submitting data to the Pediatric Health Information System from January 1, 2010, to December 31, 2016. Exposures National Heart, Lung, and Blood Institute guideline-adherent (macrolide with parenteral cephalosporin) vs non–guideline-adherent antibiotic regimens. Main Outcomes and Measures Acute chest syndrome–related and all-cause 7- and 30-day readmissions. Results Of the 14 480 hospitalizations, 6562 (45.3%) were in girls; median (interquartile range) age was 9 (4-14) years. Guideline-adherent antibiotics were provided in 10 654 of 14 480 hospitalizations for ACS (73.6%). Hospitalizations were most likely to include guideline-adherent antibiotics for children aged 5 to 9 years (3230 of 4047 [79.8%]) and declined to the lowest level for children 19 to 22 years (697 of 1088 [64.1%]). Between-hospital variation in antibiotic regimens was wide, with use of guideline-adherent antibiotics ranging from 24% to 90%. Children treated with guideline-adherent antibiotics had lower 30-day ACS-related (odds ratio [OR], 0.71; 95% CI, 0.50-1.00) and all-cause (OR, 0.50; 95% CI, 0.39-0.64) readmission rates vs children who received other regimens (cephalosporin and macrolide vs neither drug class). Conclusions and Relevance Current approaches to antibiotic treatment in children with ACS vary widely, but guideline-adherent therapy appears to result in fewer readmissions compared with non–guideline-adherent therapy. Efforts to increase the dissemination and implementation of SCD treatment guidelines are warranted as is comparative effectiveness research to strengthen the underlying evidence base.

中文翻译：

---

符合指南的抗生素治疗与镰状细胞病患儿住院急性胸综合征再入院的关联

重要性 急性胸部综合征 (ACS) 是镰状细胞病 (SCD) 的常见严重并发症，也是 SCD 儿童和成人住院和死亡的主要原因。指南推荐的抗生素治疗方案对 ACS 住院儿童的治疗效果知之甚少。目的 使用大型国家数据库来描述因 ACS 住院的 SCD 儿童的抗生素使用模式，并确定接受符合指南的抗生素是否与较低的再入院率相关。设计、设置和参与者 回顾性队列研究包括 7178 名出院诊断为 SCD 和 ACS 或肺炎的儿童（0-22 岁）的 14480 名住院患者。信息是从 2010 年 1 月 1 日至 2016 年 12 月 31 日向儿科健康信息系统提交数据的 41 家儿童医院获得的。 国家心肺血液研究所指南遵守（大环内酯类注射头孢菌素）与非指南的暴露依从性抗生素治疗方案。主要结果和措施 急性胸部综合征相关和全因 7 天和 30 天再入院。结果 14 480例住院患者中，女童6 562例（45.3%）；中位（四分位距）年龄为 9 (4-14) 岁。在 14 480 例 ACS 住院患者中，有 10 654 例（73.6%）使用了符合指南的抗生素。住院治疗最有可能包括 5 至 9 岁儿童使用符合指南的抗生素（4047 人中的 3230 人 [79.8%]），而 19 至 22 岁儿童的住院人数降至最低水平（1088 人中的 697 人 [64.1%]）。医院间抗生素方案的差异很大，使用符合指南的抗生素的范围从 24% 到 90%。使用符合指南的抗生素治疗的儿童 30 天 ACS 相关（比值比 [OR]，0.71；95% CI，0.50-1.00）和全因（OR，0.50；95% CI，0.39-0.64）再入院率较低率与接受其他治疗方案的儿童（头孢菌素和大环内酯与两种药物类别）的比较。结论和相关性 目前对 ACS 儿童的抗生素治疗方法差异很大，但与不遵守指南的治疗相比，遵守指南的治疗似乎导致更少的再入院率。努力增加 SCD 治疗指南的传播和实施是有必要的，比较有效性研究也是如此，以加强潜在的证据基础。