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Validation of an electronic algorithm to identify appropriate antibiotic use for community-acquired pneumonia in hospitalized children

Published online by Cambridge University Press:  28 October 2025

Kathleen Chiotos Open the ORCID record for Kathleen Chiotos [Opens in a new window] ,
Lauren Dutcher ,
Robert Grundmeier ,
Didien Meyahnwi ,
Ebbing Lautenbach Open the ORCID record for Ebbing Lautenbach [Opens in a new window] ,
Melinda Neuhauser ,
Lauri Hicks ,
Keith Hamilton ,
Julia E. Szymczak Open the ORCID record for Julia E. Szymczak [Opens in a new window]  and
Brandi Muller Open the ORCID record for Brandi Muller [Opens in a new window]
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Kathleen Chiotos*
Affiliation:
Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, Philadelphia, PA, USA Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Lauren Dutcher
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
Robert Grundmeier
Affiliation:
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Division of General Pediatrics, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Didien Meyahnwi
Affiliation:
Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Ebbing Lautenbach
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Melinda Neuhauser
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
Lauri Hicks
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
Keith Hamilton
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
Julia E. Szymczak
Affiliation:
Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
Brandi Muller
Affiliation:
Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
Leigh Cressman
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Anne Jaskowiak-Barr
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Jeffrey Gerber
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, PA, USA Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
*
Corresponding author: Kathleen Chiotos; Email: chiotosk@email.chop.edu
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Abstract

Background:

Algorithms using electronic health record data to identify children with community-acquired pneumonia (CAP) and to evaluate the appropriateness of antibiotic use may facilitate antibiotic stewardship efforts, but validated measures of antibiotic choice and duration are unavailable.

Methods:

We performed a cross-sectional study within a single hospital system, including hospitalized children ages 6 months to 17 years who were admitted between 1/1/2019 and 10/31/2022. CAP was defined electronically as an ICD-10 code for pneumonia, a chest x-ray or chest CT within 48 hours of admission, and at least two days of antibiotics starting within 48 hours of admission. Hospital transfers and those who died within 48 hours or had chronic conditions, intensive care unit stays ≥48 hours, or concurrent infections were excluded. We validated electronic measures of appropriate antibiotic choice and duration using a reference standard of manual chart review. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each metric.

Results:

The electronic algorithm identified 1058 CAP encounters, and 100 were randomly selected for validation. Inappropriate antibiotic choice and duration occurred in one and 75 encounters of the 100 encounters, respectively, based on manual chart review. The electronic algorithm had a sensitivity of 100%, specificity of 93%, PPV of 14%, and NPV of 100% for inappropriate antibiotic choice and a sensitivity of 97%, specificity of 88%, PPV of 96%, and NPV of 92% for inappropriate antibiotic duration.

Conclusion:

Metrics of inappropriate antibiotic choice and duration had acceptable performance characteristics and may facilitate syndrome-based stewardship efforts.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , First View , pp. 1 - 7
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Core elements of hospital antibiotic stewardship programs. Available at: https://www.cdc.gov/antibiotic-use/core-elements/hospital.html.Google Scholar
O’Leary, EN, Neuhauser, MM, McLees, A, Paek, M, Tappe, J, Srinivasan, A. An update from the national healthcare safety network on hospital Antibiotic Stewardship programs in the United States, 2014–2021. Open Forum Infect Dis 2024;11:ofad684.10.1093/ofid/ofad684CrossRefGoogle ScholarPubMed
Gill, PJ, Anwar, MR, Thavam, T, et al. Identifying conditions with high prevalence, cost, and variation in cost in US children’s hospitals. JAMA Netw Open 2021;4:e2117816.10.1001/jamanetworkopen.2021.17816CrossRefGoogle Scholar
Gerber, JS, Kronman, MP, Ross, RK, et al. Identifying targets for Antimicrobial Stewardship in children’s hospitals. Infect Control Hosp Epidemiol 2013;34:1252–1258.10.1086/673982CrossRefGoogle ScholarPubMed
Agency for Healthcare Research and Quality. National estimates on use of hospitals by children from the HCUP Kids’ Inpatient Database (KID). Available at: https://hcupnet.ahrq.gov/#setup. Accessed 1 August 2021.Google Scholar
Avdic, E, Cushinotto, LA, Hughes, AH, et al. Impact of an Antimicrobial Stewardship intervention on shortening the duration of therapy for community-acquired pneumonia. Clin Infect Dis 2012;54:1581–1587.10.1093/cid/cis242CrossRefGoogle ScholarPubMed
Foolad, F, Huang, AM, Nguyen, CT, et al. A multicentre stewardship initiative to decrease excessive duration of antibiotic therapy for the treatment of community-acquired pneumonia. J Antimicrob Chemother 2018;73:1402–1407.10.1093/jac/dky021CrossRefGoogle ScholarPubMed
van den Bergh, D, Messina, AP, Goff, DA, et al. A pharmacist-led prospective Antibiotic Stewardship intervention improves compliance to community-acquired pneumonia guidelines in 39 public and private hospitals across South Africa. Int J Antimicrob Agents 2020;56:106189.10.1016/j.ijantimicag.2020.106189CrossRefGoogle ScholarPubMed
Monday, LM, Yazdanpaneh, O, Sokolowski, C, et al. A physician-driven quality improvement stewardship intervention using lean six sigma improves patient care for community-acquired pneumonia. Glob J Qual Saf Healthc 2021;4:109–116.10.36401/JQSH-21-2CrossRefGoogle ScholarPubMed
Vaughn, VM, Gandhi, TN, Hofer, TP, et al. A statewide collaborative quality initiative to improve antibiotic duration and outcomes in patients hospitalized with uncomplicated community-acquired pneumonia. Clin Infect Dis 2022;75:460–467.10.1093/cid/ciab950CrossRefGoogle ScholarPubMed
Bradley, JS, Byington, CL, Shah, SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the pediatric infectious diseases society and the infectious diseases society of America. Clin Infect Dis 2011;53:e25–76.10.1093/cid/cir531CrossRefGoogle Scholar
Bielicki, JA, Stöhr, W, Barratt, S, et al. Effect of amoxicillin dose and treatment duration on the need for antibiotic re-treatment in children with community-acquired pneumonia: the CAP-IT randomized clinical trial. JAMA 2021;326:1713–1724.10.1001/jama.2021.17843CrossRefGoogle ScholarPubMed
Pernica, JM, Harman, S, Kam, AJ, et al. Short-course antimicrobial therapy for pediatric community-acquired pneumonia: The SAFER randomized clinical trial. JAMA Pediatr 2021;175:475–482.10.1001/jamapediatrics.2020.6735CrossRefGoogle ScholarPubMed
Williams, DJ, Creech, CB, Walter, EB, et al. Short- vs standard-course outpatient antibiotic therapy for community-acquired pneumonia in children: The SCOUT-CAP randomized clinical trial. JAMA Pediatr 2022;176:253–261.10.1001/jamapediatrics.2021.5547CrossRefGoogle ScholarPubMed
Uranga, A, España, PP, Bilbao, A, et al. Duration of antibiotic treatment in community-acquired pneumonia: A multicenter randomized clinical trial. JAMA Intern Med 2016;176:1257–1265.10.1001/jamainternmed.2016.3633CrossRefGoogle ScholarPubMed
Same, RG, Amoah, J, Hsu, AJ, et al. The association of antibiotic duration with successful treatment of community-acquired pneumonia in children. J Pediatr Infect Dis Soc 2021;10:267–273.10.1093/jpids/piaa055CrossRefGoogle ScholarPubMed
McCallum, GB, Fong, SM, Grimwood, K, et al. Extended versus standard antibiotic course duration in children <5 years of age hospitalized with community-acquired pneumonia in high-risk settings: Four-week outcomes of a multicenter, double-blind, parallel, superiority randomized controlled trial. Pediatr Infect Dis J 2022;41:549–555.10.1097/INF.0000000000003558CrossRefGoogle ScholarPubMed
Metlay, JP, Waterer, GW, Long, AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. an official clinical practice guideline of the American thoracic society and infectious diseases society of America. Am J Respir Crit Care Med 2019;200:e45–e67.10.1164/rccm.201908-1581STCrossRefGoogle ScholarPubMed
Feudtner, C, Feinstein, JA, Zhong, W, Hall, M, Dai, D. Pediatric complex chronic conditions classification system version 2: Updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr 2014;14:199.10.1186/1471-2431-14-199CrossRefGoogle ScholarPubMed
Chiotos, K, Dutcher, L, Grundmeier, RW, et al. Impact of clinician feedback reports on antibiotic use in children hospitalized with community-acquired pneumonia. Clin Infect Dis 2024;80:263–270.10.1093/cid/ciae593CrossRefGoogle Scholar
The Joint Commission. New and revised requirements for antibiotic stewardship. Available at: https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/r3_antibioticstewardship_july2022_final.pdf. Accessed 7 March 2025.Google Scholar
McCarthy, NL, Baggs, J, Wolford, H, et al. Length of antibiotic therapy among adults hospitalized with uncomplicated community-acquired pneumonia, 2013–2020. Infect Control Hosp Epidemiol 2024;45:726–732.10.1017/ice.2024.14CrossRefGoogle ScholarPubMed
Madaras-Kelly, KJ, Burk, M, Caplinger, C, et al. Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: Results of a national medication utilization evaluation. J Hosp Med 2016;11:832–839.10.1002/jhm.2648CrossRefGoogle ScholarPubMed
Jones, G, Amoah, J, Klein, EY, et al. Development of an electronic algorithm to identify in real time adults hospitalized with suspected community-acquired pneumonia. Open Forum Infect Dis 2021;8:ofab291.10.1093/ofid/ofab291CrossRefGoogle ScholarPubMed
Jones, BE, South, BR, Shao, Y, et al. Development and validation of a natural language processing tool to identify patients treated for pneumonia across VA emergency departments. Appl Clin Inform 2018;9:122–128.Google ScholarPubMed
Jones, BE, Haroldsen, C, Madaras-Kelly, K, et al. In data we trust? Comparison of electronic versus manual abstraction of antimicrobial prescribing quality metrics for hospitalized veterans with pneumonia. Med Care 2018;56:626–633.10.1097/MLR.0000000000000916CrossRefGoogle ScholarPubMed
Yarahuan, JKW, Kisvarday, S, Kim, E, et al. An algorithm to assess guideline concordance of antibiotic choice in community-acquired pneumonia. Hosp Pediatr 2024;14:137–145.10.1542/hpeds.2023-007418CrossRefGoogle ScholarPubMed
Williams, DJ, Shah, SS, Myers, A, et al. Identifying pediatric community-acquired pneumonia hospitalizations: Accuracy of administrative billing codes. JAMA Pediatr 2013;167:851–858.10.1001/jamapediatrics.2013.186CrossRefGoogle ScholarPubMed
Killien, EY, Keller, MR, Watson, RS, Hartman, ME. Epidemiology of intensive care admissions for children in the US From 2001 to 2019. JAMA Pediatr 2023;177:506–515.10.1001/jamapediatrics.2023.0184CrossRefGoogle ScholarPubMed
Burns, KH, Casey, PH, Lyle, RE, Bird, TM, Fussell, JJ, Robbins, JM. Increasing prevalence of medically complex children in US hospitals. Pediatrics 2010;126:638–646.10.1542/peds.2009-1658CrossRefGoogle ScholarPubMed
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