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Antibiotic use in children hospitalised for influenza, 2010–2021: the Canadian Immunization Monitoring Program Active (IMPACT)

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Abstract

Purpose

To determine characteristics associated with inappropriate antibiotic use amongst children hospitalised for influenza.

Methods

We performed active surveillance for laboratory-confirmed influenza hospitalizations amongst children ≤ 16 years old at the 12 Canadian Immunization Monitoring Program Active hospitals, from September 2010 to August 2021. Antibiotic use was presumed appropriate if any of the following indications were met: age < 1 month, immunocompromised, hemoglobinopathy, laboratory-confirmed bacterial infection, radiographically confirmed pneumonia, admission to an intensive care unit and mechanical ventilation. Regression analyses were used to identify baseline and clinical characteristics associated with antibiotic use amongst patients without an appropriate indication.

Results

Amongst 8971 children, 6424 (71.6%) received any antibiotics during their hospitalisation. Amongst the 4429 children without an appropriate indication, 2366 (53.2%) received antibiotics. Antibiotic use amongst children without appropriate indication differed between study centres, ranging from 33.2% to 66.1% (interquartile range [IQR] 50.6–56.3%); it did not change significantly over time (p-value for trend = 0.28). In multivariable analyses, older age (adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI] 0.96–0.99), presence of any high-risk condition (aOR 0.80, 95% CI 0.70–0.92), influenza virus type B (aOR 0.8, 95% CI 0.70–0.91) and croup (aOR 0.64, 95% CI 0.49–0.83) were associated with less, whilst fever ≥ 38.5 °C (aOR 1.82, 95% CI 1.42–2.35) and hospitalisation duration (aOR 1.12, 95% CI 1.09–1.15) were associated with more inappropriate antibiotic use.

Conclusions

Over two-third of children hospitalised for influenza received antibiotics, including over half of those without an appropriate indication for antibiotic treatment. Differences amongst study centres suggest the importance of contextual determinants of antibiotic use.

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Data availability

Data not available. Te data are owned by the Public Health Agency of Canada.

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Acknowledgements

IMPACT Investigators on this project: Cheryl Foo, Natalie Bridger, Janeway Children’s Health & Rehabilitation Centre, St. John’s, NL; Scott A. Halperin, Karina Top, IWK Health Centre, Halifax, NS; Roseline Thibeault, Centre Mere-Enfant de Quebec, CHUL, Quebec City, QC; Jesse Papenburg, The Montreal Children’s Hospital, Montreal, QC; Marc Lebel, Centre hospitalier universitaire Sainte-Justine, Montreal, QC; Nicole Le Saux, Children’s Hospital of Eastern Ontario, Ottawa, ON; Shaun K. Morris, Kescha Kazmi, The Hospital for Sick Children, Toronto, ON; Jared Bullard, Winnipeg Children’s Hospital, Winnipeg, MB; Rupeena Purewal, Jim Pattison Children’s Hospital, Saskatoon, SK; Taj Jadavji, Alberta Children’s Hospital, Calgary, AB; Catherine Burton, Stollery Children’s Hospital, Edmonton, AB; Julie A. Bettinger, Laura Sauvé, Manish Sadarangani, BC Children’s Hospital, Vancouver, BC. We acknowledge all past IMPACT site investigators and influenza working group members involved in IMPACT at the time of data collection.

We acknowledge the IMPACT nurse monitors, Annick Audet (IMPACT Nurse Monitor Liaison), the staff of the IMPACT data centre, (Hennady Shulha, Suzanne Liu, Kim Marty), and Melanie Laffin Thibodeau (Manager, Surveillance, Canadian Paediatric Society).

Funding

This surveillance activity is conducted as part of the Canadian Immunization Monitoring Program Active (IMPACT), a national surveillance initiative managed by the Canadian Pediatric Society (CPS) and conducted by the IMPACT network of paediatric investigators on behalf of the Public Health Agency of Canada’s (PHAC’s) Centre for Immunization and Respiratory Infectious Diseases. Funding for IMPACT influenza surveillance is provided by the PHAC. Dr. Sadarangani is supported via salary awards from the BC Children’s Hospital Foundation and Michael Smith Health Research BC. PHAC provided input into the study design.

Author information

Author notes

  1. Catherine Burton through Manish Sadarangani are in alphabetical order.

Authors and Affiliations

  1. Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, E05.1905, 1001 Décarie Blvd, Montreal, QC, H4A 3J1, Canada

    Tilmann Schober & Jesse Papenburg

  2. Division of Pediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Munich, Munich, Germany

    Tilmann Schober

  3. Division of Pediatric Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    Shaun K. Morris & Kescha Kazmi

  4. Vaccine Evaluation Center, BC Children’s Hospital Research Institute,, University of British Columbia, Vancouver, BC, Canada

    Julie A. Bettinger & Manish Sadarangani

  5. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada

    Julie A. Bettinger & Manish Sadarangani

  6. Division of Pediatric Infectious Diseases, Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada

    Catherine Burton

  7. Canadian Center for Vaccinology, IWK Health Center, Dalhousie University, Halifax, NS, Canada

    Scott A. Halperin

  8. Section of Infectious Diseases, Department of Pediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, AB, Canada

    Taj Jadavji

  9. Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, QC, Canada

    Jacqueline Modler & Jesse Papenburg

  10. Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, QC, Canada

    Jesse Papenburg

Authors
  1. Tilmann Schober
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Consortia

for the Canadian Immunization Monitoring Program Active (IMPACT) Investigators

  • Cheryl Foo
  • , Natalie Bridger
  • , Scott A. Halperin
  • , Karina Top
  • , Roseline Thibeault
  • , Jesse Papenburg
  • , Marc Lebel
  • , Nicole Le Saux
  • , Shaun K. Morris
  • , Kescha Kazmi
  • , Jared Bullard
  • , Rupeena Purewal
  • , Taj Jadavji
  • , Catherine Burton
  • , Julie A. Bettinger
  • , Laura Sauvé
  •  & Manish Sadarangani

Contributions

TS, SKM and JP conceptualized the study; TS, JB and JM curated the data; TS and JM performed the analysis; TS and JP wrote the original draft of the manuscript; SKM, JB, CB, SAH, TJ, KK, MS contributed to study design and reviewed and revised the manuscript; the Canadian Immunization Monitoring Program Active (IMPACT) investigators performed the investigation providing data and reviewed the manuscript; JB, SAH and MS performed project administration and funding acquisition. JP supervised the study. All authors have read and agreed to the final version of the manuscript.

Corresponding author

Correspondence to Jesse Papenburg.

Ethics declarations

Conflict of interest

Dr. Papenburg reports grants from MedImmune, grants and personal fees from Merck, personal fees from AstraZeneca, all outside the submitted work. Dr. Sadarangani has been an investigator on projects funded by GlaxoSmithKline, Merck, Moderna, Pfizer, Sanofi-Pasteur, Seqirus, Symvivo and VBI Vaccines. All funds have been paid to his institute, and he has not received any personal payments. Dr. Halperin has been an investigator on projects funded by Sanofi-Pasteur, GlaxoSmithKline and Seqirus. Dr. Morris is a coinvestigator on an investigator-led grant from Pfizer, has served on an ad-hoc advisory boards for Pfizer, Sanofi Pasteur, and Merck and has received speaker fees from GlaxoSmithKline and JNJ China; all unrelated to this study. The other authors have no conflicts of interest to disclose.

Additional information

The members of the Canadian Immunization Monitoring Program Active (IMPACT) Investigators are mentioned in the Acknowledgments section.

Supplementary Information

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Supplementary file1 (DOCX 444 KB)

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Schober, T., Morris, S.K., Bettinger, J.A. et al. Antibiotic use in children hospitalised for influenza, 2010–2021: the Canadian Immunization Monitoring Program Active (IMPACT). Infection (2023). https://doi.org/10.1007/s15010-023-02124-6

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