Antibiotics for treating community-acquired pneumonia in people with sickle cell disease

A review of the reporting of web searching to identify studies for Cochrane systematic reviews

The literature searches that are used to identify studies for inclusion in a systematic review should be comprehensively reported. This ensures that the literature searches are transparent and reproducible, which is important for assessing the strengths and weaknesses of a systematic review and re-running the literature searches when conducting an update review. Web searching using search engines and the websites of topically relevant organisations is sometimes used as a supplementary literature search method. Previous research has shown that the reporting of web searching in systematic reviews often lacks important details and is thus not transparent or reproducible. Useful details to report about web searching include the name of the search engine or website, the URL, the date searched, the search strategy, and the number of results. This study reviews the reporting of web searching to identify studies for Cochrane systematic reviews published in the 6-month period August 2016 to January 2017 (n = 423). Of these reviews, 61 reviews reported using web searching using a search engine or website as a literature search method. In the majority of reviews, the reporting of web searching was found to lack essential detail for ensuring transparency and reproducibility, such as the search terms. Recommendations are made on how to improve the reporting of web searching in Cochrane systematic reviews.

Association of Guideline-Adherent Antibiotic Treatment With Readmission of Children With Sickle Cell Disease Hospitalized With Acute Chest Syndrome

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.