International Survey on Determinants of Antibiotic Duration and Discontinuation in Pediatric Critically Ill Patients.
Pediatr Crit Care Med
; 21(9): e696-e706, 2020 09.
Article
in En
| MEDLINE
| ID: mdl-32639469
ABSTRACT
OBJECTIVES:
We hypothesized that antibiotic use in PICUs is based on criteria not always supported by evidence. We aimed to describe determinants of empiric antibiotic use in PICUs in eight different countries.DESIGN:
Cross-sectional survey.SETTING:
PICUs in Canada, the United States, France, Italy, Saudi Arabia, Japan, Thailand, and Brazil.SUBJECTS:
Pediatric intensivists.INTERVENTIONS:
None. MEASUREMENTS AND MAINRESULTS:
We used literature review and focus groups to develop the survey and its clinical scenarios (pneumonia, septic shock, meningitis, and intra-abdominal infections) in which cultures were unreliable due to antibiotic pretreatment. Data analyses included descriptive statistics and linear regression with bootstrapped SEs. Overall response rate was 39% (482/1,251), with individual country response rates ranging from 25% to 76%. Respondents in all countries prolonged antibiotic duration based on patient characteristics, disease severity, pathogens, and radiologic findings (from a median increase of 1.8 d [95% CI, 0.5-4.0 d] to 9.5 d [95% CI, 8.5-10.5 d]). Younger age, severe disease, and ventilator-associated pneumonia prolonged antibiotic treatment duration despite a lack of evidence for such practices. No variables were reported to shorten treatment duration for all countries. Importantly, more than 39% of respondents would use greater than or equal to 7 days of antibiotics for patients with a positive viral polymerase chain reaction test in all scenarios, except in France for pneumonia (29%), septic shock (13%), and meningitis (6%). The use of elevated levels of inflammatory markers to prolong antibiotic treatment duration varied among different countries.CONCLUSIONS:
Antibiotic-related decisions are complex and may be influenced by cultural and contextual factors. Evidence-based criteria are necessary to guide antibiotic duration and ensure the rational use of antibiotics in PICUs.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Critical Illness
/
Anti-Bacterial Agents
Type of study:
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Qualitative_research
/
Risk_factors_studies
/
Systematic_reviews
Limits:
Child
/
Humans
Country/Region as subject:
America do norte
/
America do sul
/
Asia
/
Brasil
/
Europa
Language:
En
Journal:
Pediatr Crit Care Med
Journal subject:
PEDIATRIA
/
TERAPIA INTENSIVA
Year:
2020
Type:
Article
Affiliation country:
Canada