Antimicrobial treatment duration for uncomplicated bloodstream infections in critically ill children: a multicentre observational study
Abstract Background Bloodstream infections (BSIs) cause significant morbidity and mortality in critically ill children but treatment duration is understudied. We describe the durations of antimicrobial treatment that critically ill children receive and explore factors associated with treatment durat...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-04-01
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| Series: | BMC Pediatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12887-022-03219-z |
| _version_ | 1819022449894752256 |
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| author | Sandra Pong Robert A. Fowler Srinivas Murthy Jeffrey M. Pernica Elaine Gilfoyle Patricia Fontela Asgar H. Rishu Nicholas Mitsakakis James S. Hutchison Michelle Science Winnie Seto Philippe Jouvet Nick Daneman on behalf of the Canadian Critical Care Trials Group |
| author_facet | Sandra Pong Robert A. Fowler Srinivas Murthy Jeffrey M. Pernica Elaine Gilfoyle Patricia Fontela Asgar H. Rishu Nicholas Mitsakakis James S. Hutchison Michelle Science Winnie Seto Philippe Jouvet Nick Daneman on behalf of the Canadian Critical Care Trials Group |
| author_sort | Sandra Pong |
| collection | DOAJ |
| description | Abstract Background Bloodstream infections (BSIs) cause significant morbidity and mortality in critically ill children but treatment duration is understudied. We describe the durations of antimicrobial treatment that critically ill children receive and explore factors associated with treatment duration. Methods We conducted a retrospective observational cohort study in six pediatric intensive care units (PICUs) across Canada. Associations between treatment duration and patient-, infection- and pathogen-related characteristics were explored using multivariable regression analyses. Results Among 187 critically ill children with BSIs, the median duration of antimicrobial treatment was 15 (IQR 11–25) days. Median treatment durations were longer than two weeks for all subjects with known sources of infection: catheter-related 16 (IQR 11–24), respiratory 15 (IQR 11–26), intra-abdominal 20 (IQR 14–26), skin/soft tissue 17 (IQR 15–33), urinary 17 (IQR 15–35), central nervous system 33 (IQR 15–46) and other sources 29.5 (IQR 15–55) days. When sources of infection were unclear, the median duration was 13 (IQR 10–16) days. Treatment durations varied widely within and across PICUs. In multivariable linear regression, longer treatment durations were associated with severity of illness (+ 0.4 days longer [95% confidence interval (CI), 0.1 to 0.7, p = 0.007] per unit increase in PRISM-IV) and central nervous system infection (+ 17 days [95% CI, 6.7 to 27.4], p = 0.001). Age and pathogen type were not associated with treatment duration. Conclusions Most critically ill children with BSIs received at least two weeks of antimicrobial treatment. Further study is needed to determine whether shorter duration therapy would be effective for selected critically ill children. |
| first_indexed | 2024-12-21T04:23:11Z |
| format | Article |
| id | doaj.art-8f973529222e44fdbd955cab7f8324b9 |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-12-21T04:23:11Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-8f973529222e44fdbd955cab7f8324b92022-12-21T19:16:07ZengBMCBMC Pediatrics1471-24312022-04-0122111110.1186/s12887-022-03219-zAntimicrobial treatment duration for uncomplicated bloodstream infections in critically ill children: a multicentre observational studySandra Pong0Robert A. Fowler1Srinivas Murthy2Jeffrey M. Pernica3Elaine Gilfoyle4Patricia Fontela5Asgar H. Rishu6Nicholas Mitsakakis7James S. Hutchison8Michelle Science9Winnie Seto10Philippe Jouvet11Nick Daneman12on behalf of the Canadian Critical Care Trials GroupDepartment of Pharmacy, The Hospital for Sick ChildrenInterdepartmental Division of Critical Care Medicine, University of TorontoDepartment of Pediatrics, Division of Critical Care, University of British ColumbiaDivision of Infectious Diseases, McMaster UniversityDepartment of Critical Care Medicine, The Hospital for Sick ChildrenDepartment of Epidemiology, Biostatistics and Occupational Health, McGill UniversityInstitute for Clinical Evaluative Sciences, Sunnybrook Health Sciences CentreChildren’s Hospital of Eastern Ontario Research InstituteDepartment of Critical Care Medicine, The Hospital for Sick ChildrenDivision of Infectious Diseases, Department of Paediatric Medicine, The Hospital for ChildrenDepartment of Pharmacy, The Hospital for Sick ChildrenPediatric Intensive Care Unit, Sainte-Justine Hospital University CenterDivision of Infectious Diseases, Sunnybrook Health Sciences CentreAbstract Background Bloodstream infections (BSIs) cause significant morbidity and mortality in critically ill children but treatment duration is understudied. We describe the durations of antimicrobial treatment that critically ill children receive and explore factors associated with treatment duration. Methods We conducted a retrospective observational cohort study in six pediatric intensive care units (PICUs) across Canada. Associations between treatment duration and patient-, infection- and pathogen-related characteristics were explored using multivariable regression analyses. Results Among 187 critically ill children with BSIs, the median duration of antimicrobial treatment was 15 (IQR 11–25) days. Median treatment durations were longer than two weeks for all subjects with known sources of infection: catheter-related 16 (IQR 11–24), respiratory 15 (IQR 11–26), intra-abdominal 20 (IQR 14–26), skin/soft tissue 17 (IQR 15–33), urinary 17 (IQR 15–35), central nervous system 33 (IQR 15–46) and other sources 29.5 (IQR 15–55) days. When sources of infection were unclear, the median duration was 13 (IQR 10–16) days. Treatment durations varied widely within and across PICUs. In multivariable linear regression, longer treatment durations were associated with severity of illness (+ 0.4 days longer [95% confidence interval (CI), 0.1 to 0.7, p = 0.007] per unit increase in PRISM-IV) and central nervous system infection (+ 17 days [95% CI, 6.7 to 27.4], p = 0.001). Age and pathogen type were not associated with treatment duration. Conclusions Most critically ill children with BSIs received at least two weeks of antimicrobial treatment. Further study is needed to determine whether shorter duration therapy would be effective for selected critically ill children.https://doi.org/10.1186/s12887-022-03219-zAntibacterial agentsBacteremiaCritical careCritical illnessDuration of therapyPediatric |
| spellingShingle | Sandra Pong Robert A. Fowler Srinivas Murthy Jeffrey M. Pernica Elaine Gilfoyle Patricia Fontela Asgar H. Rishu Nicholas Mitsakakis James S. Hutchison Michelle Science Winnie Seto Philippe Jouvet Nick Daneman on behalf of the Canadian Critical Care Trials Group Antimicrobial treatment duration for uncomplicated bloodstream infections in critically ill children: a multicentre observational study BMC Pediatrics Antibacterial agents Bacteremia Critical care Critical illness Duration of therapy Pediatric |
| title | Antimicrobial treatment duration for uncomplicated bloodstream infections in critically ill children: a multicentre observational study |
| title_full | Antimicrobial treatment duration for uncomplicated bloodstream infections in critically ill children: a multicentre observational study |
| title_fullStr | Antimicrobial treatment duration for uncomplicated bloodstream infections in critically ill children: a multicentre observational study |
| title_full_unstemmed | Antimicrobial treatment duration for uncomplicated bloodstream infections in critically ill children: a multicentre observational study |
| title_short | Antimicrobial treatment duration for uncomplicated bloodstream infections in critically ill children: a multicentre observational study |
| title_sort | antimicrobial treatment duration for uncomplicated bloodstream infections in critically ill children a multicentre observational study |
| topic | Antibacterial agents Bacteremia Critical care Critical illness Duration of therapy Pediatric |
| url | https://doi.org/10.1186/s12887-022-03219-z |
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