Kim C Noël1, Jesse Papenburg1,2, Jacques Lacroix3, Caroline Quach3,4, Shauna O'Donnell5, Milagros Gonzales5, Douglas F Willson6, Elaine Gilfoyle7, James D McNally8, Steven Reynolds9, Yasser Kazzaz10, Atsushi Kawaguchi4, Masanori Sato11, Lalida Kongkiattikul12, Stéphane Leteurtre13, François Dubos13, Yasemin Karaca13, Fabrizio Chiusolo14, Jefferson Piva15, Nandini Dendukuri1, Patricia S Fontela1,2. 1. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. 2. Department of Pediatrics, McGill University, Montreal, QC, Canada. 3. Centre Hospitalier Universitaire Sainte Justine Research Centre, Montreal, QC, Canada. 4. Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, QC, Canada. 5. Research Institute of McGill University Health Centre, Montreal, QC, Canada. 6. Department of Pediatrics, Virginia Commonwealth University, Richmond, VA. 7. Department of Pediatrics, University of Toronto, Toronto, ON, Canada. 8. Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada. 9. Department of Medicine, University of British Columbia, Vancouver, BC, Canada. 10. National Guard Health Affairs, Riyadh, Saudi Arabia. 11. Department of Pediatric Intensive Care, Nagano Children's Hospital, Nagano, Japan. 12. Pediatric Pulmonology and Critical Care, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 13. Univ. Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, F-59000 Lille, France. 14. Ospedale Pediatric Bambino Gesù, Rome, Italy. 15. Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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 MAIN RESULTS: 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.
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 MAIN RESULTS: 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.
Authors: 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 Journal: BMC Pediatr Date: 2022-04-05 Impact factor: 2.125
Authors: Sandra Pong; Robert A Fowler; Srinivas Murthy; Jeffrey M Pernica; Elaine Gilfoyle; Patricia Fontela; Nicholas Mitsakakis; Asha C Bowen; Winnie Seto; Michelle Science; James S Hutchison; Philippe Jouvet; Asgar Rishu; Nick Daneman Journal: PLoS One Date: 2022-07-26 Impact factor: 3.752