Antibiotic Indications and Appropriateness in the Pediatric Intensive Care Unit: A 10-Center Point Prevalence Study

Authors

Kathleen Chiotos
Jennifer Blumenthal
Juri Boguniewicz
Debra L Palazzi
Erika L Stalets
Jessica H Rubens
Pranita D Tamma
Stephanie S Cabler
Jason Newland
Hillary Crandall
Emily Berkman
Robert P Kavanagh
Hannah R Stinson
Jeffrey S Gerber

Language

English

Publication Date

2-8-2023

Journal

Clinical Infectious Disease

DOI

10.1093/cid/ciac698

PMID

36048543

PMCID

PMC10169439

PubMedCentral® Posted Date

9-1-2022

PubMedCentral® Full Text Version

Post-print

Abstract

BACKGROUND: Antibiotics are prescribed to most pediatric intensive care unit (PICU) patients, but data describing indications and appropriateness of antibiotic orders in this population are lacking.

METHODS: We performed a multicenter point prevalence study that included children admitted to 10 geographically diverse PICUs over 4 study days in 2019. Antibiotic orders were reviewed for indication, and appropriateness was assessed using a standardized rubric.

RESULTS: Of 1462 patients admitted to participating PICUs, 843 (58%) had at least 1 antibiotic order. A total of 1277 antibiotic orders were reviewed. Common indications were empiric therapy for suspected bacterial infections without sepsis or septic shock (260 orders, 21%), nonoperative prophylaxis (164 orders, 13%), empiric therapy for sepsis or septic shock (155 orders, 12%), community-acquired pneumonia (CAP; 118 orders, 9%), and post-operative prophylaxis (94 orders, 8%). Appropriateness was assessed for 985 orders for which an evidence-based rubric for appropriateness could be created. Of these, 331 (34%) were classified as inappropriate. Indications with the most orders classified as inappropriate were empiric therapy for suspected bacterial infection without sepsis or septic shock (78 orders, 24%), sepsis or septic shock (55 orders, 17%), CAP (51 orders, 15%), ventilator-associated infections (47 orders, 14%), and post-operative prophylaxis (44 orders, 14%). The proportion of antibiotics classified as inappropriate varied across institutions (range, 19%-43%).

CONCLUSIONS: Most PICU patients receive antibiotics. Based on our study, we estimate that one-third of antibiotic orders are inappropriate. Improved antibiotic stewardship and research focused on strategies to optimize antibiotic use in critically ill children are needed.

Keywords

Child, Humans, Anti-Bacterial Agents, Shock, Septic, Prevalence, Intensive Care Units, Pediatric, Sepsis, Bacterial Infections, pediatric intensive care unit, antimicrobial stewardship, sepsis, antibiotic

Published Open-Access

yes

Recommended Citation

Chiotos, Kathleen; Blumenthal, Jennifer; Boguniewicz, Juri; et al., "Antibiotic Indications and Appropriateness in the Pediatric Intensive Care Unit: A 10-Center Point Prevalence Study" (2023). Faculty and Staff Publications. 3368.
https://digitalcommons.library.tmc.edu/baylor_docs/3368