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Published on: April 11, 2012
Timing of Antibiotic Administration in Pediatric Sepsis
Jessica K Creedon1, Sigella Vargas1, Lisa A Asaro1
1From the Boston Children's Hospital, Boston, MA.
Insights
Early antibiotics in children with sepsis who develop septic shock may increase mortality and organ dysfunction. This study found that administering antibiotics within one hour of meeting sepsis criteria was associated with worse outcomes.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Sepsis research
Background:
- Early antibiotic administration is crucial for reducing mortality in sepsis.
- The impact of early antibiotics on outcomes in pediatric septic shock remains unclear.
Purpose of the Study:
- To investigate the association between the timing of antibiotic administration and outcomes in children with septic shock.
- To determine if antibiotics given within one hour of meeting sepsis criteria affect morbidity and mortality.
Main Methods:
- Retrospective study of children (≤18 years) with sepsis progressing to septic shock.
- Data collected from a tertiary children's hospital emergency department (2008-2012).
- Assessed time from sepsis criteria to first antibiotic dose and correlated with outcomes.
Main Results:
- Children receiving antibiotics within 1 hour of sepsis criteria had higher mortality (4/42 vs 0/93).
- This group also experienced increased organ dysfunction, longer vasoactive infusion duration, and extended ICU/hospital stays.
- Positive blood/urine cultures and pneumonia were noted in a subset of patients.
Conclusions:
- Administering antibiotics within 1 hour of meeting sepsis criteria in children who develop septic shock is associated with increased mortality.
- Early antibiotic administration in this context also correlates with greater organ dysfunction and longer hospitalizations.
Objectives:
Antibiotic administration within 1 hour of hypotension has been shown to reduce mortality. It is unknown whether antibiotics before hypotension in children who eventually meet criteria for septic shock improves outcomes. This study assesses whether antibiotic timing from the time of meeting criteria for sepsis in children with septic shock impacts morbidity and mortality.
Methods:
This is a retrospective study of children 18 years or younger presenting to a tertiary free-standing children's hospital emergency department with sepsis that subsequently progressed to septic shock and were admitted to an intensive care unit from 2008 to 2012. The time when the patient met criteria for sepsis to the time of first antibiotic administration was assessed and correlated with patient morbidity and mortality.
Results:
Among 135 children (median age, 13.1 years), 34 (25%) were previously healthy, whereas 49 (36%) had 2 or more medical comorbidities. Twenty-seven children (20%) had positive blood cultures, 17 (13%) had positive urine cultures, and 34 (25%) had chest x-ray findings that were interpreted as pneumonia. Among the 42 (31%) with antibiotics within 1 hour from criteria for sepsis, there was higher mortality (4/42 vs 0/93, P = 0.009), more organ dysfunction, longer time on a vasoactive infusion, and increased intensive care unit and hospital lengths of stay (all P < 0.05).
Conclusions:
Children with criteria for sepsis who subsequently progressed to septic shock who received antibiotics within 1 hour of meeting sepsis criteria had increased mortality, length of stay, and organ dysfunction.
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