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Antimicrobial treatment duration for uncomplicated bloodstream infections in critically ill children: a multicentre
Sandra Pong1, Robert A Fowler2,3,4, Srinivas Murthy5,6
1Department of Pharmacy, The Hospital for Sick Children, Toronto, ON, Canada. sandra.pong@sickkids.ca.
Insights
Critically ill children with bloodstream infections (BSIs) often receive antimicrobial treatment for over two weeks. Further research is needed to determine if shorter treatment durations are effective for select pediatric patients with BSIs.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Bloodstream infections (BSIs) are a major cause of illness and death in critically ill children.
- Antimicrobial treatment duration for pediatric BSIs is not well-studied.
- Understanding treatment duration is crucial for optimizing care and outcomes.
Purpose of the Study:
- To describe antimicrobial treatment durations for critically ill children with BSIs.
- To identify factors associated with varying treatment durations.
Main Methods:
- Retrospective observational cohort study in six Canadian pediatric intensive care units (PICUs).
- Analysis of patient, infection, and pathogen characteristics.
- Multivariable regression to explore associations with treatment duration.
Main Results:
- Median treatment duration for 187 children with BSIs was 15 days (IQR 11-25).
- Longer durations were associated with illness severity (PRISM-IV score) and central nervous system infections.
- Treatment durations exceeded two weeks for most infection sources, with variations across PICUs.
Conclusions:
- Most critically ill children with BSIs receive at least two weeks of antimicrobial therapy.
- Further investigation is warranted to assess the efficacy of shorter treatment durations in specific pediatric BSI cases.
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.
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