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Published on: August 30, 2018
Antibiotic Indications and Appropriateness in the Pediatric Intensive Care Unit: A 10-Center Point Prevalence Study
Kathleen Chiotos1,2,3, Jennifer Blumenthal4,5, Juri Boguniewicz6
1Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Most pediatric intensive care unit patients receive antibiotics, but a significant portion of antibiotic orders are inappropriate. This highlights a need for better antibiotic stewardship in pediatric critical care.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Antibiotics are widely used in pediatric intensive care units (PICUs).
- Data on the specific reasons for antibiotic prescription and their appropriateness in PICU settings are limited.
- Understanding antibiotic use patterns is crucial for optimizing patient outcomes and combating antimicrobial resistance.
Purpose of the Study:
- To evaluate the indications and appropriateness of antibiotic orders in critically ill children.
- To identify common reasons for antibiotic use and assess the quality of prescribing practices.
- To provide data for improving antibiotic stewardship programs in PICUs.
Main Methods:
- A multicenter point prevalence study was conducted across 10 diverse PICUs.
- Antibiotic orders for 1462 admitted patients were reviewed over 4 days in 2019.
- A standardized rubric was used to assess the appropriateness of 1277 antibiotic orders.
Main Results:
- 58% of PICU patients received at least one antibiotic order.
- Common indications included empiric therapy for suspected infections (21%), nonoperative prophylaxis (13%), and empiric therapy for sepsis (12%).
- 34% of reviewed antibiotic orders were deemed inappropriate, with significant variation between institutions (19%-43%).
Conclusions:
- A substantial proportion of antibiotic orders in PICUs are inappropriate, estimated at one-third.
- There is a critical need for enhanced antibiotic stewardship strategies in pediatric critical care.
- Further research is required to optimize antibiotic utilization in critically ill children.
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.
