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Antibiotic use in nonintubated children with bronchiolitis in the intensive care unit
Laura A Ortmann1,2, Aleisha Nabower1,2, Melissa L Cullimore1,2
1Children's Hospital & Medical Center, Omaha, Nebraska, USA.
Insights
Early antibiotic use in children with bronchiolitis requiring noninvasive respiratory support did not shorten intensive care unit (ICU) length of stay or reduce the need for intubation. This common practice, with wide center variation, showed no significant clinical benefit.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Respiratory viral infections
Background:
- Bronchiolitis is a common pediatric respiratory infection.
- Antibiotic use in bronchiolitis is frequent despite viral etiology.
- Evidence on early antibiotic impact in noninvasively supported ICU patients is limited.
Purpose of the Study:
- To describe early antibiotic use patterns in pediatric intensive care units (ICUs) for bronchiolitis.
- To assess the association between early antibiotic administration and clinical outcomes in these patients.
Main Methods:
- Retrospective analysis of the Pediatric Health Information Systems database.
- Inclusion of children under 2 years with bronchiolitis requiring noninvasive respiratory support.
- Comparison of outcomes between early antibiotic and no antibiotic groups.
Main Results:
- Over 11,000 admissions analyzed; 22.9% received early antibiotics.
- Early antibiotic use varied significantly across pediatric ICUs (10%-54%).
- No significant difference in ICU length of stay or intubation rates between groups.
Conclusions:
- Early antibiotic administration is common in pediatric ICUs for bronchiolitis.
- No clinical benefits were observed regarding length of stay or intubation.
- Current early antibiotic practices may not be supported by evidence for this patient population.
Introduction:
Antibiotic use may shorten mechanical ventilation duration and length of stay for patients with bronchiolitis that require intubation. The goals of this study were to describe antibiotic use in previously healthy children with bronchiolitis admitted to the intensive care unit (ICU) for noninvasive respiratory support and to describe associations of early antibiotic use with clinical outcomes.
Methods:
The Pediatric Health Information Systems database was queried for children <2 years of age without significant comorbidities admitted to the ICU for bronchiolitis. Children requiring mechanical ventilation on the first ICU day were excluded. Two groups were analyzed: those patients receiving antibiotics on the first day of their ICU stay (early antibiotics), and those receiving no antibiotics on their first ICU day (no antibiotics). Primary outcome was the length of ICU stay.
Results:
A total of 11,029 admissions met criteria, 2522 (22.9%) in the early antibiotic group, and 8507 (77.1%) in the no antibiotic group. The use of early antibiotics varied by center from 10% to 54%. In multivariate analysis, the early antibiotic group had similar ICU length of stay compared to the no antibiotic group (relative risk, RR [95% confidence interval, CI] 1.01 [0.98-1.05]). For patients on noninvasive ventilation, the first ICU day early antibiotics did not impact ICU length of stay (RR [95% CI] 0.97 [0.92-1.02]) or need for intubation (RR [95% CI] 1.11 [0.77-1.58]).
Conclusion:
Early antibiotic use was common with significant variation between centers. Early antibiotic use was not associated with improved clinical outcomes in children admitted to the ICU for noninvasive respiratory support for bronchiolitis.
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