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Published on: August 30, 2018
Distribution, Consequences, and Determinants of Time to Antibiotics in Children With Community-Onset Severe Bacterial
David Malorey1,2, Fleur Lorton1,2,3,4,5,6,7,8,9,10,11,12,13,14,15, Martin Chalumeau2,4
1Department of Pediatrics and Pediatric Emergency, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France.
Insights
Delays in antibiotic administration for children with severe bacterial infections did not significantly impact mortality or severe outcomes. However, initial hospital referrals may shorten treatment times for these pediatric infections.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- Community-onset severe bacterial infections (COSBIs) in children pose significant health risks.
- Timely antibiotic administration is crucial for managing pediatric infections.
- Understanding delays in care is essential for improving patient outcomes.
Purpose of the Study:
- To investigate the distribution and determinants of antibiotic administration time in children with COSBIs.
- To analyze the association between time to antibiotics and patient outcomes.
- To identify factors influencing delays in care for pediatric severe bacterial infections.
Main Methods:
- Secondary analysis of a prospective population-based study (2009-2014) in western France.
- Inclusion of children aged 1 month to 16 years with COSBIs admitted to PICU or deceased before admission.
- Statistical analysis using multinomial logistic regression and Cox proportional-hazards models.
Main Results:
- Median patient interval was 7.0 hours; median medical interval was 3.3 hours.
- No significant association found between medical interval and mortality or severe sequelae.
- Shorter patient intervals observed in younger children; reduced medical intervals with initial hospital consultations.
Conclusions:
- No significant link between delayed antibiotics and adverse outcomes in pediatric COSBIs.
- Initial hospital referral may be key to reducing antibiotic administration time.
- Further research into optimizing care pathways for pediatric severe bacterial infections is warranted.
Objectives:
To describe the distribution, consequences and potential determinants of time to antibiotics administration in children with community-onset severe bacterial infections (COSBIs).
Design:
Secondary analysis of the available data from a prospective population-based study from 2009 to 2014.
Setting:
An administrative area in western France accounting for 13% of the national pediatric population.
Patients:
All children from 1 month to 16 years old admitted to a PICU or who died before admission and had a COSBI.
Interventions:
None.
Measurements And Main Results:
The time to antibiotics was divided into patient interval (from first signs of COSBI to the first medical consultation) and medical interval (from the first consultation to appropriate antibiotics administration). The association between the medical interval and child outcome was studied by a multinomial logistic regression model and the potential determinants of the patient and medical intervals were by a Cox proportional-hazards model. Of the 227 children included (median age 2.1 yr), 22 died (9.7%), and 21 (9.3%) had severe sequelae at PICU discharge. Median patient and medical intervals were 7.0 hours (interquartile range [IQR], 2.0-16.5 hr) and 3.3 hours (IQR, 1.1-12.2 hr), respectively. The last quartile of medical interval was not associated with death (adjusted odds ratio [aOR], 3.7; 95% CI, 0.8-17.5) or survival with severe sequelae (aOR, 1.3; 95% CI, 0.4-4.0) versus survival without severe sequelae. Patient interval was shorter in younger children (adjusted hazard ratio [aHR], 0.95; 95% CI, 0.92-0.99), and medical interval was reduced when the first consultation was conducted in a hospital (aHR, 1.5; 95% CI, 1.1-2.0) versus outpatient medicine.
Conclusions:
For children with COSBI, we found no significant association between medical interval and mortality or severe sequelae. An initial hospital referral could help reduce the time to antibiotics in COSBIs.
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