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Association of delayed adequate antimicrobial treatment and organ dysfunction in pediatric bloodstream infections
Sandra Pong1, Robert A Fowler2,3,4, Patricia Fontela5,6
1Department of Pharmacy, The Hospital for Sick Children, Toronto, ON, Canada. sandra.pong@sickkids.ca.
Insights
Delayed antimicrobial therapy in children with bloodstream infections did not significantly alter organ dysfunction scores. The Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score did not appear sensitive to these treatment delays.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Clinical Trials
Background:
- Bloodstream infections (BSIs) in children are linked to severe morbidity and mortality.
- Organ dysfunction is a major complication of pediatric BSIs.
- The impact of delayed antimicrobial treatment on organ dysfunction requires further investigation.
Purpose of the Study:
- To determine if delayed adequate antimicrobial therapy in children with BSIs is associated with changes in organ dysfunction.
- To assess the utility of the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score in measuring the effects of delayed treatment.
Main Methods:
- A multicenter, retrospective cohort study involving critically ill children (<18 years) with BSIs.
- Primary outcome: change in PELOD-2 score from day 1 to day 5.
- Exposure: delayed adequate antimicrobial therapy (≥3 hours from blood culture collection).
Main Results:
- 202 children were included; 61% received delayed antimicrobial therapy (median 7 hours).
- No significant difference in PELOD-2 score changes between early (<3 hours) and delayed treatment groups.
- PELOD-2 score changes were not significantly associated with treatment delay.
Conclusions:
- Delayed adequate antimicrobial therapy was not associated with changes in PELOD-2 scores in critically ill children with BSIs.
- The PELOD-2 score may not be sensitive enough to detect clinical effects of delayed antimicrobial treatment in this population.
- Further research is needed to identify optimal outcome measures for pediatric antimicrobial intervention trials.
Background:
Bloodstream infections (BSIs) are associated with significant mortality and morbidity, including multiple organ dysfunction. We explored if delayed adequate antimicrobial treatment for children with BSIs is associated with change in organ dysfunction as measured by PELOD-2 scores.
Methods:
We conducted a multicenter, retrospective cohort study of critically ill children <18 years old with BSIs. The primary outcome was change in PELOD-2 score between days 1 (index blood culture) and 5. The exposure variable was delayed administration of adequate antimicrobial therapy by ≥3 h from blood culture collection. We compared PELOD-2 score changes between those who received early and delayed treatment.
Results:
Among 202 children, the median (interquartile range) time to adequate antimicrobial therapy was 7 (0.8-20.1) hours; 124 (61%) received delayed antimicrobial therapy. Patients who received early and delayed treatment had similar baseline characteristics. There was no significant difference in PELOD-2 score changes from days 1 and 5 between groups (PELOD-2 score difference -0.07, 95% CI -0.92 to 0.79, p = 0.88).
Conclusions:
We did not find an association between delayed adequate antimicrobial therapy and PELOD-2 score changes between days 1 and 5 from detection of BSI. PELOD-2 score was not sensitive for clinical effects of delayed antimicrobial treatment.
Impact:
In critically ill children with bloodstream infections, there was no significant change in organ dysfunction as measured by PELOD-2 scores between patients who received adequate antimicrobial therapy within 3 h of their initial positive blood culture and those who started after 3 h. Higher PELOD-2 scores on day 1 were associated with larger differences in PELOD-2 scores between days 1 and 5 from index positive blood cultures. Further study is required to determine if PELOD-2 or alternative measures of organ dysfunction could be used as primary outcome measures in trials of antimicrobial interventions in pediatric critical care research.
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