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Published on: August 30, 2018
Compliance with antibiotic therapy guidelines in french paediatric intensive care units: a multicentre observational
Romain Amadieu1, Camille Brehin2,3, Adéla Chahine4
1Neonatal and Paediatric Intensive Care Unit, Children's Hospital, Toulouse University Hospital, 330 Avenue de Grande Bretagne, TSA 70034, Toulouse Cedex 9, 31059, France. amadieu.r@chu-toulouse.fr.
Background:
Bacterial infections (BIs) are widespread in ICUs. The aims of this study were to assess compliance with antibiotic recommendations and factors associated with non-compliance.
Methods:
We conducted an observational study in eight French Paediatric and Neonatal ICUs with an antimicrobial stewardship programme (ASP) organised once a week for the most part. All children receiving antibiotics for a suspected or proven BI were evaluated. Newborns < 72 h old, neonates < 37 weeks, age ≥ 18 years and children under surgical antimicrobial prophylaxis were excluded.
Results:
139 suspected (or proven) BI episodes in 134 children were prospectively included during six separate time-periods over one year. The final diagnosis was 26.6% with no BI, 40.3% presumed (i.e., not documented) BI and 35.3% documented BI. Non-compliance with antibiotic recommendations occurred in 51.1%. The main reasons for non-compliance were inappropriate choice of antimicrobials (27.3%), duration of one or more antimicrobials (26.3%) and length of antibiotic therapy (18.0%). In multivariate analyses, the main independent risk factors for non-compliance were prescribing ≥ 2 antibiotics (OR 4.06, 95%CI 1.69-9.74, p = 0.0017), duration of broad-spectrum antibiotic therapy ≥ 4 days (OR 2.59, 95%CI 1.16-5.78, p = 0.0199), neurologic compromise at ICU admission (OR 3.41, 95%CI 1.04-11.20, p = 0.0431), suspected catheter-related bacteraemia (ORs 3.70 and 5.42, 95%CIs 1.32 to 15.07, p < 0.02), a BI site classified as "other" (ORs 3.29 and 15.88, 95%CIs 1.16 to 104.76, p < 0.03), sepsis with ≥ 2 organ dysfunctions (OR 4.21, 95%CI 1.42-12.55, p = 0.0098), late-onset ventilator-associated pneumonia (OR 6.30, 95%CI 1.15-34.44, p = 0.0338) and ≥ 1 risk factor for extended-spectrum β-lactamase-producing Enterobacteriaceae (OR 2.56, 95%CI 1.07-6.14, p = 0.0353). Main independent factors for compliance were using antibiotic therapy protocols (OR 0.42, 95%CI 0.19-0.92, p = 0.0313), respiratory failure at ICU admission (OR 0.36, 95%CI 0.14-0.90, p = 0.0281) and aspiration pneumonia (OR 0.37, 95%CI 0.14-0.99, p = 0.0486).
Conclusions:
Half of antibiotic prescriptions remain non-compliant with guidelines. Intensivists should reassess on a day-to-day basis the benefit of using several antimicrobials or any broad-spectrum antibiotics and stop antibiotics that are no longer indicated. Developing consensus about treating specific illnesses and using department protocols seem necessary to reduce non-compliance. A daily ASP could also improve compliance in these situations.
Trial Registration:
ClinicalTrials.gov: number NCT04642560. The date of first trial registration was 24/11/2020.
Insights
Over half of pediatric intensive care unit patients with bacterial infections (BIs) do not receive compliant antibiotic treatment. Adherence to antibiotic guidelines can be improved by using protocols and daily antimicrobial stewardship programs (ASPs).
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Antimicrobial stewardship
Background:
- Bacterial infections (BIs) are a significant concern in pediatric intensive care units (ICUs).
- Assessing compliance with antibiotic recommendations and identifying non-compliance factors are crucial for effective treatment.
Purpose of the Study:
- To evaluate adherence to antibiotic guidelines in pediatric and neonatal ICUs.
- To determine factors associated with non-compliance in antibiotic therapy for bacterial infections.
Main Methods:
- An observational study was conducted in eight French pediatric and neonatal ICUs.
- 139 episodes of suspected or proven BI in 134 children were analyzed over one year.
- Exclusion criteria included newborns <72h old, neonates <37 weeks, age ≥18 years, and surgical prophylaxis.
Main Results:
- 51.1% of antibiotic prescriptions were non-compliant with recommendations.
- Inappropriate antimicrobial choice, duration, and length of therapy were primary reasons for non-compliance.
- Factors associated with non-compliance included prescribing multiple antibiotics, prolonged broad-spectrum therapy, neurologic compromise, suspected catheter-related bacteraemia, sepsis with multiple organ dysfunctions, and late-onset VAP.
Conclusions:
- Half of antibiotic prescriptions in ICUs do not meet guideline recommendations.
- Daily reassessment of antibiotic use, including de-escalation and discontinuation, is recommended.
- Developing treatment consensus, utilizing department protocols, and implementing daily antimicrobial stewardship programs (ASPs) can improve compliance.
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