Antibiotic Use Among Children Requiring Respiratory Support in Intensive Care Unit (ICU) from Sofia, Bulgaria: A
Lilia Bozadzhieva1,2, Dimitrinka Miteva2,3, Lyubomila Ilarionova1,2
1Pediatric Intensive Care Unit, University Hospital for Active Treatment of Children's Diseases "Professor Ivan Mitev", Akademik Ivan Evstatiev Geshov Blvd 11, 1431 Sofia, Bulgaria.
Insights
Antibiotic use is common in critically ill children needing respiratory support, driven by illness severity, not just ventilation type. Invasive ventilation increased specific infections like ventilator-associated pneumonia.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Respiratory Medicine
Background:
- Antibiotic use in pediatric intensive care units (PICU) for respiratory support lacks standardized guidelines, especially for non-invasive ventilation (NIV).
- Limited evidence necessitates real-world data on antibiotic prescribing and infectious outcomes in critically ill children.
- Understanding these patterns is crucial for developing effective antibiotic stewardship.
Purpose of the Study:
- To describe antibiotic prescribing patterns in pediatric patients with respiratory failure.
- To analyze infectious outcomes based on the type of respiratory support received (oxygen, NIV, invasive mechanical ventilation - IMV).
- To identify factors influencing antibiotic use and infection rates in this population.
Main Methods:
- Retrospective single-center study of children (0-17 years) admitted to the PICU between January 2021 and February 2025.
- Inclusion criteria: requirement for oxygen supplementation, NIV, or IMV.
- Data collected: demographics, underlying conditions, infectious complications, antibiotic exposure, PICU stay, and outcomes. Analyzed using descriptive statistics and univariate comparisons.
Main Results:
- Eighty-nine patients were included in the analysis.
- Ventilator-associated pneumonia (VAP) occurred exclusively in IMV patients; overall infection complications were higher with IMV versus NIV (p=0.005).
- Antibiotics were given to 82% of patients; use was similar across ventilation types (p=0.195), but IMV patients received more antibiotics. *Pseudomonas aeruginosa* was the most common pathogen.
Conclusions:
- Antibiotic use in PICU patients with respiratory support is frequent, influenced more by disease severity than ventilation method.
- Infections like VAP are more common with IMV; caution is needed when interpreting non-invasive group outcomes due to varying definitions.
- Findings are descriptive, emphasizing the need for prospective multicenter studies to guide evidence-based antibiotic stewardship in pediatric critical care.
Abstract:
Antibiotic use in critically ill children requiring respiratory support remains controversial, particularly in the absence of standardized guidelines for patients managed with non-invasive ventilation (NIV). Evidence in this area remains limited, and real-world data are therefore valuable. Objective: This retrospective single-center study aimed to describe antibiotic prescribing patterns and infectious outcomes in pediatric patients admitted to the intensive care unit (PICU) with respiratory failure, according to the type of respiratory support. Methods: Children aged 0-17 years admitted between January 2021 and February 2025 who required oxygen supplementation, NIV, or invasive mechanical ventilation (IMV) were included. Demographic characteristics, underlying conditions, infectious complications, antibiotic exposure, length of PICU stay, and outcomes were analyzed using descriptive statistics and univariate comparisons. Results: Eighty-nine patients were included. Ventilator-associated pneumonia (VAP) occurred exclusively in patients receiving IMV, and infection complications were observed more in this group compared to those receiving NIV (p = 0.005). Pseudomonas aeruginosa was the most frequently isolated pathogen. Antibiotics were administered in 82% of patients, with no significant association between the respiratory support and initiation of antibiotic therapy (p = 0.195). A higher number of antibiotics was administered in patients receiving IMV compared with those receiving oxygen therapy alone. Conclusions: Antibiotic use in children requiring respiratory support in the PICU was common and appears to be driven primarily by underlying disease and illness severity rather than by the ventilation modality alone. Infections specific to invasive ventilation, such as VAP, were more frequent in patients receiving IMV, while infection-related outcomes in non-invasive groups should be interpreted cautiously due to differences in diagnostic definitions. These findings are descriptive and hypothesis-generating and highlight the need for prospective multicenter studies to create evidence-based antibiotic stewardship strategies in pediatric critical care.
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