Antibiotic Indications and Appropriateness in the Pediatric Intensive Care Unit: A 10-Center Point Prevalence Study

Kathleen Chiotos, Jennifer Blumenthal, Juri Boguniewicz, Debra L. Palazzi, Erika L. Stalets, Jessica H. Rubens, Pranita D. Tamma, Stephanie S. Cabler, Jason Newland, Hillary Crandall, Emily Berkman, Robert P. Kavanagh, Hannah R. Stinson, Jeffrey S. Gerber

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: Antibiotics are prescribed to most pediatric intensive care unit (PICU) patients, but data describing indications and appropriateness of antibiotic orders in this population are lacking. Methods: We performed a multicenter point prevalence study that included children admitted to 10 geographically diverse PICUs over 4 study days in 2019. Antibiotic orders were reviewed for indication, and appropriateness was assessed using a standardized rubric. Results: Of 1462 patients admitted to participating PICUs, 843 (58%) had at least 1 antibiotic order. A total of 1277 antibiotic orders were reviewed. Common indications were empiric therapy for suspected bacterial infections without sepsis or septic shock (260 orders, 21%), nonoperative prophylaxis (164 orders, 13%), empiric therapy for sepsis or septic shock (155 orders, 12%), community-Acquired pneumonia (CAP; 118 orders, 9%), and post-operative prophylaxis (94 orders, 8%). Appropriateness was assessed for 985 orders for which an evidence-based rubric for appropriateness could be created. Of these, 331 (34%) were classified as inappropriate. Indications with the most orders classified as inappropriate were empiric therapy for suspected bacterial infection without sepsis or septic shock (78 orders, 24%), sepsis or septic shock (55 orders, 17%), CAP (51 orders, 15%), ventilator-Associated infections (47 orders, 14%), and post-operative prophylaxis (44 orders, 14%). The proportion of antibiotics classified as inappropriate varied across institutions (range, 19%-43%). Conclusions: Most PICU patients receive antibiotics. Based on our study, we estimate that one-Third of antibiotic orders are inappropriate. Improved antibiotic stewardship and research focused on strategies to optimize antibiotic use in critically ill children are needed.

Original languageEnglish
Pages (from-to)E1021-E1030
JournalClinical Infectious Diseases
Volume76
Issue number3
DOIs
StatePublished - Feb 1 2023

Keywords

  • antibiotic
  • antimicrobial stewardship
  • pediatric intensive care unit
  • sepsis

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