Association of Empiric Antibiotic Regimen Discordance With 30-Day Mortality in Neonatal and Pediatric Bloodstream Infection-A Global Retrospective Cohort Study.

Autor:	Cook A; From the Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom., Hsia Y; From the Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom., Russell N; From the Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom., Sharland M; From the Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom., Cheung K; Monash Health, Australia., Grimwood K; Gold Coast Health, Gold Coast, QLD, Australia.; Griffith University, QLD, Australia., Cross J; Gold Coast Health, Gold Coast, QLD, Australia., Cotrim da Cunha D; Hospital Infection Control Service of Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil., Magalhães GR; Hospital Infection Control Service of Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil., Renk H; Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany., Hindocha A; North Manchester General Hospital, Manchester, United Kingdom., McMaster P; North Manchester General Hospital, Manchester, United Kingdom., Okomo U; London School of Hygiene and Tropical Medicine, London, United Kingdom., Darboe S; London School of Hygiene and Tropical Medicine, London, United Kingdom., Alvarez-Uria G; Department of Infectious Diseases, RDT Hospital, Anantapur, Andhra Pradesh, India., Jinka DR; Department of Infectious Diseases, RDT Hospital, Anantapur, Andhra Pradesh, India., Murki S; Department of Neonatology, Fernandez Hospital, Hyderabad, India., Kandraju H; Department of Neonatology, Fernandez Hospital, Hyderabad, India., Dharmapalan D; Dr. Yewale's Multispecialty Hospital for Children, Vashi, Navi Mumbai, India., Esposito S; Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy., Bianchini S; Pediatric Clinic, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy., Fukuoka K; Division of Infectious Diseases, Department of Paediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan., Aizawa Y; Division of Infectious Diseases, Department of Paediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan., Jimenez-Juarez RN; Infectious Diseases Department, Federico Gómez Children's Hospital of Mexico, Mexico City, Mexico.; Department of Pediatrics, Infectious Diseases Hospital, national Medical Center 'La Raza', Mexican Institute of Social Security, Mexico City, Mexico., Ojeda-Diezbarroso K; Infectious Diseases Department, Federico Gómez Children's Hospital of Mexico, Mexico City, Mexico., Pirš M; Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia., Rožič M; Department of Infectious Diseases and Epidemiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.; Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia., Anugulruengkitt S; Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.; Center of Excellence in Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand., Jantarabenjakul W; Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.; Center of Excellence in Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand.; Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand., Cheng CL; Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.; Department of Pharmacy, National Cheng Kung University Hospital, Tainan City, Taiwan., Jian BX; Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan., Spyridakis E; University of Florida College of Medicine, Gainesville, FL.; The Studer Family Children's Hospital at Ascension Sacred Heart, Pensacola, FL., Zaoutis T; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.; Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA., Bielicki J; From the Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	The Pediatric infectious disease journal [Pediatr Infect Dis J] 2021 Feb 01; Vol. 40 (2), pp. 137-143.
DOI:	10.1097/INF.0000000000002910
Abstrakt:	Background: While there have been studies in adults reporting discordant empiric antibiotic treatment associated with poor outcomes, this area is relatively unexplored in children and neonates despite evidence of increasing resistance to recommended first-line treatment regimens. Methods: Patient characteristics, antibiotic treatment, microbiology, and 30-day all-cause outcome from children <18 years with blood-culture-confirmed bacterial bloodstream infections (BSI) were collected anonymously using REDCap™ through the Global Antibiotic Prescribing and Resistance in Neonates and Children network from February 2016 to February 2017. Concordance of early empiric antibiotic treatment was determined using European Committee on Antimicrobial Susceptibility Testing interpretive guidelines. The relationship between concordance of empiric regimen and 30-day mortality was investigated using multivariable regression. Results: Four hundred fifty-two children with blood-culture-positive BSI receiving early empiric antibiotics were reported by 25 hospitals in 19 countries. Sixty percent (273/452) were under the age of 2 years. S. aureus, E. coli, and Klebsiella spp. were the most common isolates, and there were 158 unique empiric regimens prescribed. Fifteen percent (69/452) of patients received a discordant regimen, and 7.7% (35/452) died. Six percent (23/383) of patients with concordant regimen died compared with 17.4% (12/69) of patients with discordant regimen. Adjusting for age, sex, presence of comorbidity, unit type, hospital-acquired infections, and Gram stain, the odds of 30-day mortality were 2.9 (95% confidence interval: 1.2-7.0; P = 0.015) for patients receiving discordant early empiric antibiotics. Conclusions: Odds of mortality in confirmed pediatric BSI are nearly 3-fold higher for patients receiving a discordant early empiric antibiotic regimen. The impact of improved concordance of early empiric treatment on mortality, particularly in critically ill patients, needs further evaluation. Competing Interests: The authors have no conflicts of interest to disclose. (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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