Use of a Procalcitonin-guided Antibiotic Treatment Algorithm in the Pediatric Intensive Care Unit
| Autor: | Jessica Gillon, Sophie E Katz, Jennifer M. Colby, Jennifer Crook, Li Wang, Ritu Banerjee, J. Eric Stanford |
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| Rok vydání: | 2020 |
| Předmět: |
Microbiology (medical)
Male medicine.drug_class Critical Illness Antibiotics MEDLINE Single Center Intensive Care Units Pediatric Procalcitonin Article Cohort Studies 03 medical and health sciences Antimicrobial Stewardship 0302 clinical medicine 030225 pediatrics Sepsis Medicine Humans 030212 general & internal medicine Prospective Studies Antibiotic use Pediatric intensive care unit Critically ill business.industry Infant Newborn Infant bacterial infections and mycoses Anti-Bacterial Agents Clinical trial Hospitalization Infectious Diseases Child Preschool Pediatrics Perinatology and Child Health Female business Algorithm hormones hormone substitutes and hormone antagonists Algorithms Biomarkers |
| Zdroj: | Pediatr Infect Dis J |
| ISSN: | 1532-0987 |
| Popis: | Background The utility of procalcitonin testing in the pediatric intensive care unit (PICU) is not known. We sought to determine the impact of a procalcitonin-guided antibiotic treatment algorithm implemented with antibiotic stewardship (AS) guidance vs. usual care on antibiotic use in critically ill children. Methods Single center, pragmatic, randomized prospective clinical trial of critically ill children admitted to an ICU setting and started on intravenous antibiotics from February 15, 2018, to April 11, 2019. Patients were assigned on a monthly basis to either the procalcitonin or usual care arm. The procalcitonin arm had procalcitonin testing on hospital days 0, 1, 2, and 4 and stewardship assistance with algorithm result interpretation. Both arms had routine AS audit and feedback. The primary outcome was median antibiotic days of therapy per patient in the first 14-days after enrollment. Results Among 270 patients, 137 were in the procalcitonin arm and 133 in the usual care arm. Antibiotic days of therapy (DOT) were not significantly different between the procalcitonin arm (6.6, IQR: 3.1-10.9) and the usual care arm (7.6, IQR: 3-11.8; P = 0.37). More AS recommendations were made in the procalcitonin vs. control arm (54 vs. 37; P = 0.03). Adherence with algorithm-based antibiotic recommendations was high in the procalcitonin arm (70%). Conclusions We found no difference in antibiotic DOT between study arms. This trial was underpowered but demonstrates feasibility of using a procalcitonin-guided antibiotic treatment algorithm with AS audit and feedback in the PICU. |
| Databáze: | OpenAIRE |
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