aDepartments of Pediatrics.
bBiostatistics, Vanderbilt University School of Medicine, Nashville Tennessee.
Hosp Pediatr. 2022 Apr 1;12(4):384-391. doi: 10.1542/hpeds.2021-006510.
To determine whether empirical antibiotic initiation and selection for children with pneumonia was associated with procalcitonin (PCT) levels when results were blinded to clinicians.
We enrolled children <18 years with radiographically confirmed pneumonia at 2 children's hospitals from 2014 to 2019. Blood for PCT was collected at enrollment (blinded to clinicians). We modeled associations between PCT and (1) antibiotic initiation and (2) antibiotic selection (narrow versus broad-spectrum) using multivariable logistic regression models. To quantify potential stewardship opportunities, we calculated proportions of noncritically ill children receiving antibiotics who also had a low likelihood of bacterial etiology (PCT <0.25 ng/mL) and those receiving broad-spectrum therapy, regardless of PCT level.
We enrolled 488 children (median PCT, 0.37 ng/mL; interquartile range [IQR], 0.11-2.38); 85 (17%) received no antibiotics (median PCT, 0.32; IQR, 0.09-1.33). Among the 403 children receiving antibiotics, 95 (24%) received narrow-spectrum therapy (median PCT, 0.24; IQR, 0.08-2.52) and 308 (76%) received broad-spectrum (median PCT, 0.46; IQR, 0.12-2.83). In adjusted analyses, PCT values were not associated with antibiotic initiation (odds ratio [OR], 1.02, 95% confidence interval [CI], 0.97%-1.06%) or empirical antibiotic selection (OR 1.07; 95% CI, 0.97%-1.17%). Of those with noncritical illness, 246 (69%) were identified as potential targets for antibiotic stewardship interventions.
Neither antibiotic initiation nor empirical antibiotic selection were associated with PCT values. Whereas other factors may inform antibiotic treatment decisions, the observed discordance between objective likelihood of bacterial etiology and antibiotic use suggests important opportunities for stewardship.
当结果对临床医生设盲时，确定肺炎患儿经验性抗生素起始和选择是否与降钙素原 (PCT) 水平相关。
我们纳入了 2014 年至 2019 年在 2 家儿童医院因影像学证实的肺炎而就诊的 <18 岁儿童。在入组时采集 PCT 血样（对临床医生设盲）。我们使用多变量逻辑回归模型来建模 PCT 与（1）抗生素起始和（2）抗生素选择（窄谱与广谱）之间的关联。为了量化潜在的管理机会，我们计算了接受抗生素治疗且细菌病因可能性低（PCT <0.25ng/mL）的非危重症儿童的比例，以及无论 PCT 水平如何，接受广谱治疗的儿童的比例。
我们纳入了 488 名儿童（中位 PCT，0.37ng/mL；四分位距 [IQR]，0.11-2.38）；85 名（17%）未接受抗生素治疗（中位 PCT，0.32ng/mL；IQR，0.09-1.33）。在接受抗生素治疗的 403 名儿童中，95 名（24%）接受了窄谱治疗（中位 PCT，0.24ng/mL；IQR，0.08-2.52），308 名（76%）接受了广谱治疗（中位 PCT，0.46ng/mL；IQR，0.12-2.83）。在调整后的分析中，PCT 值与抗生素起始（优势比 [OR]，1.02；95%置信区间 [CI]，0.97%-1.06%）或经验性抗生素选择（OR 1.07；95% CI，0.97%-1.17%）无关。在非危重症患儿中，246 名（69%）被确定为抗生素管理干预的潜在目标。
抗生素起始或经验性抗生素选择均与 PCT 值无关。尽管其他因素可能会影响抗生素治疗决策，但客观细菌病因可能性与抗生素使用之间的观察到的不匹配表明，管理有重要的机会。
