Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Clin Infect Dis. 2023 Feb 8;76(3):e1021-e1030. doi: 10.1093/cid/ciac698.
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.
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.
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%).
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.
抗生素被广泛应用于大多数儿科重症监护病房（PICU）患者，但缺乏关于该人群中抗生素使用指征和合理性的数据。
我们进行了一项多中心时点患病率研究，纳入了 2019 年在 10 个地理位置不同的 PICU 进行的 4 天研究期间入院的 1462 名患儿。评估了抗生素使用的指征，并使用标准化评估工具评估了其合理性。
在参与研究的 1462 名患儿中，有 843 名（58%）至少有 1 种抗生素医嘱。共审查了 1277 种抗生素医嘱。常见的指征包括：怀疑有细菌性感染但无脓毒症或感染性休克的经验性治疗（260 条医嘱，21%）、非手术预防性治疗（164 条医嘱，13%）、脓毒症或感染性休克的经验性治疗（155 条医嘱，12%）、社区获得性肺炎（CAP；118 条医嘱，9%）和术后预防性治疗（94 条医嘱，8%）。对于可以制定合理性证据评估标准的 985 条医嘱，评估了其合理性。其中，331 条（34%）被归类为不合理。被归类为不合理的最常见的指征包括：怀疑有细菌性感染但无脓毒症或感染性休克的经验性治疗（78 条医嘱，24%）、脓毒症或感染性休克（55 条医嘱，17%）、CAP（51 条医嘱，15%）、呼吸机相关性感染（47 条医嘱，14%）和术后预防性治疗（44 条医嘱，14%）。各机构之间抗生素不合理使用的比例存在差异（范围为 19%-43%）。
大多数 PICU 患儿都接受了抗生素治疗。根据我们的研究，我们估计有三分之一的抗生素医嘱是不合理的。需要进一步加强抗生素管理，并开展研究，以优化危重症患儿的抗生素使用策略。
