de Gregorio Marion, Mortamet Guillaume, Smiljkovic Mina, Pavese Patricia, Bost-Bru Cécile, Landelle Caroline, Arata-Bardet Julie
Pediatric Intensive Care Unit, Univ.Grenoble Alpes, Grenoble-Alpes University Hospital, La Tronche, France.
Pediatric Infectious Diseases Department, Grenoble-Alpes University Hospital, La Tronche, France.
Eur J Pediatr. 2025 May 19;184(6):347. doi: 10.1007/s00431-025-06182-w.
Community or healthcare-associated infectious diseases are common in Pediatric Intensive Care Units (PICUs). The main objectives of this study were 1/to describe the clinical recommendations given during weekly round of infectious disease team into a PICU and 2/to assess its compliance.An observational prospective single-center study conducted over a one-year period in a PICU of a tertiary university hospital. All clinical recommendations provided by an infectious disease team during a weekly round were collected. We reported a total of 234 clinical recommendations on 148 patients (median age 34 months [IQR 2,5 months -126 months], 52% males). Infections occurred in patients with comorbidity in 73 (49%) of them. Ninety-three patients (40%) had pulmonary infections and patients presented with septic shock in 27 cases (12%). Clinical recommendations were categorized as diagnosis, therapeutic, preventive and monitoring in 98 (42%), 205 (88%), 41 (18%), 34 (15%) respectively. There were many therapeutic modifications after round, including treatment discontinuation (n = 82, 35%), spectrum modification (n = 54, 23%) and dosage adjustment (n = 15, 7%). The duration of treatment was also optimized in 144 situations (62%). Overall, we found a complete compliance with recommendations in most cases (n = 212, 90%).
We found a very good compliance of clinical recommendations provided on a weekly basis by an infectious disease team in a PICU. Larger pediatric studies are warranted to assess a potential benefit on patients' outcome.
• Antibiotic stewardship programs have been developed to optimize antimicrobial prescribing practices.
• A prospective audit and feedback from a pediatric infectious disease team during once weekly rounds in PICU is associated with good adherence. • Recommendations did not focus only on therapeutic management but also on diagnosis, prevention and follow-up.
社区获得性或医疗保健相关感染性疾病在儿科重症监护病房（PICU）中很常见。本研究的主要目的是：1.描述传染病团队在PICU每周查房期间给出的临床建议；2.评估其依从性。在一所三级大学医院的PICU进行了为期一年的观察性前瞻性单中心研究。收集了传染病团队在每周查房期间提供的所有临床建议。我们共报告了针对148例患者的234条临床建议（中位年龄34个月[四分位间距2.5个月 - 126个月]，52%为男性）。其中73例（49%）合并症患者发生了感染。93例患者（40%）患有肺部感染，27例患者（12%）出现感染性休克。临床建议分别归类为诊断、治疗、预防和监测，各占98条（42%）、205条（88%）、41条（18%）、34条（15%）。查房后有许多治疗调整，包括停药（n = 82，35%）、调整抗菌谱（n = 54，23%）和调整剂量（n = 15，7%）。在144种情况下（62%）治疗持续时间也得到了优化。总体而言，我们发现大多数情况下（n = 212，90%）对建议完全依从。
我们发现PICU中传染病团队每周提供的临床建议依从性非常好。有必要开展更大规模的儿科研究以评估对患者预后的潜在益处。
• 已制定抗生素管理计划以优化抗菌药物处方实践。
• PICU中儿科传染病团队每周查房期间进行的前瞻性审核和反馈与良好的依从性相关。• 建议不仅侧重于治疗管理，还包括诊断、预防和随访。
