SORA

Advancing, promoting and sharing knowledge of health through excellence in teaching, clinical practice and research into the prevention and treatment of illness

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

Cook, A; Hsia, Y; Russell, N; Sharland, M; Cheung, K; Grimwood, K; Cross, J; Cotrim da Cunha, D; Magalhães, GR; Renk, H; et al. Cook, A; Hsia, Y; Russell, N; Sharland, M; Cheung, K; Grimwood, K; Cross, J; Cotrim da Cunha, D; Magalhães, GR; Renk, H; Hindocha, Avni; McMaster, P; Okomo, U; Darboe, S; Alvarez-Uria, G; Jinka, DR; Murki, S; Kandraju, H; Dharmapalan, D; Esposito, S; Bianchini, S; Fukuoka, K; Aizawa, Y; Jimenez-Juarez, RN; Ojeda-Diezbarroso, K; Pirš, M; Rožič, M; Anugulruenkitt, S; Jantaranbenjakul, W; Cheng, C-L; Jian, B-X; Spyridakis, E; Zaoutis, T; Bielicki, J (2021) Association of Empiric Antibiotic Regimen Discordance With 30-Day Mortality in Neonatal and Pediatric Bloodstream Infection—A Global Retrospective Cohort Study. PEDIATRIC INFECTIOUS DISEASE JOURNAL, 40 (2). pp. 137-143. ISSN 0891-3668 https://doi.org/10.1097/INF.0000000000002910
SGUL Authors: Hsia, Yingfen

[img] Microsoft Word (.docx) (Title page) Accepted Version
Available under License ["licenses_description_publisher" not defined].

Download (20kB)
[img] Microsoft Word (.docx) (Abstract) Accepted Version
Available under License ["licenses_description_publisher" not defined].

Download (13kB)
[img] Microsoft Word (.docx) Accepted Version
Available under License ["licenses_description_publisher" not defined].

Download (78kB)
[img] Microsoft Word (.docx) (Table 1) Accepted Version
Available under License ["licenses_description_publisher" not defined].

Download (15kB)
[img] Microsoft Word (.docx) (Table 2) Accepted Version
Available under License ["licenses_description_publisher" not defined].

Download (18kB)
[img] Microsoft Word (.docx) (Table 3) Accepted Version
Available under License ["licenses_description_publisher" not defined].

Download (15kB)
[img] Microsoft Word (.docx) (Table 4) Accepted Version
Available under License ["licenses_description_publisher" not defined].

Download (13kB)
[img]
Preview
PDF (Supplementary Digital Content 1) Accepted Version
Available under License ["licenses_description_publisher" not defined].

Download (140kB) | Preview
[img]
Preview
PDF (Supplementary Digital Content 2) Accepted Version
Available under License ["licenses_description_publisher" not defined].

Download (90kB) | Preview
[img]
Preview
PDF (Supplementary Digital Content 3) Accepted Version
Available under License ["licenses_description_publisher" not defined].

Download (109kB) | Preview
[img]
Preview
PDF (Supplementary Digital Content 4) Accepted Version
Available under License ["licenses_description_publisher" not defined].

Download (109kB) | Preview
[img]
Preview
PDF (Supplementary Digital Content 5) Accepted Version
Available under License ["licenses_description_publisher" not defined].

Download (163kB) | Preview
[img]
Preview
PDF (Supplementary Digital Content 6) Accepted Version
Available under License ["licenses_description_publisher" not defined].

Download (199kB) | Preview
[img]
Preview
PDF (Supplementary Digital Content 7) Accepted Version
Available under License ["licenses_description_publisher" not defined].

Download (146kB) | Preview

Abstract

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.

Item Type: Article
Additional Information: This is a non-final version of an article published in final form in Cook, A; Hsia, Y; Russell, N; Sharland, M; Cheung, K; Grimwood, K; Cross, J; Cotrim da Cunha, D; Magalhães, GR; Renk, H; et al. (2021) Association of Empiric Antibiotic Regimen Discordance With 30-Day Mortality in Neonatal and Pediatric Bloodstream Infection—A Global Retrospective Cohort Study. PEDIATRIC INFECTIOUS DISEASE JOURNAL, 40 (2). pp. 137-143.
Keywords: Pediatrics, 1114 Paediatrics and Reproductive Medicine
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: PEDIATRIC INFECTIOUS DISEASE JOURNAL
ISSN: 0891-3668
Dates:
DateEvent
February 2021Published
23 August 2020Accepted
Publisher License: Publisher's own licence
URI: https://openaccess.sgul.ac.uk/id/eprint/112405
Publisher's version: https://doi.org/10.1097/INF.0000000000002910

Actions (login required)

Edit Item Edit Item