Affiliation:
1. Toulouse University Hospital
2. Hôpital Universitaire Pellegrin, Université de Bordeaux
3. Hôpital Universitaire Arnaud de Villeneuve, Université de Montpellier
4. Hôpital Universitaire mère-enfant, Université de Nantes
5. Hôpital Universitaire Estaing, Université de Clermont-Ferrand
6. Hôpital Universitaire Amiens-Picardie, Université d’Amiens
7. Hôpital Universitaire Felix Guyon, Université de La Réunion
8. Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Université de Paris
Abstract
Abstract
Background
Bacterial infections (BIs) are widespread in ICUs. The aims of this study were to assess the compliance with antibiotic recommendations, and factors associated with non-compliance.
Methods
We conducted an observational study in eight French Paediatric and Neonatal ICUs with an antimicrobial stewardship programme, mostly once a week. All children receiving antibiotics for a suspected or proven BI were evaluated. Newborns < 72 hours old, neonates < 37 weeks, age ≥ 18 years, and children under antimicrobial prophylaxis were excluded.
Results
139 suspected (or proven) BI episodes in 134 children were prospectively included during six separate time-periods over one year. The final diagnosis was 26.6% no BI, 40.3% presumed (i.e., not documented) BI, and 35.3% documented BI. Non-compliance for all parameters combined occurred in 51.1%. The main reasons for non-compliance were inappropriate choice of antimicrobials (27.3%), duration of one or more antimicrobials (26.3%), and duration of antibiotic therapy (18.0%). In multivariate analyses, main independent risk factors for non-compliance were prescribing ≥ 2 antibiotics (OR 4.06, 95%CI 1.69–9.74, p = 0.0017), a duration of broad-spectrum antibiotic therapy ≥ 4 days (OR 2.59, 95%CI 1.16–5.78, p = 0.0199), neurologic compromise at ICU admission (OR 3.41, 95%CI 1.04–11.20, p = 0.0431), suspected catheter-related bacteraemia (ORs 3.70 and 5.42, 95%CIs 1.32 to 15.07, p < 0.02), a BI site classified as “other” (ORs 3.29 and 15.88, 95%CIs 1.16 to 104.76, p < 0.03), sepsis with ≥ 2 organ dysfunctions (OR 4.21, 95%CI 1.42–12.55, p = 0.0098), late-onset ventilator-associated pneumonia (OR 6.30, 95%CI 1.15–34.44, p = 0.0338), and ≥ 1 risk factor for ESBL Enterobacteriaceae (OR 2.56, 95%CI 1.07–6.14, p = 0.0353). Main independent factors for compliance were having antibiotic therapy protocols (OR 0.42, 95%CI 0.19–0.92, p = 0.0313), respiratory failure at ICU admission (OR 0.36, 95%CI 0.14–0.90, p = 0.0281), and aspiration pneumonia (OR 0.37, 95%CI 0.14–0.99, p = 0.0486).
Conclusions
Half of antibiotic prescriptions remain non-compliant with guidelines. Intensivists should reassess on a daily basis the benefit of using several antimicrobials or any broad-spectrum antimicrobials and stop antibiotics that are no longer indicated. Developing consensus about treating specific illnesses and using department protocols seem necessary to reduce non-compliance. A daily ASP could also improve compliance in these situations.
Trial registration
: ClinicalTrials.gov: number NCT04642560. The date of first trial registration was 24/11/2020.
Publisher
Research Square Platform LLC