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Antibiotic treatment duration for bloodstream infections in critically ill children—A survey of pediatric infectious diseases and critical care clinicians for clinical equipoise

OBJECTIVE: To describe antibiotic treatment durations that pediatric infectious diseases (ID) and critical care clinicians usually recommend for bloodstream infections in critically ill children. DESIGN: Anonymous, online practice survey using five common pediatric-based case scenarios of bloodstrea...

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Autores principales: Pong, Sandra, Fowler, Robert A., Murthy, Srinivas, Pernica, Jeffrey M., Gilfoyle, Elaine, Fontela, Patricia, Mitsakakis, Nicholas, Bowen, Asha C., Seto, Winnie, Science, Michelle, Hutchison, James S., Jouvet, Philippe, Rishu, Asgar, Daneman, Nick
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9321425/
https://www.ncbi.nlm.nih.gov/pubmed/35881618
http://dx.doi.org/10.1371/journal.pone.0272021
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author Pong, Sandra
Fowler, Robert A.
Murthy, Srinivas
Pernica, Jeffrey M.
Gilfoyle, Elaine
Fontela, Patricia
Mitsakakis, Nicholas
Bowen, Asha C.
Seto, Winnie
Science, Michelle
Hutchison, James S.
Jouvet, Philippe
Rishu, Asgar
Daneman, Nick
author_facet Pong, Sandra
Fowler, Robert A.
Murthy, Srinivas
Pernica, Jeffrey M.
Gilfoyle, Elaine
Fontela, Patricia
Mitsakakis, Nicholas
Bowen, Asha C.
Seto, Winnie
Science, Michelle
Hutchison, James S.
Jouvet, Philippe
Rishu, Asgar
Daneman, Nick
author_sort Pong, Sandra
collection PubMed
description OBJECTIVE: To describe antibiotic treatment durations that pediatric infectious diseases (ID) and critical care clinicians usually recommend for bloodstream infections in critically ill children. DESIGN: Anonymous, online practice survey using five common pediatric-based case scenarios of bloodstream infections. SETTING: Pediatric intensive care units in Canada, Australia and New Zealand. PARTICIPANTS: Pediatric intensivists, nurse practitioners, ID physicians and pharmacists. MAIN OUTCOME MEASURES: Recommended treatment durations for common infectious syndromes associated with bloodstream infections and willingness to enrol patients into a trial to study treatment duration. RESULTS: Among 136 survey respondents, most recommended at least 10 days antibiotics for bloodstream infections associated with: pneumonia (65%), skin/soft tissue (74%), urinary tract (64%) and intra-abdominal infections (drained: 90%; undrained: 99%). For central vascular catheter-associated infections without catheter removal, over 90% clinicians recommended at least 10 days antibiotics, except for infections caused by coagulase negative staphylococci (79%). Recommendations for at least 10 days antibiotics were less common with catheter removal. In multivariable linear regression analyses, lack of source control was significantly associated with longer treatment durations (+5.2 days [95% CI: 4.4–6.1 days] for intra-abdominal infections and +4.1 days [95% CI: 3.8–4.4 days] for central vascular catheter-associated infections). Most clinicians (73–95%, depending on the source of bloodstream infection) would be willing to enrol patients into a trial of shorter versus longer antibiotic treatment duration. CONCLUSIONS: The majority of clinicians currently recommend at least 10 days of antibiotics for most scenarios of bloodstream infections in critically ill children. There is practice heterogeneity in self-reported treatment duration recommendations among clinicians. Treatment durations were similar across different infectious syndromes. Under appropriate clinical conditions, most clinicians would be willing to enrol patients into a trial of shorter versus longer treatment for common syndromes associated with bloodstream infections.
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spelling pubmed-93214252022-07-27 Antibiotic treatment duration for bloodstream infections in critically ill children—A survey of pediatric infectious diseases and critical care clinicians for clinical equipoise Pong, Sandra Fowler, Robert A. Murthy, Srinivas Pernica, Jeffrey M. Gilfoyle, Elaine Fontela, Patricia Mitsakakis, Nicholas Bowen, Asha C. Seto, Winnie Science, Michelle Hutchison, James S. Jouvet, Philippe Rishu, Asgar Daneman, Nick PLoS One Research Article OBJECTIVE: To describe antibiotic treatment durations that pediatric infectious diseases (ID) and critical care clinicians usually recommend for bloodstream infections in critically ill children. DESIGN: Anonymous, online practice survey using five common pediatric-based case scenarios of bloodstream infections. SETTING: Pediatric intensive care units in Canada, Australia and New Zealand. PARTICIPANTS: Pediatric intensivists, nurse practitioners, ID physicians and pharmacists. MAIN OUTCOME MEASURES: Recommended treatment durations for common infectious syndromes associated with bloodstream infections and willingness to enrol patients into a trial to study treatment duration. RESULTS: Among 136 survey respondents, most recommended at least 10 days antibiotics for bloodstream infections associated with: pneumonia (65%), skin/soft tissue (74%), urinary tract (64%) and intra-abdominal infections (drained: 90%; undrained: 99%). For central vascular catheter-associated infections without catheter removal, over 90% clinicians recommended at least 10 days antibiotics, except for infections caused by coagulase negative staphylococci (79%). Recommendations for at least 10 days antibiotics were less common with catheter removal. In multivariable linear regression analyses, lack of source control was significantly associated with longer treatment durations (+5.2 days [95% CI: 4.4–6.1 days] for intra-abdominal infections and +4.1 days [95% CI: 3.8–4.4 days] for central vascular catheter-associated infections). Most clinicians (73–95%, depending on the source of bloodstream infection) would be willing to enrol patients into a trial of shorter versus longer antibiotic treatment duration. CONCLUSIONS: The majority of clinicians currently recommend at least 10 days of antibiotics for most scenarios of bloodstream infections in critically ill children. There is practice heterogeneity in self-reported treatment duration recommendations among clinicians. Treatment durations were similar across different infectious syndromes. Under appropriate clinical conditions, most clinicians would be willing to enrol patients into a trial of shorter versus longer treatment for common syndromes associated with bloodstream infections. Public Library of Science 2022-07-26 /pmc/articles/PMC9321425/ /pubmed/35881618 http://dx.doi.org/10.1371/journal.pone.0272021 Text en © 2022 Pong et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Pong, Sandra
Fowler, Robert A.
Murthy, Srinivas
Pernica, Jeffrey M.
Gilfoyle, Elaine
Fontela, Patricia
Mitsakakis, Nicholas
Bowen, Asha C.
Seto, Winnie
Science, Michelle
Hutchison, James S.
Jouvet, Philippe
Rishu, Asgar
Daneman, Nick
Antibiotic treatment duration for bloodstream infections in critically ill children—A survey of pediatric infectious diseases and critical care clinicians for clinical equipoise
title Antibiotic treatment duration for bloodstream infections in critically ill children—A survey of pediatric infectious diseases and critical care clinicians for clinical equipoise
title_full Antibiotic treatment duration for bloodstream infections in critically ill children—A survey of pediatric infectious diseases and critical care clinicians for clinical equipoise
title_fullStr Antibiotic treatment duration for bloodstream infections in critically ill children—A survey of pediatric infectious diseases and critical care clinicians for clinical equipoise
title_full_unstemmed Antibiotic treatment duration for bloodstream infections in critically ill children—A survey of pediatric infectious diseases and critical care clinicians for clinical equipoise
title_short Antibiotic treatment duration for bloodstream infections in critically ill children—A survey of pediatric infectious diseases and critical care clinicians for clinical equipoise
title_sort antibiotic treatment duration for bloodstream infections in critically ill children—a survey of pediatric infectious diseases and critical care clinicians for clinical equipoise
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9321425/
https://www.ncbi.nlm.nih.gov/pubmed/35881618
http://dx.doi.org/10.1371/journal.pone.0272021
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