DOI: 10.1097/01.ccm.0000457993.99400.ac
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Issn Print: 0090-3493
Publication Date: 2014/12/01
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Excerpt
Methods: We evaluated children growing healthcare-associated GNRs (e.g. Pseudomonas, ESBL-producers) in our tertiary care PICU over a 1-year period for empiric antibiotic appropriateness. Cultured organisms could be susceptible to monotherapy (β-lactam), combination therapy (with a 2nd agent [aminoglycoside or quinolone]), or not covered by empiric therapy. We compared patient characteristics and outcomes between these groups.
Results: Out of 72 infections evaluated, empiric coverage was appropriate in 89% of cases. In 55 infections (76%), the cultured GNR was susceptible to monotherapy. Combination therapy was necessary for 9 infections (13%). No appropriate empiric antibiotic was prescribed in 8 infections. The organism most commonly not covered was Stenotrophomonas, which is not a routine target of our antibiotic protocol. No demographic or illness severity differences were seen between groups. Children with organisms susceptible to monotherapy were more likely to have been hospitalized >48 hours prior to infection (53% vs 11%; p=0.03). While no patient with appropriate coverage had a history of resistant pathogens, 25% without appropriate coverage did have prior resistant organisms (p=0.01). 88% without appropriate coverage had recent antibiotic use compared to 52% with appropriate empiric coverage (p=0.07). No mortality difference was seen between those covered by monotherapy vs combination therapy.
Conclusions: Combination antibiotic use resulted in increased rate of appropriate empiric therapy for healthcare-associated GNRs in the PICU. Further research is needed to better define patients in whom combination therapy is beneficial and if improved appropriateness is associated with better outcomes.
