scholarly journals Antibiotic Surveillance in the Pediatric Intensive Care Unit (PICU) at Sanglah Hospital Denpasar in the Year of 2015-2017

2019 ◽  
Vol 13 (1) ◽  
pp. 146-153
Author(s):  
Dyah Kanya Wati ◽  
I Wayan Gustawan ◽  
Ni Nengah Dwi Fatmawati ◽  
I Ketut Tunas ◽  
Putu Andrie Setiawan
Keyword(s):  
Intensive Care Unit ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Length Of Stay ◽  
Pediatric Intensive Care Unit ◽  
Antibiotic Sensitivity ◽  
Pediatric Intensive Care ◽  
Antibiotic Use ◽  
Chi Square ◽  
Chi Square Test

Background: Antibiotic surveillance in hospital settings is mandatory for optimal antibiotic therapy for the patient. Only a small number of studies have focused on antibiotic surveillance in hospitalized newborns, infants, and children. Objectives: The goal was to evaluate antibiotic use in our Pediatric Intensive Care Unit (PICU) and evaluate it for a possible association with the length of PICU stay. Methods: A retrospective, observational, cohort study was conducted from January 2015 to April 2017, involving subjects who were hospitalized in the PICU at Sanglah Hospital. The inclusion criteria were children aged between 1-month-12-years old, who had a blood culture and antibiotic sensitivity test result in their medical record. The exclusion criteria were incomplete medical records, blood cultures showing 2 types of bacteria at the same time (gram-positive and negative), or contaminated blood results. Factors associated with mortality were analyzed using a Chi-square test, with p < 0.05 considered to be statistically significant and the Risk Ratio (RR) of the associated factors was determined by 95% CI. Results: Multivariate analysis showed that the significant predictors of PICU length of stay were the appropriate continuation of antibiotics (RR 1.19; 95% CI 1.043 to 1.373; P = 0.047). There were also significant results for antibiotic compatibility and length of stay (RR 3.6; 95% CI 0.869 to 15.428; P = 0.049). Conclusion: Appropriate continuation of antibiotics and the compatibility of continuation antibiotics were significant predictors of length of PICU stay based on multivariate analysis.

scholarly journals Implementation of a Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: the Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study

2018 ◽  
Vol 9 (1) ◽  
pp. 36-43 ◽  
Author(s):  
Kevin J Downes ◽  
Julie C Fitzgerald ◽  
Emily Schriver ◽  
Craig L K Boge ◽  
Michael E Russo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bacterial Infection ◽  
Pediatric Intensive Care Unit ◽  
Bacterial Infections ◽  
Pediatric Intensive Care ◽  
Antibiotic Use ◽  
Antibiotic Administration ◽  
Period 2 ◽  
Rate Ratios

Abstract Background Biomarkers can facilitate safe antibiotic discontinuation in critically ill patients without bacterial infection. Methods We tested the ability of a biomarker-based algorithm to reduce excess antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) without bacterial infections (uninfected) in our pediatric intensive care unit (PICU). The algorithm suggested that PICU clinicians stop antibiotics if (1) C-reactive protein &lt;4 mg/dL and procalcitonin &lt;1 ng/mL at SIRS onset and (2) no evidence of bacterial infection by exam/testing by 48 hours. We evaluated excess broad-spectrum antibiotic use, defined as administration on days 3–9 after SIRS onset in uninfected children. Incidence rate ratios (IRRs) compared unadjusted excess length of therapy (LOT) in the 34 months before (Period 1) and 12 months after (Period 2) implementation of this algorithm, stratified by biomarker values. Segmented linear regression evaluated excess LOT among all uninfected episodes over time and between the periods. Results We identified 457 eligible SIRS episodes without bacterial infection, 333 in Period 1 and 124 in Period 2. When both biomarkers were below the algorithm’s cut-points (n = 48 Period 1, n = 31 Period 2), unadjusted excess LOT was lower in Period 2 (IRR, 0.53; 95% confidence interval, 0.30–0.93). Among all 457 uninfected episodes, there were no significant differences in LOT (coefficient 0.9, P = .99) between the periods on segmented regression. Conclusions Implementation of a biomarker-based algorithm did not decrease overall antibiotic exposure among all uninfected patients in our PICU, although exposures were reduced in the subset of SIRS episodes where biomarkers were low.

scholarly journals 1134. Antibiotic Indications and Appropriateness in the Pediatric Intensive Care Unit: A 10 Center Point Prevalence Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S403-S404
Author(s):  
Kathleen Chiotos ◽  
Jennifer Blumenthal ◽  
Juri Boguniewicz ◽  
Debra Palazzi ◽  
Emily Berkman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Antibiotic Use ◽  
Empiric Therapy ◽  
Point Prevalence ◽  
Prevalence Study ◽  
Point Prevalence Study

Abstract Background Antibiotics are prescribed in up to 80% of pediatric intensive care unit (PICU) patients, but multicenter studies systematically evaluating antibiotic indications and appropriateness in this high-utilizing population are lacking. Methods A multicenter point prevalence study was conducted at 10 geographically diverse tertiary care US children’s hospitals. All PICU patients < 21 years of age who were receiving systemic antibiotics at 8:00 AM on each study day were included. Study days occurred in February and March 2019. Data were abstracted by critical care and/or infectious diseases trained clinicians using standardized data collection forms and definitions of antibiotic appropriateness. Results 408 of 732 PICU patients (56%) received 618 antibiotics on the two study days. Empiric therapy for suspected bacterial infections without sepsis was the most common indication for antibiotics (22%), followed by treatment of community-acquired pneumonia and empiric therapy for septic shock (12% each, Figure 1). Overall, 194 antibiotic orders (32%) were classified as inappropriate and 158 patients (39%) received at least one inappropriate antibiotic. Vancomycin, cefepime, and ceftriaxone were the antibiotics most often inappropriately prescribed (Figure 2). Antibiotics prescribed inappropriately for the top 5 indications shown in Figure 1 accounted for 77% of all inappropriate antibiotic use. Prolonged ( >4 days) empiric therapy and prolonged ( >24 hours) post-operative prophylaxis were the most common reasons antibiotics prescribed for these indications were classified as inappropriate. Pneumonia and ventilator-associated infections were the most common infections for which antibiotics were prescribed inappropriately (46%). Reasons for inappropriate antibiotic use included lack of evidence supporting a bacterial infection (no radiographic infiltrate or significant increase in respiratory support) and use of unnecessarily broad antibiotics (Table 1). Conclusion Inappropriate antibiotic use is common in the PICU, particularly for pneumonia. Studies focused on defining optimal treatment strategies, as well as improved diagnostic approaches to curtail prolonged courses of empiric therapy, should be prioritized. Disclosures All authors: No reported disclosures.

scholarly journals Ventilator-Associated Pneumonia in Neonatal and Pediatric Intensive Care Unit Patients

2007 ◽  
Vol 20 (3) ◽  
pp. 409-425 ◽  
Author(s):  
Elizabeth Foglia ◽  
Mary Dawn Meier ◽  
Alexis Elward
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Antibiotic Use ◽  
Educational Interventions ◽  
Empiric Therapy ◽  
Attributable Mortality ◽  
Ventilator Associated Pneumonia ◽  
Case Control Studies

SUMMARY Ventilator-associated pneumonia (VAP) is the second most common hospital-acquired infection among pediatric intensive care unit (ICU) patients. Empiric therapy for VAP accounts for approximately 50% of antibiotic use in pediatric ICUs. VAP is associated with an excess of 3 days of mechanical ventilation among pediatric cardiothoracic surgery patients. The attributable mortality and excess length of ICU stay for patients with VAP have not been defined in matched case control studies. VAP is associated with an estimated $30,000 in attributable cost. Surveillance for VAP is complex and usually performed using clinical definitions established by the CDC. Invasive testing via bronchoalveolar lavage increases the sensitivity and specificity of the diagnosis. The pathogenesis in children is poorly understood, but several prospective cohort studies suggest that aspiration and immunodeficiency are risk factors. Educational interventions and efforts to improve adherence to hand hygiene for children have been associated with decreased VAP rates. Studies of antibiotic cycling in pediatric patients have not consistently shown this measure to prevent colonization with multidrug-resistant gram-negative rods. More consistent and precise approaches to the diagnosis of pediatric VAP are needed to better define the attributable morbidity and mortality, pathophysiology, and appropriate interventions to prevent this disease.

Antimicrobial justification form for restricting antibiotic use in a pediatric intensive care unit

2016 ◽  
Vol 53 (4) ◽  
pp. 304-306 ◽  
Author(s):  
Harkirat Singh Bhullar ◽  
Farhan A. R. Shaikh ◽  
R. Deepak ◽  
Preetham Kumar Poddutoor ◽  
Dinesh Chirla
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Antibiotic Use

Etiology of Fever and Opportunities for Reduction of Antibiotic Use in a Pediatric Intensive Care Unit

2001 ◽  
Vol 22 (08) ◽  
pp. 499-504 ◽  
Author(s):  
Philip Toltzis ◽  
Bonnie Rosolowski ◽  
Ann Salvator
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Tertiary Care ◽  
Case Series ◽  
Pediatric Intensive Care ◽  
Antibiotic Use ◽  
Critically Ill Children ◽  
Axillary Temperature ◽  
Prospective Case Series

Abstract Objective: To determine the cause of fever in critically ill children and to identify opportunities for reducing antibiotic use in this population. Design: Prospective case series. Setting: A tertiary-care medical-surgical pediatric intensive care unit (PICU). Patients: Children admitted to the PICU who experienced fever (axillary temperature &gt;38.3°C). Measurements: Consecutive children who were febrile at any point in their PICU stay were investigated over two winter seasons. Etiology of the fever was determined by physical examination and routine microbiology and radiographic tests. Three subgroups were reviewed to approximate the number of antibiotic-days that could have been reduced; namely, those with an indeterminate source, those with a documented viral infection, and those receiving a prolonged course of antibiotics. A set of standards reflecting common antibiotic use then was applied to these three patient groups. Results: Of 211 subjects, the majority (83.3%) had either a definitive or suspected focus for their fever, and nearly all of these patients were judged to have an infectious etiology. The study population received a total of 2,036 antibiotic-days. Despite the high incidence of infectious causes of fever in our subjects, however, approximately 15% of total antibiotic-days could have been reduced by applying common-use standards. Conclusions: Fever in the PICU was usually of defined focus and infectious in origin. However, among febrile patients in the PICU, substantial opportunity exists for reduction of antibiotic use. Trials determining the safety of antibiotic reduction in this population should be pursued vigorously.

scholarly journals Impact of a Drug Shortage on Medication Errors and Clinical Outcomes in the Pediatric Intensive Care Unit

2015 ◽  
Vol 20 (6) ◽  
pp. 453-461 ◽  
Author(s):  
Kaitlin M. Hughes ◽  
Elizabeth S. Goswami ◽  
Jennifer L. Morris
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Adverse Events ◽  
Pediatric Intensive Care Unit ◽  
Clinical Pharmacist ◽  
Pediatric Intensive Care ◽  
Retrospective Chart Review ◽  
Prescribing Errors ◽  
Drug Shortage

OBJECTIVES: The purpose of this study was to assess the rate of prescribing errors, resulting adverse events, and patient outcomes associated with sedation and analgesia in the pediatric intensive care unit (PICU) before and during a national shortage of fentanyl and injectable benzodiazepines. METHODS: A retrospective chart review was performed of patients admitted to the PICU with at least 1 prescribed order for a sedative or analgesic agent during the time periods of January to February of 2011 and 2012. Initial orders for sedative and analgesic agents were identified and investigated for appropriateness of dose and were assessed for error-associated adverse events. Orders were stratified by timing in regard to clinical pharmacist on-site availability. Demographic and outcome information, including unintended extubations, ventilator days, and PICU length of stay, were gathered. RESULTS: One hundred sixty-nine orders representing 72 patients and 179 orders representing 75 patients in 2011 and 2012, respectively, were included in analysis. No differences were found in the rate of prescribing errors in 2011 and 2012 (33 errors in 169 orders vs. 39 errors in 179 orders, respectively, p=0.603). No differences were found in rates of prescribing errors in regard to clinical pharmacist on-site availability. A significant increase was seen in unintended extubations per 100 ventilator days, with 0.15 in 2011 vs. 1.13 in 2012, respectively (p&lt;0.001). A significant decrease was seen in ventilator days per patient (p&lt;0.001) and PICU length of stay per patient (p=0.019). CONCLUSIONS: There were no differences in rates of prescribing errors before versus during the fentanyl and benzodiazepine shortage.

Thrombocytopenia and Bloodstream Infection: Incidence and Implication on Length of Stay in the Pediatric Intensive Care Unit

2021 ◽  
Author(s):  
Reut Kassif Lerner ◽  
Dana Levinkopf ◽  
Inna Zaslavsky Paltiel ◽  
Tal Sadeh ◽  
Marina Rubinstein ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Bloodstream Infection ◽  
Critically Ill ◽  
Pediatric Intensive Care Unit ◽  
Odds Ratio ◽  
Pediatric Patients ◽  
Pediatric Intensive Care ◽  
University Hospital

AbstractThe incidence and prognosis of thrombocytopenia in critically ill patients with bloodstream infection (BSI) is not well delineated in the pediatric intensive care unit (PICU) setting. We assessed these variables in our PICU and sought to determine whether thrombocytopenia could serve as a prognostic marker for length of stay (LOS). The study was conducted at the medical PICU of a university hospital, on all critically ill pediatric patients consecutively admitted during a 3-year period. Patient surveillance and data collection have been used to identify the risk factors during the study period. The main outcomes were BSI incidence and implication on morbidity and LOS. Data from 2,349 PICU patients was analyzed. The overall incidence of BSI was 3.9% (93/2,349). Overall, 85 of 93 patients (91.4%) with BSI survived and 8 patients died (8.6% mortality rate). The overall incidence of thrombocytopenia among these 93 patients was 54.8% (51/93) and 100% (8/8) for the nonsurvivors. Out of the 85 survivors, 27 thrombocytopenic patients were hospitalized for >14 days versus 14 of nonthrombocytopenic patients (p = 0.007). Thrombocytopenia was associated with borderline significance with an increased LOS (adjusted odds ratio = 3.00, 95% confidence interval: 0.93–9.71, p = 0.066). Thrombocytopenia is common in critically ill pediatric patients with BSI and constitutes a simple and readily available risk marker for PICU LOS.

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