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

Aislinn Cook, Yingfen Hsia, Neal Russell, Mike Sharland, Kaman Cheung, Keith Grimwood, Jack Cross, Denise Cotrim Da Cunha, Gloria Regina Magalhães, Hanna Renk, Avni Hindocha, Paddy McMaster, Uduak Okomo, Saffiatou Darboe, Gerardo Alvarez-Uria, Dasaratha R. Jinka, Srinivas Murki, Hemasree Kandraju, Dhanya Dharmapalan, Susanna EspositoSonia Bianchini, Kahoru Fukuoka, Yuta Aizawa, Rodolfo Norberto Jimenez-Juarez, Karla Ojeda-Diezbarroso, Mateja Pirš, Mojca Rožič, Suvaporn Anugulruengkitt, Watsamon Jantarabenjakul, Ching Lan Cheng, Bai Xiu Jian, Evangelos Spyridakis, Theoklis Zaoutis, Julia Bielicki

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

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.

Original languageEnglish
Pages (from-to)137-143
Number of pages7
JournalPediatric Infectious Disease Journal
DOIs
Publication statusAccepted/In press - 2021

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

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