First name
Luke
Last name
Keele

Title

Effect of the Procalcitonin Assay on Antibiotic Use in Critically Ill Children.

Year of Publication

2018

Number of Pages

e430e46

Date Published

2018 May 15

ISSN Number

2048-7207

Abstract

<p>We retrospectively studied the effect of introducing procalcitonin into clinical practice on antibiotic use within a large academic pediatric intensive care unit. In the absence of a standardized algorithm, availability of the procalcitonin assay did not reduce the frequency of antibiotic initiations or the continuation of antibiotics for greater than 72 hours.</p>

DOI

10.1093/jpids/piy004

Alternate Title

J Pediatric Infect Dis Soc

PMID

29529219

Title

Association of Delayed Antimicrobial Therapy with One-Year Mortality in Pediatric Sepsis.

Year of Publication

2017

Date Published

2017 Jan 20

ISSN Number

1540-0514

Abstract

<p><strong>OBJECTIVE: </strong>Delayed antimicrobial therapy in sepsis is associated with increased hospital mortality, but the impact of antimicrobial timing on long-term outcomes is unknown. We tested the hypothesis that hourly delays to antimicrobial therapy are associated with 1-year mortality in pediatric severe sepsis.</p>

<p><strong>DESIGN: </strong>Retrospective observational study.</p>

<p><strong>SETTING: </strong>Quaternary academic pediatric intensive care unit (PICU) from February 1, 2012 to June 30, 2013.</p>

<p><strong>PATIENTS: </strong>One hundred sixty patients aged ≤21 years treated for severe sepsis.</p>

<p><strong>INTERVENTIONS: </strong>None.</p>

<p><strong>MEASUREMENTS AND MAIN RESULTS: </strong>We tested the association of hourly delays from sepsis recognition to antimicrobial administration with 1-year mortality using multivariable Cox and logistic regression. Overall 1-year mortality was 24% (39 patients), of whom 46% died after index PICU discharge. Median time from sepsis recognition to antimicrobial therapy was 137 min (IQR 65-287). After adjusting for severity of illness and comorbid conditions, hourly delays up to 3 h were not associated with 1-year mortality. However, increased 1-year mortality was evident in patients who received antimicrobials ≤1 h (aOR 3.8, 95% CI 1.2, 11.7) or &gt;3 h (aOR 3.5, 95% CI 1.3, 9.8) compared with patients who received antimicrobials within 1 to 3 h from sepsis recognition. For the subset of patients who survived index PICU admission, antimicrobial therapy ≤1 h was also associated with increased 1-year mortality (aOR 5.5, 95% CI 1.1, 27.4), while antimicrobial therapy &gt;3 h was not associated with 1-year mortality (aOR 2.2, 95% CI 0.5, 11.0).</p>

<p><strong>CONCLUSIONS: </strong>Hourly delays to antimicrobial therapy, up to 3 h, were not associated with 1-year mortality in pediatric severe sepsis in this study. The finding that antimicrobial therapy ≤1 h from sepsis recognition was associated with increased 1-year mortality should be regarded as hypothesis-generating for future studies.</p>

DOI

10.1097/SHK.0000000000000833

Alternate Title

Shock

PMID

28114166

Title

Crystalloid Fluid Choice and Clinical Outcomes in Pediatric Sepsis: A Matched Retrospective Cohort Study.

Year of Publication

2017

Date Published

2017 Jan 04

ISSN Number

1097-6833

Abstract

<p><strong>OBJECTIVE: </strong>To test the hypothesis that resuscitation with balanced fluids (lactated Ringer [LR]) is associated with improved outcomes compared with normal saline (NS) in pediatric sepsis.</p>

<p><strong>STUDY DESIGN: </strong>We performed matched analyses using data from 12 529 patients &lt;18 years of age with severe sepsis/septic shock at 382 US hospitals between 2000 and 2013 to compare outcomes with vs without LR as part of initial resuscitation. Patients receiving LR were matched 1:1 to patients receiving only NS (NS group), including separate matches for any (LR-any group) or exclusive (LR-only group) LR use. Outcomes included 30-day hospital mortality, acute kidney injury, new dialysis, and length of stay.</p>

<p><strong>RESULTS: </strong>The LR-any group was older, received larger crystalloid volumes, and was less likely to have malignancies than the NS group. After matching, mortality was not different between LR-any (7.2%) and NS (7.9%) groups (risk ratio 0.99, 95% CI 0.98, 1.01; P = .20). There were no differences in secondary outcomes except longer hospital length of stay in LR-any group (absolute difference 2.4, 95% CI 1.4, 5.0 days; P &lt; .001). Although LR was preferentially used as adjunctive fluid with large-volume resuscitation or first-line fluid in patients with lower illness severity, outcomes were not different after matching stratified by volume and proportionate LR utilization, including for patients in the LR-only group.</p>

<p><strong>CONCLUSIONS: </strong>Balanced fluid resuscitation with LR was not associated with improved outcomes compared with NS in pediatric sepsis. Although the current practice of NS resuscitation is justified, selective LR use necessitates a prospective trial to definitively determine comparative effectiveness among crystalloids.</p>

DOI

10.1016/j.jpeds.2016.11.075

Alternate Title

J. Pediatr.

PMID

28063688

WATCH THIS PAGE

Subscription is not available for this page.