Compliance with antibiotic therapy guidelines in French paediatric intensive care units: a multicentre observational study Article Swipe
Romain Amadieu
,
Camille Bréhin
,
Adéla Chahine
,
Erick Grouteau
,
Damien Dubois
,
Caroline Munzer
,
Olivier Brissaud
,
Barbara Ros
,
Gaël Jean
,
Camille Brotelande
,
Brendan Travert
,
Nadia Savy
,
Benoît Bœuf
,
Ghida Ghostine
,
Isabelle Popov
,
Pauline Duport
,
Richard Wolff
,
Laure Maurice
,
Stéphane Dauger
,
Sophie Breinig
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.21203/rs.3.rs-3143698/v1
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.21203/rs.3.rs-3143698/v1
Background Bacterial infections (BIs) are widespread in ICUs. The aims of this study were to assess the compliance with antibiotic recommendations, and factors associated with non-compliance. Methods We conducted an observational study in eight French Paediatric and Neonatal ICUs with an antimicrobial stewardship programme, mostly once a week. All children receiving antibiotics for a suspected or proven BI were evaluated. Newborns < 72 hours old, neonates < 37 weeks, age ≥ 18 years, and children under antimicrobial prophylaxis were excluded. Results 139 suspected (or proven) BI episodes in 134 children were prospectively included during six separate time-periods over one year. The final diagnosis was 26.6% no BI, 40.3% presumed (i.e., not documented) BI, and 35.3% documented BI. Non-compliance for all parameters combined occurred in 51.1%. The main reasons for non-compliance were inappropriate choice of antimicrobials (27.3%), duration of one or more antimicrobials (26.3%), and duration of antibiotic therapy (18.0%). In multivariate analyses, main independent risk factors for non-compliance were prescribing ≥ 2 antibiotics (OR 4.06, 95%CI 1.69–9.74, p = 0.0017), a duration of broad-spectrum antibiotic therapy ≥ 4 days (OR 2.59, 95%CI 1.16–5.78, p = 0.0199), neurologic compromise at ICU admission (OR 3.41, 95%CI 1.04–11.20, p = 0.0431), suspected catheter-related bacteraemia (ORs 3.70 and 5.42, 95%CIs 1.32 to 15.07, p < 0.02), a BI site classified as “other” (ORs 3.29 and 15.88, 95%CIs 1.16 to 104.76, p < 0.03), sepsis with ≥ 2 organ dysfunctions (OR 4.21, 95%CI 1.42–12.55, p = 0.0098), late-onset ventilator-associated pneumonia (OR 6.30, 95%CI 1.15–34.44, p = 0.0338), and ≥ 1 risk factor for ESBL Enterobacteriaceae (OR 2.56, 95%CI 1.07–6.14, p = 0.0353). Main independent factors for compliance were having antibiotic therapy protocols (OR 0.42, 95%CI 0.19–0.92, p = 0.0313), respiratory failure at ICU admission (OR 0.36, 95%CI 0.14–0.90, p = 0.0281), and aspiration pneumonia (OR 0.37, 95%CI 0.14–0.99, p = 0.0486). Conclusions Half of antibiotic prescriptions remain non-compliant with guidelines. Intensivists should reassess on a daily basis the benefit of using several antimicrobials or any broad-spectrum antimicrobials and stop antibiotics that are no longer indicated. Developing consensus about treating specific illnesses and using department protocols seem necessary to reduce non-compliance. A daily ASP could also improve compliance in these situations. Trial registration : ClinicalTrials.gov: number NCT04642560. The date of first trial registration was 24/11/2020.
Related Topics
Concepts
Medicine
Observational study
Antibiotics
Antimicrobial stewardship
Pediatrics
Intensive care
Antimicrobial
Antibiotic Stewardship
Emergency medicine
Intensive care medicine
Internal medicine
Antibiotic resistance
Biology
Organic chemistry
Chemistry
Microbiology
Metadata
- Type
- preprint
- Language
- en
- Landing Page
- https://doi.org/10.21203/rs.3.rs-3143698/v1
- https://www.researchsquare.com/article/rs-3143698/latest.pdf
- OA Status
- green
- References
- 43
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4385550099
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4385550099Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.21203/rs.3.rs-3143698/v1Digital Object Identifier
- Title
-
Compliance with antibiotic therapy guidelines in French paediatric intensive care units: a multicentre observational studyWork title
- Type
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preprintOpenAlex work type
- Language
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enPrimary language
- Publication year
-
2023Year of publication
- Publication date
-
2023-08-03Full publication date if available
- Authors
-
Romain Amadieu, Camille Bréhin, Adéla Chahine, Erick Grouteau, Damien Dubois, Caroline Munzer, Olivier Brissaud, Barbara Ros, Gaël Jean, Camille Brotelande, Brendan Travert, Nadia Savy, Benoît Bœuf, Ghida Ghostine, Isabelle Popov, Pauline Duport, Richard Wolff, Laure Maurice, Stéphane Dauger, Sophie BreinigList of authors in order
- Landing page
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https://doi.org/10.21203/rs.3.rs-3143698/v1Publisher landing page
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https://www.researchsquare.com/article/rs-3143698/latest.pdfDirect link to full text PDF
- Open access
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YesWhether a free full text is available
- OA status
-
greenOpen access status per OpenAlex
- OA URL
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https://www.researchsquare.com/article/rs-3143698/latest.pdfDirect OA link when available
- Concepts
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Medicine, Observational study, Antibiotics, Antimicrobial stewardship, Pediatrics, Intensive care, Antimicrobial, Antibiotic Stewardship, Emergency medicine, Intensive care medicine, Internal medicine, Antibiotic resistance, Biology, Organic chemistry, Chemistry, MicrobiologyTop concepts (fields/topics) attached by OpenAlex
- Cited by
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0Total citation count in OpenAlex
- References (count)
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43Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.main | 127, 153 |
| abstract_inverted_index.more | 141 |
| abstract_inverted_index.old, | 65 |
| abstract_inverted_index.once | 46 |
| abstract_inverted_index.over | 98 |
| abstract_inverted_index.risk | 155, 256 |
| abstract_inverted_index.seem | 351 |
| abstract_inverted_index.site | 215 |
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| abstract_inverted_index.with | 19, 25, 40, 231, 314 |
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| abstract_inverted_index.0.37, | 301 |
| abstract_inverted_index.0.42, | 279 |
| abstract_inverted_index.2.56, | 262 |
| abstract_inverted_index.2.59, | 181 |
| abstract_inverted_index.26.6% | 105 |
| abstract_inverted_index.3.41, | 193 |
| abstract_inverted_index.35.3% | 115 |
| abstract_inverted_index.4.06, | 165 |
| abstract_inverted_index.4.21, | 237 |
| abstract_inverted_index.40.3% | 108 |
| abstract_inverted_index.5.42, | 205 |
| abstract_inverted_index.6.30, | 247 |
| abstract_inverted_index.95%CI | 166, 182, 194, 238, 248, 263, 280, 292, 302 |
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| abstract_inverted_index.Trial | 366 |
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| abstract_inverted_index.basis | 322 |
| abstract_inverted_index.could | 359 |
| abstract_inverted_index.daily | 321, 357 |
| abstract_inverted_index.eight | 34 |
| abstract_inverted_index.final | 102 |
| abstract_inverted_index.first | 375 |
| abstract_inverted_index.hours | 64 |
| abstract_inverted_index.organ | 234 |
| abstract_inverted_index.study | 13, 32 |
| abstract_inverted_index.these | 364 |
| abstract_inverted_index.trial | 376 |
| abstract_inverted_index.under | 76 |
| abstract_inverted_index.using | 326, 348 |
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| abstract_inverted_index.year. | 100 |
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| abstract_inverted_index.0.02), | 212 |
| abstract_inverted_index.0.03), | 229 |
| abstract_inverted_index.15.07, | 209 |
| abstract_inverted_index.15.88, | 222 |
| abstract_inverted_index.51.1%. | 125 |
| abstract_inverted_index.95%CIs | 206, 223 |
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| abstract_inverted_index.assess | 16 |
| abstract_inverted_index.choice | 133 |
| abstract_inverted_index.during | 94 |
| abstract_inverted_index.factor | 257 |
| abstract_inverted_index.having | 274 |
| abstract_inverted_index.longer | 339 |
| abstract_inverted_index.mostly | 45 |
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| abstract_inverted_index.proven | 57 |
| abstract_inverted_index.reduce | 354 |
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| abstract_inverted_index.years, | 73 |
| abstract_inverted_index.104.76, | 226 |
| abstract_inverted_index.Methods | 27 |
| abstract_inverted_index.Results | 81 |
| abstract_inverted_index.benefit | 324 |
| abstract_inverted_index.factors | 23, 156, 270 |
| abstract_inverted_index.failure | 286 |
| abstract_inverted_index.improve | 361 |
| abstract_inverted_index.proven) | 85 |
| abstract_inverted_index.reasons | 128 |
| abstract_inverted_index.several | 327 |
| abstract_inverted_index.therapy | 148, 176, 276 |
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| abstract_inverted_index.(26.3%), | 143 |
| abstract_inverted_index.(27.3%), | 136 |
| abstract_inverted_index.0.0017), | 170 |
| abstract_inverted_index.0.0098), | 242 |
| abstract_inverted_index.0.0199), | 186 |
| abstract_inverted_index.0.0281), | 296 |
| abstract_inverted_index.0.0313), | 284 |
| abstract_inverted_index.0.0338), | 252 |
| abstract_inverted_index.0.0353). | 267 |
| abstract_inverted_index.0.0431), | 198 |
| abstract_inverted_index.0.0486). | 306 |
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| abstract_inverted_index.Newborns | 61 |
| abstract_inverted_index.children | 50, 75, 90 |
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| abstract_inverted_index.duration | 137, 145, 172 |
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| abstract_inverted_index.included | 93 |
| abstract_inverted_index.neonates | 66 |
| abstract_inverted_index.occurred | 123 |
| abstract_inverted_index.presumed | 109 |
| abstract_inverted_index.reassess | 318 |
| abstract_inverted_index.separate | 96 |
| abstract_inverted_index.specific | 345 |
| abstract_inverted_index.treating | 344 |
| abstract_inverted_index.Bacterial | 2 |
| abstract_inverted_index.admission | 191, 289 |
| abstract_inverted_index.analyses, | 152 |
| abstract_inverted_index.conducted | 29 |
| abstract_inverted_index.consensus | 342 |
| abstract_inverted_index.diagnosis | 103 |
| abstract_inverted_index.excluded. | 80 |
| abstract_inverted_index.illnesses | 346 |
| abstract_inverted_index.necessary | 352 |
| abstract_inverted_index.pneumonia | 245, 299 |
| abstract_inverted_index.protocols | 277, 350 |
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| abstract_inverted_index.suspected | 55, 83, 199 |
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| abstract_inverted_index.Paediatric | 36 |
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| abstract_inverted_index.aspiration | 298 |
| abstract_inverted_index.associated | 24 |
| abstract_inverted_index.classified | 216 |
| abstract_inverted_index.compliance | 18, 272, 362 |
| abstract_inverted_index.compromise | 188 |
| abstract_inverted_index.department | 349 |
| abstract_inverted_index.documented | 116 |
| abstract_inverted_index.evaluated. | 60 |
| abstract_inverted_index.indicated. | 340 |
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| abstract_inverted_index.neurologic | 187 |
| abstract_inverted_index.parameters | 121 |
| abstract_inverted_index.programme, | 44 |
| abstract_inverted_index.widespread | 6 |
| abstract_inverted_index.24/11/2020. | 379 |
| abstract_inverted_index.Conclusions | 307 |
| abstract_inverted_index.antibiotics | 52, 163, 335 |
| abstract_inverted_index.bacteraemia | 201 |
| abstract_inverted_index.documented) | 112 |
| abstract_inverted_index.guidelines. | 315 |
| abstract_inverted_index.independent | 154, 269 |
| abstract_inverted_index.prescribing | 160 |
| abstract_inverted_index.prophylaxis | 78 |
| abstract_inverted_index.respiratory | 285 |
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| abstract_inverted_index.stewardship | 43 |
| abstract_inverted_index.“other” | 218 |
| abstract_inverted_index.0.14–0.90, | 293 |
| abstract_inverted_index.0.14–0.99, | 303 |
| abstract_inverted_index.0.19–0.92, | 281 |
| abstract_inverted_index.1.07–6.14, | 264 |
| abstract_inverted_index.1.16–5.78, | 183 |
| abstract_inverted_index.1.69–9.74, | 167 |
| abstract_inverted_index.Intensivists | 316 |
| abstract_inverted_index.NCT04642560. | 371 |
| abstract_inverted_index.dysfunctions | 235 |
| abstract_inverted_index.multivariate | 151 |
| abstract_inverted_index.registration | 367, 377 |
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| abstract_inverted_index.1.04–11.20, | 195 |
| abstract_inverted_index.1.15–34.44, | 249 |
| abstract_inverted_index.1.42–12.55, | 239 |
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| abstract_inverted_index.inappropriate | 132 |
| abstract_inverted_index.non-compliant | 313 |
| abstract_inverted_index.observational | 31 |
| abstract_inverted_index.prescriptions | 311 |
| abstract_inverted_index.prospectively | 92 |
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| abstract_inverted_index.Enterobacteriaceae | 260 |
| abstract_inverted_index.ClinicalTrials.gov: | 369 |
| abstract_inverted_index.ventilator-associated | 244 |
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| countries_distinct_count | 1 |
| institutions_distinct_count | 20 |
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