Abstract
To identify bacteraemic children who are at increased risk of inappropriate empiric antibiotic therapy, we performed univariate and multivariate analyses of prospectively-studied bacteraemic episodes. Appropriateness of therapy was defined according to the in vitro susceptibility of the isolate. Inappropriate empiric therapy was found in 38% of 516 bacteraemic episodes and was associated with higher mortality. The rate of inappropriate treatment was lower in neonates and infants (28% and 33%, respectively) but higher in children 1- to 5-years old (51%,P=0.0029). The rate was dependent on the source of bacteraemia (range, 18%–70%,P=0.0092), underlying conditions (range, 26%–53%,P=0.0001), the specific paediatric section in which the child was hospitalized (range, 24%–70%,P=0.0002), and the causative micro-organism (range, 15%–75%,P<0.0001). Four clinical variables that independently and significantly affected the rate of inappropriate antibiotic treatment were identified by multivariate stepwise logistic regression analysis (odds ratios in parenthese): hospital-acquired bacteraemia (2.3), age of 1- to 5-years (2.1), cytotoxic therapy (1.8) and presence of central IV line (1.6).
Similar content being viewed by others
References
Ashkenazi S, Leibovici L, Samra Z, Konisberger H, Drucker M (1992) Risk factors for mortality due to bacteremia and fungemia in childhood. Clin Infect Dis 14:949–951
Bauer RW, Kirby WMM, Sherms JC, Turck M (1966) Antibiotic susceptibility testing by standardized single disk method. Am J Clin Pathol 45:493–496
Carroll WL, Farell MK, Singer JI, et al. (1983) Treatment of occult bacteremia: a prospective randomized clinical trial. Pediatrics 72:608–612
Cotton MF, Burger PJ, Bodenstein WJM (1992) Bacteremia in children in South-Western Cape. A hospital-based survey. S Afr Med J 81:87–90
Ford-Jones EL, Midorff CM, Langley JM, et al. (1989) Epidemiologic study of 4684 hospital-acquired infections in pediatric patients. Pediatr Infect Dis J 8: 668–675
Freeman J, Epstein MF, Smith NE, Platt R, Sidebottom DG, Goldmann DA (1990) Extra hospital stay and antibiotic usage with nosocomial coagulase-negative staphylococcal bacteremia in two neonatal intensive care unit populations. Am J Dis Child 144: 324–329
Garner JS, Jarvis WR, Emori TG, et al (1988) CDC definition for nosocomial infections 1988. Am J Infect Control 16:128–140
Gladstone IM, Ehrenkranz RA, Edberg SC, Baltimore RS (1990) A ten-year review of neonatal sepsis and comparison with the previous fifty-year experience. Pediatr Infect Dis J 9:819–825
Gransden WR, Phillips I (1991) Predictive index for optimizing empiric treatment of gram-negative bacteremia. J Infect Dis 164:211–212
Gross PA, Barrett TL, Dellinger EP, et al (1994) Quality standard for the treatment of bacteremia. Clin Infect Dis 18: 428–430
Harrell FE (1986) The LOGIST procedure. In: SAS Institut SUGI supplemental library user's guide, version 5, Gary, North Carolina: SAS Institut, pp 269–293
Klein JO (1984) Bacteremia in ambulatory children. Pediatr Infect Dis 3: S5-S8
Langley J, Gold R (1988) Sepsis in febrile neutropenic children with cancer. Pediatr Infect Dis J 7:34–37
Leibovici L, Konisberger H, Pitlik SD, Samra Z, Drucker M (1991) Predictive index for optimizing empiric treatment of gram-negative bacteremia. J Infect Dis 163:193–196
Leibovici L, Konisberger H, Pitlik SD, Samra Z, Drucker M (1992) Patients at risk of inappropriate antibiotic treatment of bacteremia. J Intern Med 231: 371–374
Maki DG, Schuna AA (1978) A study of antimicrobial misuse in a university hospital. Am J Med Sci 275:271–282
National Committee for Clinical Laboratory Standards (1984) Approved standards MS-A3. National Committee for Clinical Laboratory Standards
Peltola H, Salomaa T, Sivonen A, Renkonen OV (1987) Septicemia in a university pediatric hospital: a five-year analysis of the bacterial and fungal isolates and outcome of the infection. Scand J Infect Dis 19:277–282
Powell KR (1990) Fever in young children. Pediatr Infect Dis J 9:153–157
SAS Institute (1986) SAS user's guide statistics, version 5. Gary, SAS Institut, pp 420–424
Winchester PD, Todd JK, Roe MH (1977) Bacteremia in hospitalized children. Am J Dis Child 131:753–758
Woods ER, Merola JL, Bithoney WG, Spivak H, Wise PH (1990) Bacteremia in an ambulatory setting: improved outcome in children treated with antibiotics. Am J Dis Child 144:1195–1199
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ashkenazi, S., Samra, Z., Konisberger, H. et al. Factors associated with increased risk of inappropriate empiric antibiotic treatment of childhood bacteraemia. Eur J Pediatr 155, 545–550 (1996). https://doi.org/10.1007/BF01957902
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01957902