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.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/mortality , Global Health , Sepsis/drug therapy , Sepsis/mortality , Adolescent , Anti-Bacterial Agents/administration & dosage , Bacteremia/microbiology , Bacterial Infections/drug therapy , Bacterial Infections/mortality , Child , Child, Preschool , Cohort Studies , Cross Infection/drug therapy , Cross Infection/microbiology , Female , Humans , Infant , Infant, Newborn , Male , Retrospective StudiesABSTRACT
Este estudo tem como objetivo a parceria entre as enfermeiras do cuidado e a enfermeira da Comissão de Controle das Infecções Hospitalares (CCIH) como um caminho rumo à redução dessas infecções. A investigação, de natureza qualitativa, fundam entou-se na Teoria das Representações Sociais, de Serge Moscovici e Denise Jodelet e teve como objetivo principal compreender o que acontece na prática hospitalar para que as ações de controle de infecções não tenham a eficácia esperada, partindo-se do pressuposto da existência de fatos que impedem o bom entrosamento entre as enfermeiras do cuidado e a enfermeira da CCIH. Para coletar os dados foram realizadas vinte entrevistas semi-estruturadas com enfermeiras que atuavam em Unidades de Terapia intensiva (adulto, pediatria e neonatal). ...
