Factors associated with increased risk of inappropriate empiric antibiotic treatment of childhood bacteraemia

Shai Ashkenazi, Zmira Samra, Hana Konisberger, Moshe M. Drucker, Leonard Leibovici

Research output: Contribution to journalArticlepeer-review

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 parentheses): 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). Conclusion: We defined bacteraemic children who are at risk of inappropriate empiric antibiotic therapy. Special efforts are needed to improve their treatment and consequently their outcome.

Original languageEnglish
Pages (from-to)545-550
Number of pages6
JournalEuropean Journal of Pediatrics
Volume155
Issue number7
DOIs
StatePublished - 1996

Keywords

  • Antibiotics
  • Bacteraemia
  • Children
  • Quality control
  • Treatment

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