Antibiotic treatment duration for bloodstream infections in critically ill children-A survey of pediatric infectious diseases and critical care clinicians for clinical equipoise

Sandra Pong; Robert A Fowler; Srinivas Murthy; Jeffrey M Pernica; Elaine Gilfoyle; Patricia Fontela; Nicholas Mitsakakis; Asha C Bowen; Winnie Seto; Michelle Science; James S Hutchison; Philippe Jouvet; Asgar Rishu; Nick Daneman

doi:10.1371/journal.pone.0272021

Antibiotic treatment duration for bloodstream infections in critically ill children-A survey of pediatric infectious diseases and critical care clinicians for clinical equipoise

PLoS One. 2022 Jul 26;17(7):e0272021. doi: 10.1371/journal.pone.0272021. eCollection 2022.

Authors

Sandra Pong¹, Robert A Fowler^{2

3

4}, Srinivas Murthy^{5

6}, Jeffrey M Pernica⁷, Elaine Gilfoyle⁸, Patricia Fontela^{9

10}, Nicholas Mitsakakis^{11

12}, Asha C Bowen^{13

14}, Winnie Seto^{1

4

15}, Michelle Science¹⁶, James S Hutchison⁸, Philippe Jouvet^{17

18}, Asgar Rishu¹⁹, Nick Daneman²⁰

Affiliations

¹ Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada.
² Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto Ontario, Canada.
³ Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Pediatrics, Division of Critical Care, University of British Columbia, Vancouver, British Columbia, Canada.
⁶ Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada.
⁷ Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada.
⁸ Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁹ Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada.
¹⁰ Department of Pediatrics, McGill University, Montreal, Québec, Canada.
¹¹ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
¹² Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
¹³ Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia Perth Children's Hospital, Nedlands, Western Australia, Australia.
¹⁴ Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.
¹⁵ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
¹⁶ Division of Infectious Diseases, Department of Paediatric Medicine, The Hospital for Children, Toronto, Ontario, Canada.
¹⁷ Pediatric Intensive Care Unit, Sainte-Justine Hospital University Center, Montreal, Québec, Canada.
¹⁸ Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada.
¹⁹ Critical Care Research Unit, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
²⁰ Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Abstract

Objective: To describe antibiotic treatment durations that pediatric infectious diseases (ID) and critical care clinicians usually recommend for bloodstream infections in critically ill children.

Design: Anonymous, online practice survey using five common pediatric-based case scenarios of bloodstream infections.

Setting: Pediatric intensive care units in Canada, Australia and New Zealand.

Participants: Pediatric intensivists, nurse practitioners, ID physicians and pharmacists.

Main outcome measures: Recommended treatment durations for common infectious syndromes associated with bloodstream infections and willingness to enrol patients into a trial to study treatment duration.

Results: Among 136 survey respondents, most recommended at least 10 days antibiotics for bloodstream infections associated with: pneumonia (65%), skin/soft tissue (74%), urinary tract (64%) and intra-abdominal infections (drained: 90%; undrained: 99%). For central vascular catheter-associated infections without catheter removal, over 90% clinicians recommended at least 10 days antibiotics, except for infections caused by coagulase negative staphylococci (79%). Recommendations for at least 10 days antibiotics were less common with catheter removal. In multivariable linear regression analyses, lack of source control was significantly associated with longer treatment durations (+5.2 days [95% CI: 4.4-6.1 days] for intra-abdominal infections and +4.1 days [95% CI: 3.8-4.4 days] for central vascular catheter-associated infections). Most clinicians (73-95%, depending on the source of bloodstream infection) would be willing to enrol patients into a trial of shorter versus longer antibiotic treatment duration.

Conclusions: The majority of clinicians currently recommend at least 10 days of antibiotics for most scenarios of bloodstream infections in critically ill children. There is practice heterogeneity in self-reported treatment duration recommendations among clinicians. Treatment durations were similar across different infectious syndromes. Under appropriate clinical conditions, most clinicians would be willing to enrol patients into a trial of shorter versus longer treatment for common syndromes associated with bloodstream infections.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents / therapeutic use
Bacteremia* / drug therapy
Catheter-Related Infections* / drug therapy
Child
Communicable Diseases* / drug therapy
Critical Care
Critical Illness
Duration of Therapy
Humans
Intraabdominal Infections* / drug therapy
Sepsis* / drug therapy
Surveys and Questionnaires
Syndrome

Substances

Anti-Bacterial Agents

Grants and funding

The authors received no specific funding for this work. Sandra Pong is supported by a SickKids Clinician-Scientist Training Program Scholarship from The Hospital for Sick Children.