Abstract
Background
Bloodstream infections (BSIs) are associated with significant mortality and morbidity, including multiple organ dysfunction. We explored if delayed adequate antimicrobial treatment for children with BSIs is associated with change in organ dysfunction as measured by PELOD-2 scores.
Methods
We conducted a multicenter, retrospective cohort study of critically ill children <18 years old with BSIs. The primary outcome was change in PELOD-2 score between days 1 (index blood culture) and 5. The exposure variable was delayed administration of adequate antimicrobial therapy by ≥3 h from blood culture collection. We compared PELOD-2 score changes between those who received early and delayed treatment.
Results
Among 202 children, the median (interquartile range) time to adequate antimicrobial therapy was 7 (0.8–20.1) hours; 124 (61%) received delayed antimicrobial therapy. Patients who received early and delayed treatment had similar baseline characteristics. There was no significant difference in PELOD-2 score changes from days 1 and 5 between groups (PELOD-2 score difference −0.07, 95% CI −0.92 to 0.79, p = 0.88).
Conclusions
We did not find an association between delayed adequate antimicrobial therapy and PELOD-2 score changes between days 1 and 5 from detection of BSI. PELOD-2 score was not sensitive for clinical effects of delayed antimicrobial treatment.
Impact
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In critically ill children with bloodstream infections, there was no significant change in organ dysfunction as measured by PELOD-2 scores between patients who received adequate antimicrobial therapy within 3 h of their initial positive blood culture and those who started after 3 h.
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Higher PELOD-2 scores on day 1 were associated with larger differences in PELOD-2 scores between days 1 and 5 from index positive blood cultures.
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Further study is required to determine if PELOD-2 or alternative measures of organ dysfunction could be used as primary outcome measures in trials of antimicrobial interventions in pediatric critical care research.
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Data availability
The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
We acknowledge Lisa Buckingham at CLARITY/McMaster University for help with building the electronic case report form, Ruxandra Pinto for additional input on data analyses; Cheyenne Matinnia, Arash Khosroawshahi, Matthew Van Huyse (The Hospital for Sick Children), Amy Bartholomew, William Blair (McMaster Children’s Hospital), Afsanah Afshar (BC Children’s Hospital), Dejana Nikitovic, Donovan Duncan, Farhan Zahid (Alberta Children’s Hospital), Amina Hasanova, Mary-Ellen French (CHU Ste. Justine), and Shauna O’Donnell (Montreal Children’s Hospital) for assistance with data collection.
Funding
This work was supported (in part) by the Canadian Society of Hospital Pharmacists Research and Education Foundation. S.P. is supported by a SickKids Clinician-Scientist Training Program Scholarship from The Hospital for Sick Children. The funder/sponsor did not play any role in the study design, conduct, data collection, management, interpretation, manuscript review, or preparation of this work.
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S.P. conceptualized and designed the study, designed the data collection instrument, collected data, carried out the analyses, drafted the initial manuscript and reviewed and revised the manuscript. N.D. and R.A.F. conceptualized and designed the study, designed the data collection instrument, supervised data collection, and critically reviewed the manuscript for important intellectual content. P.F., E.G., J.S.H., P.J., N.M., S.M., J.M.P., A.H.R., M.S., and W.S. designed the data collection instrument and reviewed and revised the manuscript. All authors read and approved the final manuscript.
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All research was performed in accordance with the Declaration of Helsinki and institutional research ethics board approval with waiver for informed consent was obtained at all sites: The Hospital for Sick Children, McMaster Children’s Hospital, BC Children’s Hospital, Alberta Children’s Hospital, CHU Ste Justine and Montreal Children’s Hospital.
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Pong, S., Fowler, R.A., Fontela, P. et al. Association of delayed adequate antimicrobial treatment and organ dysfunction in pediatric bloodstream infections. Pediatr Res 95, 705–711 (2024). https://doi.org/10.1038/s41390-023-02836-3
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DOI: https://doi.org/10.1038/s41390-023-02836-3
