Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 26;17(7):e0272021.
doi: 10.1371/journal.pone.0272021. eCollection 2022.

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  1 , Robert A Fowler  2   3   4 , Srinivas Murthy  5   6 , Jeffrey M Pernica  7 , Elaine Gilfoyle  8 , Patricia Fontela  9   10 , Nicholas Mitsakakis  11   12 , Asha C Bowen  13   14 , Winnie Seto  1   4   15 , Michelle Science  16 , James S Hutchison  8 , Philippe Jouvet  17   18 , Asgar Rishu  19 , Nick Daneman  20
Affiliations

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 et al. PLoS One. .

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.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Violin plot distribution of recommended treatment durations for bacteremia from different sources.
The shaded area represents the density of responses for treatment duration. Inside each violin, the thick line marks the median, the boxes indicate the interquartile range (IQR) and the lines mark 1.5xIQR for the treatment duration recommendation.
Fig 2
Fig 2. Violin plot distribution of recommended treatment durations for central vascular catheter-related bacteremia caused by different pathogens.
Fig 3
Fig 3. Outcomes in pediatric trials that could influence antibiotic treatment practices.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Gray J, Gossain S, Morris K. Three-year survey of bacteremia and fungemia in a pediatric intensive care unit. Pediatr Infect Dis J. 2001;20(4):416–21. doi: 10.1097/00006454-200104000-00009 . - DOI - PubMed
    1. Armenian SH, Singh J, Arrieta AC. Risk factors for mortality resulting from bloodstream infections in a pediatric intensive care unit. Pediatr Infect Dis J. 2005;24(4):309–14. doi: 10.1097/01.inf.0000157086.97503.bd . - DOI - PubMed
    1. Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000;118(1):146–55. doi: 10.1378/chest.118.1.146 . - DOI - PubMed
    1. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al.. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–96. doi: 10.1097/01.CCM.0000217961.75225.E9 . - DOI - PubMed
    1. Havey TC, Fowler RA, Daneman N. Duration of antibiotic therapy for bacteremia: a systematic review and meta-analysis. Crit Care. 2011;15(6):R267. doi: 10.1186/cc10545 . - DOI - PMC - PubMed

Publication types

Substances

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.