Arid
DOI10.1093/jpids/piw023
A Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: The Optimizing Antibiotic Strategies in Sepsis (OASIS) Study
Downes, Kevin J.1,2; Weiss, Scott L.3; Gerber, Jeffrey S.1,2,5; Klieger, Sarah B.2; Fitzgerald, Julie C.3; Balamuth, Fran4; Kubis, Sherri E.3; Tolomeo, Pam5; Bilker, Warren B.5; Han, Xiaoyan5; Nachamkin, Irving6; Garrigan, Charles6; Han, Jennifer H.5,7; Lautenbach, Ebbing5,7; Coffin, Susan E.1
通讯作者Downes, Kevin J.
来源期刊JOURNAL OF THE PEDIATRIC INFECTIOUS DISEASES SOCIETY
ISSN2048-7193
EISSN2048-7207
出版年2017
卷号6期号:2页码:134-141
英文摘要

Background. Biomarkers that identify critically ill children with systemic inflammatory response syndrome (SIRS) at low risk for bacterial infection may help clinicians reduce unnecessary antibiotic use.


Methods. We conducted a prospective cohort study of children with SIRS and suspected infection admitted to a pediatric intensive care unit from January 5, 2012 to March 7, 2014. We enrolled patients upon initiation of new antibiotics (Time 0) and measured a panel of 8 serum biomarkers daily over 72 hours. Microbiology, imaging, and clinical data were reviewed to classify bacterial infections using Centers for Disease Control and Prevention definitions. We identified cut points of biomarker combinations to maximize the negative predictive value (NPV) and specificity for bacterial infection. Excess antibiotics were calculated as days of therapy beyond day 2 after SIRS onset in patients without bacterial infection.


Results. Infections were identified in 46 of 85 patients: bacterial (n = 22) and viral (24), whereas 39 patients had no infection identified. At Time 0, C-reactive protein (CRP) < 5 mg/dL plus serum amyloid A < 15.0 mu g/mL had an NPV of 0.92 (95% confidence interval [CI], 0.79-1.0) and specificity of 0.54 (95% CI, 0.42-0.66) to identify patients without bacterial infection, whereas CRP < 4 mg/dL plus procalcitonin <1.75 ng/mL had an NPV of 0.90 (95% CI, 0.79-1.0) and specificity of 0.43 (95% CI, 0.30-0.55). Patients without bacterial infection received a mean of 3.8 excess days of therapy.


Conclusions. Early measurement of select biomarkers can identify children with SIRS in whom antibiotics might be safely discontinued when there is no other objective evidence of infection at 48 hours.


英文关键词antimicrobial stewardship biomarkers critical care pediatrics
类型Article
语种英语
国家USA
收录类别SCI-E
WOS记录号WOS:000416621100007
WOS关键词C-REACTIVE PROTEIN ; PROCALCITONIN ; THERAPY ; MORTALITY ; CHILDREN ; OUTCOMES ; TRENDS ; EPIDEMIOLOGY ; INFECTIONS ; PREVALENCE
WOS类目Infectious Diseases ; Pediatrics
WOS研究方向Infectious Diseases ; Pediatrics
资源类型期刊论文
条目标识符http://119.78.100.177/qdio/handle/2XILL650/200856
作者单位1.Childrens Hosp Philadelphia, Div Infect Dis, 3535 Market St,Ste 1409, Philadelphia, PA 19104 USA;
2.Childrens Hosp Philadelphia, Ctr Pediat Clin Effectiveness, Philadelphia, PA 19104 USA;
3.Childrens Hosp Philadelphia, Dept Anesthesia & Crit Care Med, Philadelphia, PA 19104 USA;
4.Childrens Hosp Philadelphia, Div Emergency Med, Philadelphia, PA 19104 USA;
5.Univ Penn, Dept Biostat & Epidemiol, Ctr Clin Epidemiol & Biostat, Philadelphia, PA 19104 USA;
6.Univ Penn, Dept Med, Dept Pathol & Lab Med, Philadelphia, PA 19104 USA;
7.Univ Penn, Dept Med, Perelman Sch Med, Div Infect Dis, Philadelphia, PA 19104 USA
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Downes, Kevin J.,Weiss, Scott L.,Gerber, Jeffrey S.,et al. A Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: The Optimizing Antibiotic Strategies in Sepsis (OASIS) Study[J],2017,6(2):134-141.
APA Downes, Kevin J..,Weiss, Scott L..,Gerber, Jeffrey S..,Klieger, Sarah B..,Fitzgerald, Julie C..,...&Coffin, Susan E..(2017).A Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: The Optimizing Antibiotic Strategies in Sepsis (OASIS) Study.JOURNAL OF THE PEDIATRIC INFECTIOUS DISEASES SOCIETY,6(2),134-141.
MLA Downes, Kevin J.,et al."A Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: The Optimizing Antibiotic Strategies in Sepsis (OASIS) Study".JOURNAL OF THE PEDIATRIC INFECTIOUS DISEASES SOCIETY 6.2(2017):134-141.
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