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DOI | 10.1093/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
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ISSN | 2048-7193 |
EISSN | 2048-7207 |
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 |
推荐引用方式 GB/T 7714 | 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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