干旱区生态环境知识资源中心(Arid): Implementation of a Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: the Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study

Arid

DOI	10.1093/jpids/piy113
	Implementation of a Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: the Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study
	Downes, Kevin J.; Fitzgerald, Julie C.; Schriver, Emily; Boge, Craig L. K.; Russo, Michael E.; Weiss, Scott L.; Balamuth, Fran; Kubis, Sherri E.; Tolomeo, Pam; Bilker, Warren B.; Han, Jennifer H.; Lautenbach, Ebbing; Coffin, Susan E.; Gerber, Jeffrey S.
通讯作者	Downes, KJ
来源期刊	JOURNAL OF THE PEDIATRIC INFECTIOUS DISEASES SOCIETY
ISSN	2048-7193
EISSN	2048-7207
出版年	2020
卷号	9 期号:1 页码:36-43
英文摘要	Background. Biomarkers can facilitate safe antibiotic discontinuation in critically ill patients without bacterial infection. Methods. We tested the ability of a biomarker-based algorithm to reduce excess antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) without bacterial infections (uninfected) in our pediatric intensive care unit (PICU). The algorithm suggested that PICU clinicians stop antibiotics if (1) C-reactive protein <4 mg/dL and procalcitonin <1 ng/mL at SIRS onset and (2) no evidence of bacterial infection by exam/testing by 48 hours. We evaluated excess broad-spectrum antibiotic use, defined as administration on days 3-9 after SIRS onset in uninfected children. Incidence rate ratios (IRRs) compared unadjusted excess length of therapy (LOT) in the 34 months before (Period 1) and 12 months after (Period 2) implementation of this algorithm, stratified by biomarker values. Segmented linear regression evaluated excess LOT among all uninfected episodes over time and between the periods. Results. We identified 457 eligible SIRS episodes without bacterial infection, 333 in Period 1 and 124 in Period 2. When both biomarkers were below the algorithm's cut-points (n = 48 Period 1, n = 31 Period 2), unadjusted excess LOT was lower in Period 2 (IRR, 0.53; 95% confidence interval, 0.30-0.93). Among all 457 uninfected episodes, there were no significant differences in LOT (coefficient 0.9, P = .99) between the periods on segmented regression. Conclusions. Implementation of a biomarker-based algorithm did not decrease overall antibiotic exposure among all uninfected patients in our PICU, although exposures were reduced in the subset of SIRS episodes where biomarkers were low.
英文关键词	antimicrobial stewardship biomarkers critical care pediatrics
类型	Article
语种	英语
开放获取类型	Green Published
收录类别	SCI-E
WOS记录号	WOS:000559003800007
WOS关键词	ANTIMICROBIAL THERAPY ; PCT-ALGORITHM ; PROCALCITONIN ; INFECTIONS ; EXPOSURE ; DURATION ; TRENDS
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/2XILL650/325588
作者单位	[Downes, Kevin J.; Russo, Michael E.; Coffin, Susan E.; Gerber, Jeffrey S.] Childrens Hosp Philadelphia, Div Infect Dis, 2716 Soutli St,Suite 10360, Philadelphia, PA 19146 USA; [Downes, Kevin J.; Schriver, Emily; Boge, Craig L. K.; Balamuth, Fran; Coffin, Susan E.; Gerber, Jeffrey S.] Childrens Hosp Philadelphia, Ctr Pediat Clin Effectiveness, Philadelphia, PA 19146 USA; [Downes, Kevin J.; Schriver, Emily; Boge, Craig L. K.; Coffin, Susan E.; Gerber, Jeffrey S.] Childrens Hosp Philadelphia, Pediat Infect Dis Epidemiol & Antimicrobial Stewa, Philadelphia, PA 19146 USA; [Fitzgerald, Julie C.; Weiss, Scott L.; Kubis, Sherri E.] Childrens Hosp Philadelphia, Dept Anesthesiol & Crit Care Med, Philadelphia, PA 19146 USA; [Balamuth, Fran] Childrens Hosp Philadelphia, Div Emergency Med, Philadelphia, PA 19146 USA; [Downes, Kevin J.; Russo, Michael E.; Balamuth, Fran; Coffin, Susan E.; Gerber, Jeffrey S.] Univ Penn, Dept Pediat, Perelman Sch Med, Philadelphia, PA 19104 USA; [Fitzgerald, Julie C.; Weiss, Scott L.] U...
推荐引用方式 GB/T 7714	Downes, Kevin J.,Fitzgerald, Julie C.,Schriver, Emily,et al. Implementation of a Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: the Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study[J],2020,9(1):36-43.
APA	Downes, Kevin J..,Fitzgerald, Julie C..,Schriver, Emily.,Boge, Craig L. K..,Russo, Michael E..,...&Gerber, Jeffrey S..(2020).Implementation of a Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: the Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study.JOURNAL OF THE PEDIATRIC INFECTIOUS DISEASES SOCIETY,9(1),36-43.
MLA	Downes, Kevin J.,et al."Implementation of a Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: the Optimizing Antibiotic Strategies in Sepsis (OASIS) II Study".JOURNAL OF THE PEDIATRIC INFECTIOUS DISEASES SOCIETY 9.1(2020):36-43.