학술논문
Association of empiric antibiotic selection and clinical outcomes in hospitalised children with severe orbital infections: a retrospective cohort study.
Document Type
Academic Journal
Author
Krueger C; Alberta Children's Hospital, Calgary, Alberta, Canada.; Nguyen EL; The Hospital for Sick Children, Toronto, Ontario, Canada.; Mahant S; The Hospital for Sick Children, Toronto, Ontario, Canada.; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Borkhoff CM; The Hospital for Sick Children, Toronto, Ontario, Canada.; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Cichon J; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.; Drouin O; Division of General Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada.; Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.; Pound C; Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.; Quet J; Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.; Wahi G; Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.; Bayliss A; Department of Pediatrics, Trillium Health Partners, Mississauga, Ontario, Canada.; Vomiero G; Alberta Children's Hospital, Calgary, Alberta, Canada.; Foulds J; Stollery Children's Hospital, Edmonton, Alberta, Canada.; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.; Kanani R; North York General Hospital, Toronto, Ontario, Canada.; Sakran M; Lakeridge Health, Oshawa, Ontario, Canada.; Sehgal A; Kingston Health Sciences Centre, Kingston, Ontario, Canada.; Pullenayegum E; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.; Widjaja E; The Hospital for Sick Children, Toronto, Ontario, Canada.; Reginald A; The Hospital for Sick Children, Toronto, Ontario, Canada.; Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada.; Wolter N; The Hospital for Sick Children, Toronto, Ontario, Canada.; Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.; Parkin P; The Hospital for Sick Children, Toronto, Ontario, Canada.; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.; Gill PJ; The Hospital for Sick Children, Toronto, Ontario, Canada peter.gill@sickkids.ca.; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Source
Publisher: BMJ Pub. Group [etc.] Country of Publication: England NLM ID: 0372434 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1468-2044 (Electronic) Linking ISSN: 00039888 NLM ISO Abbreviation: Arch Dis Child Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: To determine the association of initial empiric antibiotic regimens with clinical outcomes in hospitalised children with severe orbital infections.
Design: Multi-centre observational cohort study using data from 2009 to 2018 clinical records.
Setting: Canadian children's hospitals (7) and community hospitals (3).
Patients: Children between 2 months and 18 years hospitalised for >24 hours with severe orbital infections.
Interventions: Empiric intravenous antibiotic regimen in the first 24 hours of hospitalisation.
Main Outcome Measures: Length of hospital stay and surgical intervention using multivariable median regression and multivariate logistic regression, with adjustment for covariates.
Results: Of 1421 patients, 60.0% were male and the median age was 5.5 years (IQR 2.4-9.9). Median length of stay was 86.4 hours (IQR 56.9-137.5) and 180 (12.7%) received surgical intervention. Patients receiving broad-spectrum empiric antibiotics had an increased median length of stay, ranging from an additional 13.8 hours (third generation cephalosporin and anaerobic coverage) to 19.5 hours (third generation cephalosporin, staphylococcal and anaerobic coverage). No antibiotic regimen was associated with a change in the odds of surgical intervention. These findings remained unchanged in sensitivity analyses restricted to more severely ill patients. There was a twofold increase in the percentage of patients receiving the broadest empiric antibiotic regimens containing both staphylococcal and anaerobic coverage from 17.8% in 2009 to 40.3% in 2018.
Conclusions: Empiric use of broad-spectrum antibiotics with staphylococci and anaerobic coverage was associated with longer length of stay and similar rates of surgery in children with orbital infections. There is an urgent need for comparative effectiveness studies of various antibiotic regimes.
Competing Interests: Competing interests: PJG has received grants from the Canadian Institutes of Health Research (CIHR), the PSI Foundation and The Hospital for Sick Children. He has received non-financial support from the EBMLive Steering Committee (expenses reimbursed to attend conferences) and the CIHR Institute of Human Development, Child and Youth Health (as a member of the institute advisory board, expenses reimbursed to attend meetings), is a member of the CMAJ Open and BMJ Evidence-Based Medicine Editorial Board. OD was supported by a Chercheur Boursier Clinicien Award, from the Fonds de recherche du Québec – Santé. PP has received grants from the Hospital for Sick Children Foundation and CIHR. The other authors have no conflicts of interest to disclose.
(© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Design: Multi-centre observational cohort study using data from 2009 to 2018 clinical records.
Setting: Canadian children's hospitals (7) and community hospitals (3).
Patients: Children between 2 months and 18 years hospitalised for >24 hours with severe orbital infections.
Interventions: Empiric intravenous antibiotic regimen in the first 24 hours of hospitalisation.
Main Outcome Measures: Length of hospital stay and surgical intervention using multivariable median regression and multivariate logistic regression, with adjustment for covariates.
Results: Of 1421 patients, 60.0% were male and the median age was 5.5 years (IQR 2.4-9.9). Median length of stay was 86.4 hours (IQR 56.9-137.5) and 180 (12.7%) received surgical intervention. Patients receiving broad-spectrum empiric antibiotics had an increased median length of stay, ranging from an additional 13.8 hours (third generation cephalosporin and anaerobic coverage) to 19.5 hours (third generation cephalosporin, staphylococcal and anaerobic coverage). No antibiotic regimen was associated with a change in the odds of surgical intervention. These findings remained unchanged in sensitivity analyses restricted to more severely ill patients. There was a twofold increase in the percentage of patients receiving the broadest empiric antibiotic regimens containing both staphylococcal and anaerobic coverage from 17.8% in 2009 to 40.3% in 2018.
Conclusions: Empiric use of broad-spectrum antibiotics with staphylococci and anaerobic coverage was associated with longer length of stay and similar rates of surgery in children with orbital infections. There is an urgent need for comparative effectiveness studies of various antibiotic regimes.
Competing Interests: Competing interests: PJG has received grants from the Canadian Institutes of Health Research (CIHR), the PSI Foundation and The Hospital for Sick Children. He has received non-financial support from the EBMLive Steering Committee (expenses reimbursed to attend conferences) and the CIHR Institute of Human Development, Child and Youth Health (as a member of the institute advisory board, expenses reimbursed to attend meetings), is a member of the CMAJ Open and BMJ Evidence-Based Medicine Editorial Board. OD was supported by a Chercheur Boursier Clinicien Award, from the Fonds de recherche du Québec – Santé. PP has received grants from the Hospital for Sick Children Foundation and CIHR. The other authors have no conflicts of interest to disclose.
(© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)