Low diagnostic yield and time to diagnostic confirmation results in prolonged use of antimicrobials in critically ill children [version 2; peer review: 2 approved, 1 approved with reservations]
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Authors
Clark, John
White, Deborah
Daubney, Esther
Curran, Martin
Bousfield, Rachel
Gouliouris, Theodore
Powell, Elizabeth
Palmer, Adam
Agrawal, Shruti
Török, M Estée
Baker, Stephen
Publication Date
2022-03-03Journal Title
Wellcome open research
ISSN
2398-502X
Publisher
F1000 Research Ltd
Volume
6
Language
eng
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Clark, J., White, D., Daubney, E., Curran, M., Bousfield, R., Gouliouris, T., Powell, E., et al. (2022). Low diagnostic yield and time to diagnostic confirmation results in prolonged use of antimicrobials in critically ill children [version 2; peer review: 2 approved, 1 approved with reservations]. Wellcome open research, 6 https://doi.org/10.12688/wellcomeopenres.16848.2
Description
Funder: Action Medical Research; Grant(s):
Funder: Academy of Medical Sciences; Grant(s):
Funder: NIHR Cambridge Biomedical Research Centre; Grant(s):
Funder: Gates Cambridge Trust; Grant(s):
Abstract
Background: Broad-spectrum antimicrobial therapy is a key driver of antimicrobial resistance. Here, we aimed to review indications for antimicrobial therapy, determine the proportion of suspected bacterial infections that are confirmed by culture, and assess the time taken for microbiology test results to become available in the paediatric intensive care unit (PICU). Methods: A single-centre prospective observational cohort study of 100 consecutive general PICU admissions from 30 October 2019 to 19 February 2020. Data were collected from the hospital medical record and entered into a study database prior to statistical analysis using standard methods. Results: Of all episodes of suspected infection, 22% of lower respiratory tract infection, 43% of bloodstream and 0% of central nervous system infection were associated with growth on microbiology culture. 90% of children received antimicrobial therapy. Hospital-acquired infection occurred less commonly than primary infection, but an organism was grown in a greater proportion (64%) of cultures. Final laboratory reports for negative cultures were issued at a median of 120.3 hours for blood cultures and 55.5 hours for endotracheal tube aspirate cultures. Conclusions: Despite most critically children receiving antimicrobial therapy, infection was often not microbiologically confirmed. Novel molecular diagnostics may improve rationalisation of treatment in this population.
Keywords
Infections, anti-infective agents, Microbiological Techniques, Routine Diagnostic Tests, Paediatric Intensive Care Units, Microbial Drug-Resistance
Sponsorship
Wellcome Trust (215515/Z/19/Z)
Identifiers
PMC8902261
External DOI: https://doi.org/10.12688/wellcomeopenres.16848.2
This record's URL: https://www.repository.cam.ac.uk/handle/1810/336164
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