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Rivista di Pediatria, Neonatologia, Medicina dell’Adolescenza
e Neuropsichiatria Infantile
Indexed/Abstracted in: CAB, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,532
Minerva Pediatrica 2016 Nov 10
Observational clinical study on organ dysfunction associated with dosing of antibiotics in a paediatric intensive care unit
Sascha TAFELSKI 1, Alexander GRATOPP 2, Florian RICHTER 1, Sylvia KRAMER 1, Claudia SPIES 1, Klaus D. WERNECKE 3, Irit NACHTIGALL 1, 4 ✉
1 Charité, Universitaetsmedizin Berlin, Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany; 2 Charité, Universitaetsmedizin Berlin, Department for Paediatrics Endocrinology, Gastroenterology and Metabolic Medicine, Campus Virchow-Klinikum, Berlin, Germany; 3 SOSTANA GmbH, Berlin, Germany; 4 Department of Anaesthesiology, Intensive Care and Pain Medicine, Hospital Waldfriede, Berlin, Germany
BACKGROUND: Medication errors are of concern especially in paediatric patients. This study investigates impact of dosing errors of antibiotics on outcome in critically ill paediatric patients.
METHODS: Retrospective study including all consecutive patients admitted to one university paediatric intensive care unit (PICU) in 2010 with length of PICU stay >24hrs, age <18 years and antibiotic therapy. Antibiotic dosages were evaluated for compliance with recommended dosing individually adapted for bodyweight, age and organ function. Primary endpoint was organ dysfunction defined as occurrence of liver injury (LI) or acute kidney injury (AKI) after initiation of antibiotic therapy. AKI was defined as reduced estimated glomerular filtration below 50ml/min or renal replacement therapy. LI was defined as more than two-fold elevation of liver enzymes. Additionally, duration of PICU stay, ventilation and all-cause PICU mortality were investigated.
RESULTS: Altogether 305 patients were evaluated with 2577 patient PICU days and 4021 antibiotic dosages. Overall 38.6% of dosages were incorrect according to recommendations and were applied in 130 patients (low-adherence-group). 175 children received antibiotic dosing according to recommendations (high-adherence-group). Patients in the low-adherence- group showed a 7-fold increase in adjusted risk to develop new-onset organ dysfunction (95%CI: 2.1–26.4), needed longer median PICU treatment (7 versus 3 days, p<0.001) and prolonged duration of mechanical ventilation (8 versus 2 days, p<0.001). In subgroup analyses, organ dysfunction and PICU mortality were associated with non-adherence to recommendations.
CONCLUSIONS: Adherence to a bodyweight- and age-adapted dosage-protocol is associated with less organ dysfunction and a more favourable clinical outcome in paediatric patients.