Minerva Pediatrica 2019 Oct 11

DOI: 10.23736/S0026-4946.19.05508-7

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Pneumonia in paediatric critical care medicine and the adherence to guidelines

Sascha TAFELSKI ¹, Martin LANGE ¹, Felix WEGENER ¹, Alexander GRATOPP ², Claudia SPIES ¹, Klaus D. WERNECKE ³, Irit NACHTIGALL ^{1, 4} ✉

¹ Department of Anesthesiology and Operative Intensive Care Medicine (CCM,CVK) Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; ² Department of Paediatrics Campus Virchow-Klinikum Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; ³ Institute of Medical Biometrics, and SOSTANA GmbH Berlin, Germany Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; ⁴ Department of Hygiene and Preventive Medicine, Helios Kliniken Region Middle North and Bad Saarow, Bad Saarow, Germany

BACKGROUND: Different studies in adults reported significant outcome improvement for patients treated with high adherence to guidelines. The present study was initiated to evaluate the impact of adherence to antibiotic prescription guidelines on health outcomes of children on paediatric intensive care unit (PICU) suffering from pneumonia.
METHODS: This retrospective cohort study was conducted on a paediatric intensive care unit at Charité hospital Berlin. All patients with a length of stay (LOS) >24 hours, age <18 years, antimicrobial therapies and a radiologically confirmed diagnosis of pneumonia according to the “Centers for Disease Control and Prevention” definitions were included during the study period of 2009 and 2010. Adherence to national guidelines was evaluated daily and two groups were defined: Low adherence group (LAG) with a presence of <70% of days with compliant therapy and high adherence group (HAG) with an adherence of ≥70%.
RESULTS: High adherence was observed in 65 patients compared with 61 in low-adherence group. Number of patients needing invasive ventilation did not vary between HAG and LAG (n=37 vs. n=41; p=0.235). There was a statistically significant shorter duration of ventilation in HAG patients (p=0.031). Time to clinical recovery from pneumonia tended to be shorter in HAG patients (7.5d vs. 10.9d; p=0.07). There was a significant reduction in LOS in HAG patients (9.3d vs. 13.7d; p=0.016). However, mortality appeared comparable between groups.
CONCLUSIONS: Similar to previous evidence in adult patients children with pneumonia seem to benefit from guideline-based antibiotic therapy. Further studies are needed to explore strategies to improve guideline adherence.

KEY WORDS: Intensive care unit; Paediatric; Antibacterial agents; Pneumonia