Distribution, Consequences, and Determinants of Time to Antibiotics in Children With Community-Onset Severe Bacterial Infection: A Secondary Analysis of a Prospective Population-Based Study

David Malorey; Fleur Lorton; Martin Chalumeau; Pierre Bourgoin; Gérald Boussicault; Julie Chantreuil; Théophile Gaillot; Jean-Michel Roué; Alain Martinot; Rémy Assathiany; Jean-Pascal Saulnier; Jocelyne Caillon; Audrey Grain; Christèle Gras-Le Guen; Elise Launay

doi:10.1097/PCC.0000000000003306

Distribution, Consequences, and Determinants of Time to Antibiotics in Children With Community-Onset Severe Bacterial Infection: A Secondary Analysis of a Prospective Population-Based Study

Pediatr Crit Care Med. 2023 Sep 1;24(9):e441-e451. doi: 10.1097/PCC.0000000000003306. Epub 2023 Jun 1.

Authors

David Malorey^{1

2}, Fleur Lorton^{1

2

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15}, Martin Chalumeau^{2

4}, Pierre Bourgoin⁵, Gérald Boussicault⁶, Julie Chantreuil⁷, Théophile Gaillot⁸, Jean-Michel Roué⁹, Alain Martinot¹⁰, Rémy Assathiany¹¹, Jean-Pascal Saulnier¹², Jocelyne Caillon¹³, Audrey Grain^{14

15}, Christèle Gras-Le Guen^{1

2

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11

12

13

14

15}, Elise Launay^{1

2

3

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15}

Affiliations

¹ Department of Pediatrics and Pediatric Emergency, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France.
² Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre of Research in Epidemiology and StatisticS (CRESS), Paris Descartes University, Paris, France.
³ Inserm 1413 CIC FEA, Nantes University Hospital, Nantes, France.
⁴ Department of General Pediatrics and Pediatric Infectious Diseases, Necker Hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
⁵ Department of Pediatric and Neonatal Critical Care, Femme Enfant Adolescent, CHU de Nantes, Nantes, France.
⁶ Department of Pediatric Critical Care, CHU d'Angers, Angers, France.
⁷ Department of Pediatric Critical Care, Hôpital Clocheville, CHU de Tours, Tours, France.
⁸ Department of Pediatric Critical Care, Hôpital Sud, CHU de Rennes, Rennes, France.
⁹ Department of Pediatric and Neonatal Critical Care, Hôpital Morvan, CHU de Brest, Brest, France.
¹⁰ University Lille, ULR 2694-METRICS: Evaluation des technologies de Santé et des pratiques médicales, CHU Lille, Lille, France.
¹¹ Association pour la Recherche et l'Enseignement en Pédiatrie Générale (AREPEGE); Association Française de Pédiatrie Ambulatoire (AFPA), Cabinet de Pédiatrie, Issy-les-Moulineaux, France.
¹² Department of Pediatric and Neonatal Critical Care, Tour Jean Bernard, CHU de Poitiers, Poitiers, France.
¹³ Department of Microbiology, Hôtel Dieu, CHU de Nantes, Nantes, France.
¹⁴ Pediatric Haematology and Oncology Department, University Hospital of Nantes, Nantes, France.
¹⁵ Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France.

PMID: 37260312
DOI: 10.1097/PCC.0000000000003306

Abstract

Objectives: To describe the distribution, consequences and potential determinants of time to antibiotics administration in children with community-onset severe bacterial infections (COSBIs).

Design: Secondary analysis of the available data from a prospective population-based study from 2009 to 2014.

Setting: An administrative area in western France accounting for 13% of the national pediatric population.

Patients: All children from 1 month to 16 years old admitted to a PICU or who died before admission and had a COSBI.

Interventions: None.

Measurements and main results: The time to antibiotics was divided into patient interval (from first signs of COSBI to the first medical consultation) and medical interval (from the first consultation to appropriate antibiotics administration). The association between the medical interval and child outcome was studied by a multinomial logistic regression model and the potential determinants of the patient and medical intervals were by a Cox proportional-hazards model. Of the 227 children included (median age 2.1 yr), 22 died (9.7%), and 21 (9.3%) had severe sequelae at PICU discharge. Median patient and medical intervals were 7.0 hours (interquartile range [IQR], 2.0-16.5 hr) and 3.3 hours (IQR, 1.1-12.2 hr), respectively. The last quartile of medical interval was not associated with death (adjusted odds ratio [aOR], 3.7; 95% CI, 0.8-17.5) or survival with severe sequelae (aOR, 1.3; 95% CI, 0.4-4.0) versus survival without severe sequelae. Patient interval was shorter in younger children (adjusted hazard ratio [aHR], 0.95; 95% CI, 0.92-0.99), and medical interval was reduced when the first consultation was conducted in a hospital (aHR, 1.5; 95% CI, 1.1-2.0) versus outpatient medicine.

Conclusions: For children with COSBI, we found no significant association between medical interval and mortality or severe sequelae. An initial hospital referral could help reduce the time to antibiotics in COSBIs.

Trial registration: ClinicalTrials.gov NCT01485705.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents* / therapeutic use
Bacterial Infections* / drug therapy
Child
Child, Preschool
Hospitalization
Humans
Proportional Hazards Models
Prospective Studies

Substances

Anti-Bacterial Agents

Associated data

ClinicalTrials.gov/NCT01485705