Aims & Objectives:
To compare length of stay, mortality and other important clinical outcomes in children with severe sepsis/ septic shock who received antibiotics within the first hour (Early antibiotic group) with those who received antibiotics after the first hour (Delayed antibiotic group).
We conducted this ambispective cohort study from 2013 to August 2017. Children admitted to pediatric intensive care unit (PICU) with septic shock but without prior antibiotic therapy formed the prospective cohort (Jan to Sep 2017) while records of these children between 2013 and 2016 were reviewed for the retrospective cohort. The key clinical outcomes were compared between the ‘Early’ and ‘Delayed’ antibiotic groups. Data were analyzed using Stata 13
A total of 78 children were enrolled. Fourteen children (18%) received antibiotics after the 1st hour while sixty four (82%) received antibiotics within 1 hour. Those in the early antibiotic group had higher Pediatric Index of Mortality -2 probability. When compared to the Early antibiotic group, duration of ICU stay was significantly longer in the Delayed antibiotic group (4 vs. 13 days; p=0.01). However, after excluding the deaths, this difference was no longer statistically significant. There was no significant difference in other outcomes such as proportion attaining shock reversal (71% vs 57%) or mortality - 2/14 (14%) vs. 23/64 (35%) (RR 0.53; 95% CI 0.14 to 2.06) between the early and delayed antibiotic groups respectively).
Early antibiotic administration may not be the only factor that affects the clinical outcomes in children with septic shock