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Timing of Correct Parenteral Antibiotic Initiation and Outcomes From Severe Bacterial Community-acquired Pneumonia in Children

Muszynski, Jennifer A. MD*; Knatz, Nina L. PharmD; Sargel, Cheryl L. PharmD; Fernandez, Soledad A. PhD§; Marquardt, David J. MD*; Hall, Mark W. MD*†

The Pediatric Infectious Disease Journal: April 2011 - Volume 30 - Issue 4 - p 295-301
doi: 10.1097/INF.0b013e3181ff64ec
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Background: The impact of timing of appropriate antibiotic initiation for critically ill children with severe bacterial community-acquired pneumonia (CAP) is unknown. We hypothesized that longer time to initiation of correct parenteral antibiotic would be associated with longer durations of mechanical ventilation, intensive care unit length of stay, and hospital length of stay.

Methods: We retrospectively reviewed medical records of children admitted to Nationwide Children's Hospital between January 2004 and December 2006 with bacterial CAP treated with mechanical ventilation, excluding those with documented viral infection. Time to correct antibiotic was defined as time from presentation to any emergency department to the initiation of a parenteral antibiotic to which cultured pathogens were susceptible.

Results: In all, 45 patients, median age 17 months, were identified. Median time to correct antibiotic was 10.3 hours, with 71% of patients receiving correct empiric therapy. After adjusting for severity of illness, longer time to correct antibiotic was independently associated with longer hospital stay (P = 0.007). For the 23 patients in the cohort for whom pneumonia was the primary diagnosis, longer time to correct antibiotic was independently associated with longer durations of mechanical ventilation (P = 0.01), intensive care unit stay (P = 0.001), and hospital stay (P = 0.006). Delays in antibiotic administration as short as 2 to 4 hours were associated with adverse outcomes in this group.

Conclusions: In our critically ill children with severe bacterial CAP, longer delays in receipt of appropriate empiric antibiotics were independently associated with adverse outcomes.

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From *Pediatric Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH; †The Research Institute at Nationwide Children's Hospital, Columbus, OH; ‡Department of Pharmacy, Nationwide Children's Hospital, Columbus, OH; and §Center for Biostatistics, The Ohio State University, Columbus, OH.

Accepted for publication September 30, 2010.

Supported in part by the Research Institute at Nationwide Children's Hospital.

Address for correspondence: Mark W. Hall, MD, Critical Care Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205. E-mail: Mark.Hall@NationwideChildrens.org.

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© 2011 Lippincott Williams & Wilkins, Inc.