Developing a Biomarker-Driven Algorithm to Improve Antibiotic Use in the Pediatric Intensive Care Unit: The Optimizing Antibiotic Strategies in Sepsis (OASIS) Study
Year: 2015
Type: article
Study design: Observational Study
Abstract: Background. Biomarkers that identify children at low risk for bacterial infection may reduce unnecessary antibiotic use. We sought to derive an algorithm to classify critically ill children with SIRS at low likelihood for bacterial infection. Methods. Prospective cohort study of children with new-onset SIRS admitted to a pediatric ICU from January 2012 to March 2014. We enrolled patients upon initiation/expansion of antibiotics (time 0) and measured a panel of 8 serum biomarkers daily over 72 hours. Patients with immune compromise, neutropenia, or without blood cultures were excluded. Bacterial and viral testing were performed at the discretion of the clinical team. Microbiology, imaging, and clinical data were reviewed for 48 hours after enrollment and CDC definitions were used to classify infections as proven/probable bacterial, laboratory-confirmed viral, or no infection; Kruskal-Wallis tests compared biomarkers among the 3 groups. Excess antibiotics (abx) were calculated as use >48 hours without bacterial infection. We tested various cut points of C-reactive protein (CRP) and procalcitonin (PCT) combinations to maximize the negative predictive value (NPV) for bacterial infection. Results. Of 87 patients, 24 (28%) had bacterial (11 pneumonia, 4 BSI, 3 sinusitis, and 6 other), 24 had viral, and 39 had no infection; 38 were female and median age was 4.2 years (IQR 1.0–12.4). At 0 and 24 hours, tissue plasminogen activator (TPA), PCT and CRP were higher in children with bacterial vesus viral or no infection (P < .05; figure). Serum amyloid A was higher in patients with bacterial versus viral or no infections at 0 hours (P = .01; figure). Patients without bacterial infection received 153 days of excess abx (55% of all abx, mean: 2.4 excess days/patient). Of all biomarker and time point combinations, CRP <4 mg/dL plus PCT <1 ng/mL at time 0 had a NPV of 0.89 (95% CI, 0.77–1.01) for identifying patients with bacterial infections. All patients misclassified as “low-risk” had identifiable bacterial infections on standard diagnostic evaluation at 48 hours. Conclusion. Early measurement of CRP and PCT can identify critically ill children with SIRS at low risk of bacterial infection and, in combination with standard diagnostic tests, may augment a clinically useful algorithm to decrease unnecessary antibiotic use. Disclosures. All authors: No reported disclosures.
Source: Open Forum Infectious Diseases
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2158451809