The Impact of Antibiotic Initiation Timing in Children with Severe Community-Acquired Pneumonia: A Post-Hoc Analysis of an Observational Study
Year: 2026
Type: article
Abstract: INTRODUCTION: The aim of this study was to examine the association between early antibiotic initiation and clinical outcomes in children admitted to the paediatric intensive care unit (PICU) with severe community-acquired pneumonia (CAP). METHODS: We conducted a post-hoc analysis of a multicentre observational study across nine Asian PICUs. Children with severe CAP were categorized into early (≤ 6 h) or late (> 6 h) antibiotic initiation groups (early and late antibiotic groups, respectively) relative to PICU admission. The primary outcome was PICU mortality; secondary outcomes were 28-day ventilation-free days (VFD) and intensive care unit-free days (IFD). Multivariable analyses adjusted for country as fixed effect, age, Paediatric Index of Mortality 3 (PIM 3) score and comorbidities, when feasible. RESULTS: Among the 544 paediatric patients included in the analysis, median age was 14.0 [interquartile range (IQR) 4.0-34.0] months and the PIM 3 score was 0.3 (IQR 0.0-6.8) %. Viral and bacterial pathogens were isolated in 206 (37.9%) and 145 (26.7%) patients, respectively. Almost all patients [537 (98.7%)] received antibiotics, with 475 (87.3%) and 62 (11.4%) patients in the early and late antibiotic groups, respectively. Late antibiotic initiation was associated with higher PICU mortality [adjusted odds ratio (aOR) 5.19, 95% confidence interval (CI) 1.94-13.88, P < 0.01], septic shock requiring inotropic support (aOR 3.25, 95% CI 1.45-7.28, P < 0.01) and multi-organ failure (aOR 4.60, 95% CI 2.11-10.04, P < 0.01). No significant associations were observed between late antibiotic initiation and VFD or IFD. CONCLUSION: In critically ill children with severe CAP, initiating antibiotics within 6 h of PICU admission was associated with improved outcomes. This 6-h window may serve as a practical benchmark for quality improvement initiatives.
Source: Pulmonary Therapy
Authors: Sin Wee Loh, Judith Ju-Ming Wong, Qalab Abbas, Suresh Kumar Angurana, Hwa Jin Cho, Hongxing Dang, Pustika Efar, Phuc Huu Phan, Pei Chuen Lee, Chunfeng Liu, Lijia Fan, Minchaya Pukdeetraipop, Justin Qi Yuee Wang, Saptadi Yuliarto, Mary Xuemei Zhu, Rehena Sultana, Jan Hau Lee, The Paediatric Acute Critical Care Asian Network (PACCMAN)
Institutions: KK Women's and Children's Hospital, Duke-NUS Medical School, Aga Khan University Hospital, Post Graduate Institute of Medical Education and Research, Chonnam National University, Chonnam National University Children's Hospital, Children's Hospital of Chongqing Medical University, Vietnam National Children's Hospital, University Kebangsaan Malaysia Medical Centre, China Medical University, National University Hospital, King Chulalongkorn Memorial Hospital, University Malaya Medical Centre, RSUD Prof. Dr. Saiful Anwar Malang, Children's Hospital of Fudan University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $7,400
Funders: SingHealth, SingHealth Foundation
OpenAlex ID: W7223856199