Use of antibiotics in pediatric intensive care and potential savings

Objective: Minimizing unwarranted prescription of antibiotics remains an important objective. Because of the heterogeneity between units regarding patient mix and other characteristics, site-specific targets for reduction must be identified. Here we present a model to address the issue by means of an observational cohort study. Setting: A tertiary, multidisciplinary, neonatal, and pediatric intensive care unit of a university teaching hospital. Patients: All newborns and children present in the unit (n = 456) between September 1998 and March 1999. Reasons for admission included postoperative care after cardiac surgery, major neonatal or pediatric surgery, severe trauma, and medical conditions requiring critical care. Methods: Daily recording of antibiotics given and of indications for initiation. After discontinuation, each treatment episode was assessed as to the presence or absence of infection. Results: Of the 456 patients 258 (56.6 %)received systemic antibiotics, amounting to 1815 exposure days (54.6 %) during 3322 hospitalization days. Of these, 512 (28 %) were prescribed as prophylaxis and 1303 for suspected infection. Treatment for suspected ventilator-associated pneumonia accounted for 616 (47 %) of 1303 treatment days and suspected sepsis for 255 days (20 %). Patients were classified as having no infection or viral infection during 552 (40 %) treatment days. The average weekly exposure rate in the unit varied considerably during the 29-week study period (range: 40-77/100 hospitalization days). Patient characteristics did not explain this variation. Conclusion: In this unit the largest reduction in antibiotic treatment would result from measures assisting suspected ventilator-associated pneumonia to be ruled out and from curtailing extended prophylaxis.