911. A Risk Based Empiric Antibiotic Protocol Improves Appropriate Initial Antibiotic Selection in Critically Ill Children
Session: Poster Abstract Session: Antimicrobial Utilization and Resistance in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Early appropriate empiric antibiotics may improve outcomes in critically ill adults and children with infections.  However, indiscriminate use of broad antibiotics can increase resistance.  We hypothesize an empiric antibiotic protocol will improve initial antibiotic appropriateness in infected critically ill children.

Methods: An empiric PICU antibiotic protocol was designed using risk stratification to identify patients at risk for resistant bacteria. Children at low risk for healthcare-associated organisms received vancomycin and cefotaxime.  Those with risk factors (e.g. immunocompromise, recent or current hospitalization) received vancomycin, an aminoglycoside, and an antipseudomonal β-lactam. All PICU patients with an infection-related ICD-9 code were evaluated for a calendar year before (2004) and after (2007) protocol implementation.  We collected demographics, length of stay, antibiotic dates, culture results and sensitivities, comorbid conditions and mortality data.  Likelihood of receiving risk-factor based antibiotics was compared pre- and post-protocol. For children with positive cultures, antibiotics were deemed appropriate if organism was sensitive to 1 agent ordered; in polymicrobial infections, each organism had to be sensitive to at least 1 ordered antibiotic. Data were analyzed using Fisher’s exact or Mann-Whitney U test.

Results: There were 278 protocol patients (304 episodes) and 217 pre-protocol patients (269 episodes). No significant demographic or illness severity differences were seen.  More protocol than pre-protocol patients received risk-factor based antibiotics (76% vs 16%; p<0.0001).  More protocol than pre-protocol patients with positive cultures received appropriate initial antibiotics (88% vs 67%; p<0.0001).  75% of 2004 patients with positive cultures and inappropriate antibiotics grew organisms covered by the protocol.

Conclusion: Institution of a PICU empiric antibiotic protocol was associated with increased initial antibiotic appropriateness.  Most pre-protocol patients with inappropriate antibiotics would have had correct coverage using the protocol. Further work is ongoing to evaluate protocol impact on time to correct antibiotics and outcomes.

Subject Category: P. Pediatric and perinatal infections

Todd Karsies, MD1, Cheryl Sargel, PharmD1, David Marquardt, MD2, Nadeem Khan, MBBS1 and Mark Hall, MD1, (1)The Ohio State University/Nationwide Children's Hospital, Columbus, OH, (2)Sunrise Children's Hospital, Las Vegas, NV


T. Karsies, None

C. Sargel, None

D. Marquardt, None

N. Khan, None

M. Hall, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.