Association of Antibiotics Administration Timing With Mortality in Children With Sepsis in a Tertiary Care Hospital of a Developing Country

Abstract

Objective: To investigate the association between antibiotics administration timing with morbidity and mortality in children with severe sepsis and septic shock, presenting to a tertiary care center in a developing country. Methods: This is a retrospective study of children aged 14 years or younger diagnosed with severe sepsis or septic shock at a free-standing tertiary children's hospital in Saudi Arabia between April 2015 and February 2018. We investigated the association between antibiotic administration timing and pediatric intensive care unit (PICU) mortality, PICU length of stay (LOS), hospital LOS, and ventilation-free days after adjusting for confounders. Results: Among the 189 admissions, 77 patients were admitted with septic shock and 112 with severe sepsis. Overall, the mortality rate was 16.9%. The overall median time from sepsis recognition to antibiotic administration was 105 min (IQR: 65-185.5 min); for septic shock patients, it was 85 min (IQR: 55-148 min), and for severe sepsis, 130 min (IQR: 75.5-199 min). Delayed antibiotic administration (> 3 h) was associated with 3.85 times higher PICU mortality (95% confidence intervals 1.032-14.374) in children with septic shock than in children who receive antibiotics within 3 h, after controlling for severity of illness, age, comorbidities, and volume resuscitation. However, delayed antibiotics administration was not significantly associated with higher PICU mortality in children diagnosed with severe sepsis. Conclusions: Delayed antibiotics administration in children with septic shock admitted to a free-standing children's hospital in a developing country was associated with PICU mortality.

Epidemiology of pediatric sepsis in the pediatric intensive care unit of king Abdulaziz Medical City, Jeddah, Saudi Arabia

“…A study conducted by Hassan et al to assess the feasibility and efficacy of sepsis management guidelines in the PICU revealed a mortality rate of 47.8 and 26.2%, before and after implementing the guidelines, respectively [ 8 ]. Another study conducted in a tertiary PICU in Riyadh reported an overall mortality rate of 17.9% for severe sepsis and septic shock [ 6 ]. Moreover, in Egypt, the mortality rate of sepsis has been reported as 28.1 and 8.8% by Bekhit et al and El-Mashad et al, respectively [ 7 , 9 ].…”

“…There was no difference in mortality rate between patients with early versus delayed antibiotic administration, which could be attributed to the small number of enrolled patients and the underpowered design of the study. However, a study conducted by Alsadoon et al in Riyadh, Saudi Arabia reported delayed antibiotic administration was not significantly associated with higher PICU mortality in children diagnosed with severe sepsis [ 6 ].…”

“…Knowledge regarding the disease is the first step to fully comprehend the impact of sepsis. A limited number of studies have described the epidemiology of pediatric sepsis in Saudi Arabia and the Middle East and North Africa region [ 6 – 10 ]. Understanding the local epidemiology is necessary to develop guidelines that will increase the early identification and improve the management of sepsis.…”

Antimicrobial Therapy in Pediatric Sepsis: What Is the Best Strategy?

“…Two studies support the recommendation of antibiotic prescription within the first hour of sepsis identification ( 4 , 12 ). Most patients in both studies had severe disease, with 69% ( 4 ) and 79% ( 12 ) with septic shock, respectively.…”

“…Timely prescription of antimicrobials is one of the main goals to prevent mortality ( 11 ). Especially for patients with shock and end-organ disfunction, the ideal moment for receiving antibiotics is within the first hour of health assistance ( 4 , 5 , 12 , 13 ). However, the indiscriminate use of antibiotics can lead to increased resistance, risk of Clostridioides difficile infection, as well as drug related toxicity (acute kidney injury, diarrhea, cytopenia, skin rash and anaphylaxis) ( 7 , 9 ).…”