Effects of Delayed Antibiotic Therapy on Outcomes in Children with Streptococcus pneumoniae Sepsis

Abstract

Delayed antimicrobial therapy is associated with poor outcomes in sepsis, but the optimal antibiotic administration time remains unclear. We aimed to investigate the effects of the time of antimicrobial administration on outcomes and evaluate an optimal empirical antibiotic administration time window for children with Streptococcus pneumoniae sepsis. This retrospective study enrolled children with S. pneumoniae sepsis who presented to the Children’s Hospital of Chongqing Medical University from May 2011 to December 2018. Classification and regression tree (CART) analysis was used to determine the time-to-appropriate-therapy (TTAT) breakpoint. Outcomes were compared between patients receiving early or delayed therapy, defined by CART-derived TTAT breakpoint. During the study period, 172 patients were included. The CART-derived TTAT breakpoint was 13.6 h. After adjustment for confounding factors, a TTAT of ≥13.6 hours was found to be an independent predictor of sepsis-related in-hospital mortality (odds ratio [OR] = 39.26; 95% confidence interval [CI] = 6.10 to 252.60), septic shock (OR = 4.58; 95% CI = 1.89 to 11.14), and requiring mechanical ventilation (OR = 2.70; 95% CI = 1.01 to 7.35). A Pediatric Risk of Mortality (PRISM) III score of ≥10 was independently associated with delayed therapy. Delayed antibiotic therapy was associated with poor outcomes in children with S. pneumoniae sepsis. The optimal empirical antibiotic administration time window in children with S. pneumoniae sepsis was within 13.6 h. Efforts should be made to ensure timely and appropriate therapy.

Long-term sequelae of Pneumococcal Sepsis in children: a systematic review

“…USA (6 studies), [13][14][15][16][17][18] China (3 studies), [19][20][21] Saudi Arabia (2 studies) 22,23 and Spain (2 studies), 24,25 and one study each in Kenya, 26 Pakistan, 27 Chile, 28 Taiwan, 29 Germany, 30 Italy, 31 Switzerland, 32 Uruguay, 33 Costa Rica 34 and Peru. 35 One study was conducted in seven different European countries.…”

“…All 24 studies reported sequelae in frequencies and proportions. Nine studies reported physical sequelae, 4,13,14,16,18,23,25,30,32, 16 studies reported death 4,14,15,[18][19][20][21]23,[28][29][30][32][33][34]35 and 19 studies reported discharge outcomes. 4,13,14,[16][17][18][19][20][21][22][23][24][25]28,229,31,32,[34][35] The type and proportion of physical sequelae is presented as a graph.…”

“…Prognostic factors were reported in 5 studies. 20,21,24,27,32 Quality Appraisal Nine studies (37.5%) met at least 50% of the quality assessment criteria; 8 (33%) met at least 80% of their respective criteria. In particular, eight (72%) of the 11 prospective cohort studies and the only randomized controlled trial study met 80% of the quality assessment criteria.…”

“…Post 2010, the reported mortality ranged from 3.65% to 50%. [19][20][21]32 Time to death after PS diagnosis ranged from less than 9 hours to 30 days across 19 studies.…”

“…Nineteen studies reported discharge outcomes with no clear specification on recovery status (i.e., full or partial). 4,10,17,[20][21][22][23][24][26][27][28][29][30][31][32][33][34]36 Among the 19 studies, 80% of patients (n= 905) recovered after treatment. In two studies that reported physical sequelae, about 8% of patients (n=63) had "residual effect" in one study 23 and 10% (n= 30) experienced "residual effect" in another after hospital discharge.…”