Prevalence, Characteristics, and Determinants of Suboptimal Care in the Initial Management of Community-Onset Severe Bacterial Infections in Children

Lorton, Fleur; Martinot, A.; Assathiany, R.; Roué, Jean‐Michel; Bourgoin, Pierre; Chantreuil, J.; Boussicault, Gérald; Gaillot, T.; Saulnier, J.-P.; Caillon, Jocelyne; Guen, Christèle Gras‐Le; Launay, Élise

doi:10.1001/jamanetworkopen.2022.16778

Cited by 6 publications

(5 citation statements)

References 62 publications

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“…This population was selected because the problem of concern was the initial management in PEDs, where the clinician is not certain of septic shock. This initial management has a major prognostic impact, as recently highlighted in 259 French children 12. In addition, given the short inclusion period of the study (5 weeks), this population of interest allowed the inclusion of more patients (n=63) than only severe sepsis cases (n=10).…”

Section: Discussionmentioning

confidence: 99%

Assessment of adherence to the 2020 Surviving Sepsis Campaign guidelines for fluid resuscitation in children with suspected septic shock in paediatric emergency departments: a prospective multicentre study

San Geroteo,

Levy,

Bailhache

et al. 2024

Arch Dis Child

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BackgroundPaediatric sepsis is the leading cause of death in children under 5 years. No studies have evaluated the application of the Surviving Sepsis Campaign 2020 (SSC-2020) guidelines in paediatric emergency departments (PEDs).ObjectiveTo assess physician adherence to the SSC-2020 fluid resuscitation guidelines in children with suspected septic shock in PEDs.MethodsThis was a prospective multicentre observational study conducted in 21 French hospitals over 5 sequential weeks, between November 2021 and March 2022. Children with suspected septic shock and who received antimicrobial therapy within 72 hours were included. Primary outcome was SSC-2020 fluid resuscitation guidelines adherence (low 0–24%; moderate 25–74%; high 75–100%) according to: bolus volume of 10–20 mL/kg each, exclusive administration of balanced crystalloids at 1 and 24 hours of management, and initiation of fluid resuscitation within 1 hour of septic shock recognition.Results63 children were included. 10 (16%) children had severe sepsis and 2 (3%) met the definition of septic shock. Compared with the SSC-2020 guidelines, 43 (68%) patients received boluses of 10–20 mL/kg; fluid resuscitation was initiated within 1 hour of septic shock recognition in 42 (76%) cases; balanced crystalloids were the only fluids administrated in 35 (56%) and 34 (55%) children at 1 and 24 hours of management, respectively. Main barriers reported by physicians were difficult intravenous access (43%), lack of team training (29%), workload constraints (28%), and absence or out-of-date protocols (24%).ConclusionsThis study found high adherence for fluid resuscitation initiation but moderate adherence for bolus volume and fluid choice.Trial registration numberNCT05066464.

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Section: Discussionmentioning

confidence: 99%

Assessment of adherence to the 2020 Surviving Sepsis Campaign guidelines for fluid resuscitation in children with suspected septic shock in paediatric emergency departments: a prospective multicentre study

San Geroteo,

Levy,

Bailhache

et al. 2024

Arch Dis Child

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“…Значительные различия в доступе к здравоохранению, наличии ресурсов, оказании медицинской помощи и ограниченной доказательной базе означают, что многие из имеющихся рекомендаций «Surviving Sepsis Campaign» неп рименимы или невыполнимы в клиниках с ограниченным финансированием [40,41]. По мнению F. Lorton et al (2022), неадекватные мероприятия интенсивной терапии могут быть связаны со следующим:…”

Section: анализ особеннос тей внедрения протоколированного лечения се...unclassified

Adherence to treatment in intensive care units on the example of pediatric sepsis: a review

Миронов

Aleksandrovich

Пшениснов

et al. 2023

Annals of Critical Care

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INTRODUCTION: Intensive care does not always require only a large amount of resources. An important aspect is the formation of a multidisciplinary team involved in the treatment of patients in critical condition. OBJECTIVE: To demonstrate the need for the staff of intensive care units to use protocols for the diagnosis and treatment of critical conditions on the example of sepsis in children. MATERIALS AND METHODS: The analysis of publications devoted to the study of the impact of the implementation of the clinical recommendations of the Surviving Sepsis Campaign for the treatment of sepsis in children on the outcomes of the disease. The articles were searched in the abstract databases PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection and Google Scholar for the period from 2011 to July 2022. Keywords were used: “pediatric sepsis”, “implementation”, “protocolized treatment”, “adherence”. RESULTS: During the search, only thirteen observational studies were found, nine of which were presented retrospectively, which can be attributed to the design flaws of the submitted works. It was revealed that the use of the entire complex of diagnostic and therapeutic measures presented in clinical recommendations and protocols for intensive therapy of sepsis in children can significantly improve the results of treatment, but the commitment of doctors to their use in routine clinical practice remains low and does not exceed 40 %. CONCLUSIONS: The main reason for the lack of commitment to the implementation of recommendations and standards for the treatment of sepsis in children is not only in the presence of organizational obstacles, but also in the absence of reasonable algorithms for its implementation.

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“…We conducted a secondary analysis of data from a previously described prospective, observational, population-based study in 15 adjacent administrative districts in western France (13)(14)(15), representing 13% of the national pediatric population (16). The main objective of this original study was evaluation of the quality of care in the initial management of COSBIs in children (13).…”

Section: Study Design and Populationmentioning

confidence: 99%

Distribution, Consequences, and Determinants of Time to Antibiotics in Children With Community-Onset Severe Bacterial Infection: A Secondary Analysis of a Prospective Population-Based Study

Malorey

Lorton²,

Bourgoin

et al. 2023

Pediatric Critical Care Medicine

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OBJECTIVES:To describe the distribution, consequences and potential determinants of time to antibiotics administration in children with community-onset severe bacterial infections (COSBIs).DESIGN: Secondary analysis of the available data from a prospective population-based study from 2009 to 2014. SETTING:An administrative area in western France accounting for 13% of the national pediatric population.

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Prevalence, Characteristics, and Determinants of Suboptimal Care in the Initial Management of Community-Onset Severe Bacterial Infections in Children

Cited by 6 publications

References 62 publications

Assessment of adherence to the 2020 Surviving Sepsis Campaign guidelines for fluid resuscitation in children with suspected septic shock in paediatric emergency departments: a prospective multicentre study

Assessment of adherence to the 2020 Surviving Sepsis Campaign guidelines for fluid resuscitation in children with suspected septic shock in paediatric emergency departments: a prospective multicentre study

Adherence to treatment in intensive care units on the example of pediatric sepsis: a review

Distribution, Consequences, and Determinants of Time to Antibiotics in Children With Community-Onset Severe Bacterial Infection: A Secondary Analysis of a Prospective Population-Based Study

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