• Kim C Noël, Jesse Papenburg, Jacques Lacroix, Caroline Quach, Shauna O'Donnell, Milagros Gonzales, Douglas F Willson, Elaine Gilfoyle, James D McNally, Steven Reynolds, Yasser Kazzaz, Atsushi Kawaguchi, Masanori Sato, Lalida Kongkiattikul, Stéphane Leteurtre, François Dubos, Yasemin Karaca, Fabrizio Chiusolo, Jefferson Piva, Nandini Dendukuri, Patricia S Fontela, and Canadian Critical Care Trials Group (CCCTG) and the Pediatric Lung Injury and Sepsis Investigators (PALISI) Network.
• Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.
• Pediatr Crit Care Me. 2020 Sep 1; 21 (9): e696-e706.

ObjectivesWe hypothesized that antibiotic use in PICUs is based on criteria not always supported by evidence. We aimed to describe determinants of empiric antibiotic use in PICUs in eight different countries.DesignCross-sectional survey.SettingPICUs in Canada, the United States, France, Italy, Saudi Arabia, Japan, Thailand, and Brazil.SubjectsPediatric intensivists.InterventionsNone.Measurements And Main ResultsWe used literature review and focus groups to develop the survey and its clinical scenarios (pneumonia, septic shock, meningitis, and intra-abdominal infections) in which cultures were unreliable due to antibiotic pretreatment. Data analyses included descriptive statistics and linear regression with bootstrapped SEs. Overall response rate was 39% (482/1,251), with individual country response rates ranging from 25% to 76%. Respondents in all countries prolonged antibiotic duration based on patient characteristics, disease severity, pathogens, and radiologic findings (from a median increase of 1.8 d [95% CI, 0.5-4.0 d] to 9.5 d [95% CI, 8.5-10.5 d]). Younger age, severe disease, and ventilator-associated pneumonia prolonged antibiotic treatment duration despite a lack of evidence for such practices. No variables were reported to shorten treatment duration for all countries. Importantly, more than 39% of respondents would use greater than or equal to 7 days of antibiotics for patients with a positive viral polymerase chain reaction test in all scenarios, except in France for pneumonia (29%), septic shock (13%), and meningitis (6%). The use of elevated levels of inflammatory markers to prolong antibiotic treatment duration varied among different countries.ConclusionsAntibiotic-related decisions are complex and may be influenced by cultural and contextual factors. Evidence-based criteria are necessary to guide antibiotic duration and ensure the rational use of antibiotics in PICUs.

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