• Patricia S Fontela, Caroline Quach, Mohammad E Karim, Douglas F Willson, Elaine Gilfoyle, James Dayre McNally, Milagros Gonzales, Jesse Papenburg, Steven Reynolds, Jacques Lacroix, Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, and Canadian Critical Care Trials Group.
• 1Department of Pediatrics, McGill University, Montreal, QC, Canada. 2Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada. 3Department of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Montreal, QC, Canada. 4Center for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care, University of British Columbia, Vancouver, BC, Canada. 5Department of Pediatrics, Virginia Commonwealth University, Richmond, VA. 6Department of Pediatrics, University of Calgary, Calgary, AB, Canada. 7Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada. 8Research Institute of McGill University Health Center, Montreal, QC, Canada. 9Department of Medicine, University of British Columbia, Vancouver, BC, Canada. 10Department of Pediatrics, Université de Montréal, Montreal, QC, Canada.
• Pediatr Crit Care Me. 2017 Sep 1; 18 (9): e395-e405.

ObjectivesTo describe the criteria that currently guide empiric antibiotic treatment in children admitted to Canadian PICUs.DesignCross-sectional survey.SettingCanadian PICUs.SubjectsPediatric intensivists and pediatric infectious diseases specialists.InterventionsNone.Measurements And Main ResultsWe used focus groups and literature review to design the survey questions and its four clinical scenarios (sepsis, pneumonia, meningitis, and intra-abdominal infections). We analyzed our results using descriptive statistics and multivariate linear regression. Our response rate was 60% for pediatric intensivists (62/103) and 36% for pediatric infectious diseases specialists (37/103). Variables related to patient characteristics, disease severity, pathogens, and clinical, laboratory, and radiologic infection markers were associated with longer courses of antibiotics, with median increment ranging from 1.75 to 7.75 days. The presence of positive viral polymerase chain reaction result was the only variable constantly associated with a reduction in antibiotic use (median decrease from, -3.25 to -8.25 d). Importantly, 67-92% of respondents would still use a full course of antibiotics despite positive viral polymerase chain reaction result and marked clinical improvement for patients with suspected sepsis, pneumonia, and intra-abdominal infection. Clinical experience was associated with shorter courses of antibiotics for meningitis and sepsis (-1.3 d [95% CI, -2.4 to -0.2] and -1.8 d [95% CI, -2.8 to -0.7] per 10 extra years of clinical experience, respectively). Finally, site and specialty also influenced antibiotic practices.ConclusionsDecisions about antibiotic management for PICU patients are complex and involve the assessment of several different variables. With the exception of a positive viral polymerase chain reaction, our findings suggest that physicians rarely consider reducing the duration of antibiotics despite clinical improvement. In contrast, they will prolong the duration when faced with a nonreassuring characteristic. The development of objective and evidence-based criteria to guide antibiotic therapy in critically ill children is crucial to ensure the rational use of these agents in PICUs.

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