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American Academy of Pediatrics
Research Articles

Antibiotic Timing in Pediatric Septic Shock

Roni D. Lane, Jared Olson, Ron Reeder, Benjamin Miller, Jennifer K. Workman, Emily A. Thorell and Gitte Y. Larsen
Hospital Pediatrics April 2020, 10 (4) 311-317; DOI: https://doi.org/10.1542/hpeds.2019-0250
Roni D. Lane
aDivisions of Pediatric Emergency Medicine,
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Jared Olson
bPrimary Children’s Hospital Pharmacy, Salt Lake City, Utah
cPediatric Infectious Diseases, and
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Ron Reeder
dCritical Care, Department of Pediatrics, The University of Utah, Salt Lake City, Utah; and
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Benjamin Miller
dCritical Care, Department of Pediatrics, The University of Utah, Salt Lake City, Utah; and
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Jennifer K. Workman
dCritical Care, Department of Pediatrics, The University of Utah, Salt Lake City, Utah; and
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Emily A. Thorell
cPediatric Infectious Diseases, and
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Gitte Y. Larsen
dCritical Care, Department of Pediatrics, The University of Utah, Salt Lake City, Utah; and
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Abstract

BACKGROUND AND OBJECTIVES: National guidelines advocate for the administration of antibiotics within 1 hour to children with septic shock, although there is variance in the pediatric evidence-based literature supporting this benchmark. Our objective for this study was to describe the association of target time to antibiotic administration (TTAA) with outcomes of children treated for suspected septic shock in a pediatric emergency department. Septic shock is suspected when signs of perfusion and/or hypotension are present. The primary outcome was mortality. Secondary outcomes included PICU admission, hospital and PICU length of stay, and organ dysfunction resolution by hospital day 2.

METHODS: We conducted a retrospective study of children <18 years of age admitted from the pediatric emergency department and treated for suspected septic shock between February 1, 2007, and December 31, 2015. Associations between TTAA and outcomes were evaluated by using multivariable linear and logistic regression models obtained from stepwise selection.

RESULTS: Of 1377 patients, 47% were boys with a median age of 4.0 (interquartile range 1.4–11.6) years, 1.5% (20) died, 90% were compliant with TTAA goals, 40% required PICU admission, 38% had ≥2 unique complex chronic conditions, 71% received antibiotics in ≤2 hours, and 30% had a culture-positive bacterial etiology. There were no significant associations between TTAA and outcomes.

CONCLUSIONS: We found no association with TTAA and any clinical outcomes, adding to the growing body of literature questioning the timing benchmark of antibiotic administration. Although the importance of antibiotics is not in question, elucidating the target TTAA may improve resource use and decrease inappropriate or unnecessary antibiotic exposure.

  • Copyright © 2020 by the American Academy of Pediatrics
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Hospital Pediatrics: 10 (4)
Hospital Pediatrics
Vol. 10, Issue 4
1 Apr 2020
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Antibiotic Timing in Pediatric Septic Shock
Roni D. Lane, Jared Olson, Ron Reeder, Benjamin Miller, Jennifer K. Workman, Emily A. Thorell, Gitte Y. Larsen
Hospital Pediatrics Apr 2020, 10 (4) 311-317; DOI: 10.1542/hpeds.2019-0250

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Antibiotic Timing in Pediatric Septic Shock
Roni D. Lane, Jared Olson, Ron Reeder, Benjamin Miller, Jennifer K. Workman, Emily A. Thorell, Gitte Y. Larsen
Hospital Pediatrics Apr 2020, 10 (4) 311-317; DOI: 10.1542/hpeds.2019-0250
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