The prospective, non-interventional, pharmaco-vigilant study of antibiotic treatment of pediatric patients in pediatric intensive care unit and in-patient wards suffering from sepsis in a tertiary care hospital
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20183019Keywords:
Antibiotic resistance, Combination of antibiotic, Sepsis, Septic shockAbstract
Background: Sepsis with septic shock has remained a dreadful disease inspite of early intervention mostly due to lack of sensitivity to first line antibiotics. This observational study was conducted to evaluate the utilization of antimicrobials and sensitivity-resistance pattern in paediatric patients suffering from sepsis due to various causes.
Methods: A prospective, non-interventional, pharmaco-vigilant study. 38 patients suffering from sepsis admitted in paediatric ward and PICU from September 2012 to February 2014 were evaluated. The research protocol was approved by Institutional Ethical Committee, KIMS. Data were collected from case sheets of patients from the ward as well as Medical Record and Data section. Average of Data on a continuous scale was expressed as a mean along with standard deviation, Categorical data was expressed as percentage. Comparative statistical analysis was done by using student's t-test in respect of data measured on a continuous scale. All differences with P value below 0.05 were labelled as statistically significant.
Results: Total 38 patients were admitted with provisional diagnosis of sepsis. 52.5% patients were suffering from ≥2 diseases while pneumonia (64%) and meningitis (22%) were observed to cause sepsis. 10(27%) patients presented with septic shock while 39.3% patients having single organ failure and 10.4% patients having multiple organ failure. inj Dopamine (33%) and inj Dobutamine 11% were used and ventilator was used in 1 patient. Most of the patients received multiple antibiotics in I.V. route, 30 (79%) patients received ≥3 antibiotics. Linezolid+ piperacillin+ tazo + aminoglycoside + 4th drug combination was observed to be used in 34% patients while Linezolid+ 3rd gen. cephalosporin+ aminoglycoside+ 4th drug combination was used in 21% patients. Cephalosporin was most frequently withdrawn antibiotic (47 % of use). High resistance was observed for both gram +ve and gram -ve bacteria against cephalosporin.
Conclusions: Anti-MRSA agents (Linezolid) and anti-MDR GNB agent (Meropenem) significantly used to control the severe sepsis in conjunction to Piperacilin/ ceftriaxone + amikacin.
References
Khilnani P, Singhi S, Lodha R, Santhanam I, Sachdev A, Chugh K, et al. Pediatric Sepsis Guidelines: Summary for resource-limited countries. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2010 Jan;14(1):41.
Camussi G, Tetta C, Ronco C, Fonsato V. Recent insights into the pathogenesis of severe sepsis. Critical Care and Resuscitation. 2005 Mar;7(1):32.
Dremsizov T, Clermont G, Kellum JA, Kalassian KG, Fine MJ, Angus DC. Severe sepsis in community-acquired pneumonia: when does it happen, and do systemic inflammatory response syndrome criteria help predict course?. Chest. 2006 Apr 1;129(4):968-78.
Seifert H. The clinical importance of microbiological findings in the diagnosis and management of bloodstream infections. Clinical Infectious Diseases. 2009 May 15;48(Supplement_4):S238-45.
Seifert H. The clinical importance of microbiological findings in the diagnosis and management of bloodstream infections. Clinical Infectious Diseases. 2009 May 15;48(Supplement_4):S238-45.
Lorry R. Kache FS. Shock (Severe sepsis and septic shock) Kliegman: Nelson Textbook of Pediatrics. Part XVII-XXXIII, chapter 68,19th Edn; 2008.
Munford RS. Severe Sepsis and Septic shock, Harrison’s Principle of Internal Medicine. 19th Edition. 1751-1758.
Bernard Rosner. Fundamental of Biostatistics. Chapter 7 and chapter 8. 7th Edition.
Mahajan BK. Methods in Biostatistics. Chapter 9. 7th Edition.
Cha´vez-Bueno S, McCracken GH. Bacterial Meningitis in Children Pediatr Clin N Am. 2005;52:795-810.
Kumar A, Zarychanski R, Light B, Parrillo JE, Maki D, Simon D, et al. Early combination antibiotic therapy yields improved survival compared to monotherapy in septic shock: A propensity-matched analysis. Crit Care Med. 2010:38.
Kumar A, Safdar N, Kethireddy S, Chateau D. A survival benefit of combination antibiotic therapy for serious infections associated with sepsis and septic shock is contingent on the risk of death: A meta-analytic/meta-regression study. Crit Care Med. 2010;38:8.
Safdar N, Handelsman J, Maki DG. Does combination antimicrobial therapy reduce mortality in Gram-negative bacteraemia? A meta-analysis. The Lancet infectious diseases. 2004 Aug 1;4(8):519-27.
Kaul DR, Collins CD, Hyzy RC. New developments in antimicrobial use in sepsis. Current pharmaceutical design. 2008 Jul 1;14(19):1912-20.
Sick AC, Tschudin-Sutter S, Turnbull AE, Weissman SJ, Tamma PD. Empiric combination therapy for gram-negative bacteremia. Pediatrics. 2014 Apr 1:peds-2013.