Compliance with antibiotic therapy guidelines in French paediatric intensive care units: a multicentre observational study

Abstract Background Bacterial infections (BIs) are widespread in ICUs. The aims of this study were to assess the compliance with antibiotic recommendations, and factors associated with non-compliance. Methods We conducted an observational study in eight French Paediatric and Neonatal ICUs with an antimicrobial stewardship programme, mostly once a week. All children receiving antibiotics for a suspected or proven BI were evaluated. Newborns < 72 hours old, neonates < 37 weeks, age ≥ 18 years, and children under antimicrobial prophylaxis were excluded. Results 139 suspected (or proven) BI episodes in 134 children were prospectively included during six separate time-periods over one year. The final diagnosis was 26.6% no BI, 40.3% presumed (i.e., not documented) BI, and 35.3% documented BI. Non-compliance for all parameters combined occurred in 51.1%. The main reasons for non-compliance were inappropriate choice of antimicrobials (27.3%), duration of one or more antimicrobials (26.3%), and duration of antibiotic therapy (18.0%). In multivariate analyses, main independent risk factors for non-compliance were prescribing ≥ 2 antibiotics (OR 4.06, 95%CI 1.69–9.74, p = 0.0017), a duration of broad-spectrum antibiotic therapy ≥ 4 days (OR 2.59, 95%CI 1.16–5.78, p = 0.0199), neurologic compromise at ICU admission (OR 3.41, 95%CI 1.04–11.20, p = 0.0431), suspected catheter-related bacteraemia (ORs 3.70 and 5.42, 95%CIs 1.32 to 15.07, p < 0.02), a BI site classified as “other” (ORs 3.29 and 15.88, 95%CIs 1.16 to 104.76, p < 0.03), sepsis with ≥ 2 organ dysfunctions (OR 4.21, 95%CI 1.42–12.55, p = 0.0098), late-onset ventilator-associated pneumonia (OR 6.30, 95%CI 1.15–34.44, p = 0.0338), and ≥ 1 risk factor for ESBL Enterobacteriaceae (OR 2.56, 95%CI 1.07–6.14, p = 0.0353). Main independent factors for compliance were having antibiotic therapy protocols (OR 0.42, 95%CI 0.19–0.92, p = 0.0313), respiratory failure at ICU admission (OR 0.36, 95%CI 0.14–0.90, p = 0.0281), and aspiration pneumonia (OR 0.37, 95%CI 0.14–0.99, p = 0.0486). Conclusions Half of antibiotic prescriptions remain non-compliant with guidelines. Intensivists should reassess on a daily basis the benefit of using several antimicrobials or any broad-spectrum antimicrobials and stop antibiotics that are no longer indicated. Developing consensus about treating specific illnesses and using department protocols seem necessary to reduce non-compliance. A daily ASP could also improve compliance in these situations. Trial registration : ClinicalTrials.gov: number NCT04642560. The date of first trial registration was 24/11/2020.