Optimizing antibiotic therapy in the pediatric intensive care unit: a study of prescription trends
Abstract
Abstract Objective: The study aims at determining factors that influence antibiotic initiation, continuation, escalation, modification, and discontinuation among children admitted to pediatric intensive care unit (PICU) of a tertiary-care center in South India. Design: Prospective observational study. Setting: Tertiary-care PICU in South India. Participants: Children aged from 1 month to 18 years admitted to the PICU during the study period (1 January 2024–31 May 2024) Methods: Clinical, demographic, laboratory, radiological, and microbiological data were prospectively collected using a structured proforma. Cases were classified as infective versus non-infective based on clinical presentation, laboratory parameters, radiological findings, microbiological investigations when available, and final diagnosis. The decision to initiate antibiotic therapy and subsequent modifications were documented. Results: Among 308 PICU admissions, 291 children were analyzed. Respiratory (39.5%) and nervous system (24.9%) involvement were the most common presentations. An infectious etiology was identified in 61.9% of cases. Antibiotics were prescribed in 59.1%. Factors influencing antibiotic initiation included clinical assessment, inflammatory markers, pyuria, and radiological findings. A total of 126 culture specimens were obtained. Blood cultures were positive in 2/83 (2.4%) and urine cultures in 7/14 (50%). Cephalosporin and aminoglycoside combination was the most prescribed combination during the study (48.3%). Antibiotic escalation was required in 10% of respiratory infections, antibiotics were discontinued in 74% of the nervous system cases, and culture-guided antibiotic modification was observed most in genitourinary infections. Conclusion: Antibiotic prescribing in the PICU is driven by clinical, laboratory, radiological, and microbiological evidence. Structured reassessments and timely de-escalation of antibiotics represent important opportunities for antibiotic stewardship.