Factors and outcomes of pediatric sepsis under an antimicrobial stewardship program in a tertiary care teaching hospital in Thailand: a retrospective cohort study
Theerapong Seesin, Suvaporn Anugulruengkitt, Chankit PuttilerpongAbstract
Objective:
To investigate the factors associated with mortality and the outcomes of an antimicrobial stewardship program (ASP) in pediatric patients with sepsis.
Design:
Retrospective cohort study.
Setting:
A tertiary care teaching hospital in Thailand.
Patients:
Pediatric patients with sepsis.
Methods:
This study reviewed electronic medical records of pediatric patients. A computer-generated random sequence was used to select 240 patients who met the inclusion criteria for the analysis.
Results:
Between January 1, 2021, and December 31, 2024, a total of 1,777 patients were enrolled in the ASP. Of 240 eligible patients, males accounted for 56.7% of the cohort, with a median age of 1.0 year (interquartile range 0–6). Positive blood cultures were identified in 72 patients (30.0%). ASP interventions identified antibiotic-related problems in 93 patients (38.8%), with primary physicians adhering to ASP recommendations in 55 cases (59.1%). Septic shock was the only factor significantly associated with 30-day mortality (adjusted odds ratio 4.064; 95% confident interval: CI 1.265–13.061; P = .019). Mortality rates were not different between groups regarding ASP compliance or blood culture results. The day of therapy/1,000 PD for vancomycin and meropenem were significantly lower in the compliance group compared to the non-compliance group (81.9 vs 135.4, P = .026; and 169.9 vs 260.3, P = .012, respectively).
Conclusions:
Septic shock was the only factor associated with 30-day mortality. ASP help detected antibiotic-related problems and reduced meropenem and vancomycin consumption in pediatric patients with sepsis.