Observational clinical study on organ dysfunction associated with dosing of antibiotics in a Pediatric Intensive Care Unit.
BACKGROUND
Medication errors are of concern especially in pediatric patients. This study investigates impact of dosing errors of antibiotics on outcome in critically ill pediatric patients.


METHODS
Retrospective study including all consecutive patients admitted to one university pediatric intensive care unit (PICU) in 2010 with length of PICU stay >24 hrs, age <18 years and antibiotic therapy. Antibiotic dosages were evaluated for compliance with recommended dosing individually adapted for bodyweight, age and organ function. Primary endpoint was organ dysfunction defined as occurrence of liver injury (LI) or acute kidney injury (AKI) after initiation of antibiotic therapy. AKI was defined as reduced estimated glomerular filtration below 50 mL/min or renal replacement therapy. LI was defined as more than two-fold elevation of liver enzymes. Additionally, duration of PICU stay, ventilation and all-cause PICU mortality were investigated.


RESULTS
Altogether 305 patients were evaluated with 2577 patient PICU days and 4021 antibiotic dosages. Overall 38.6% of dosages were incorrect according to recommendations and were applied in 130 patients (low-adherence-group). 175 children received antibiotic dosing according to recommendations (high-adherence-group). Patients in the low-adherence-group showed a 7-fold increase in adjusted risk to develop new-onset organ dysfunction (95% CI: 2.1-26.4), needed longer median PICU treatment (7 versus 3 days, P<0.001) and prolonged duration of mechanical ventilation (8 versus 2 days, P<0.001). In subgroup analyses, organ dysfunction and PICU mortality were associated with non-adherence to recommendations.


CONCLUSIONS
Adherence to a bodyweight- and age-adapted dosage-protocol is associated with less organ dysfunction and a more favorable clinical outcome in pediatric patients.
Department of Anesthesiology and Intensive Care Medicine Campus, Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
Sascha
S
Tafelski
Department for Pediatrics Endocrinology, Charité-Universitaetsmedizin Berlin, Gastroenterology and Metabolic Medicine, Campus Virchow-Klinikum, Berlin, Germany.
Alexander
A
Gratopp
Department of Anesthesiology and Intensive Care Medicine Campus, Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
Florian
F
Richter
Department of Anesthesiology and Intensive Care Medicine Campus, Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
Sylvia
S
Kramer
Department of Anesthesiology and Intensive Care Medicine Campus, Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
Claudia
C
Spies
SOSTANA GmbH Berlin, Berlin, Germany.
Klaus-Dieter
KD
Wernecke
Department of Anesthesiology and Intensive Care Medicine Campus, Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany - i.nachtigall@waldfriede.de.|Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Waldfriede, Berlin, Germany.
Irit
I
Nachtigall
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000453:epidemiology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D055118:Medication Adherence; D008508:Medication Errors; D017582:Renal Replacement Therapy / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents