Delay in antibiotic initiation adversely affects children with bacterial CAP

In children with bacterial community-acquired pneumonia (CAP), delay in initiation of appropriate antibiotics is independently associated with adverse outcomes, according to a retrospective study reported in the Pediatric Infectious Disease Journal.

The effect of timing of antibiotic initiation in children with severe CAP is unknown, and no guidelines for these patients are available. Researchers reviewed medical records of children hospitalized with bacterial CAP who were treated with mechanical ventilation. Of the 45 children (median age, 17 months) included in the study, 19 had an underlying complex chronic condition, and 22 had an acute comorbidity.

Median time to initiation of the correct antibiotic was 10.3 hours, and 71% of patients received correct empiric therapy. For all children, a longer delay in starting the correct parenteral antibiotic was independently associated with a significantly longer hospital stay. For the 23 children without acute comorbidities, longer time to correct antibiotic initiation was independently associated with significantly longer durations of mechanical ventilation, intensive care-unit stay, and hospital stay. Delays as short as 2 to 4 hours were associated with adverse outcomes.

The researchers note that this was the first study of the associations between timing and selection of empiric antibiotics and outcomes in critically ill children with bacterial CAP. The findings suggest that lower airway cultures and empiric antibiotics may be useful in children with acute respiratory failure, even if bacterial etiology is not strongly suspected. Also, the findings highlight the potential importance of early and appropriate empiric antibiotic therapy in these children.

Muszynski JA, Knatz, NL, Sargel CL, Fernandez SA, Marquardt DJ, Hall MW. Timing of correct parenteral antibiotic initiation and outcomes from severe bacterial community-acquired pneumonia in children. Pediatr Infect Dis J. 2011;30(4):295-301.