FACTORS ASSOCIATED WITH INCREASED RISK OF INAPPROPRIATE EMPIRIC ANTIBIOTIC-TREATMENT OF CHILDHOOD BACTEREMIA

To identify bacteraemic children who are at increased risk of inapprop riate empiric antibiotic therapy, we performed univariate and multivar iate analyses of prospectively-studied bacteraemic episodes. Appropria teness of therapy was de fined according to the in vitro susceptibilit y of the isolate. Inappropriate empiric therapy was found in 38% of 51 6 bacteraemic episodes and was associated with higher mortality. The r ate of inappropriate treatment was lower in neonates and infants (28% and 33%, respectively) but higher in children 1- to 5-years old (51%, P = 0.0029). The rate was dependent on the source of bacteraemia (rang e, 18%-70%, P = 0.0092), underlying conditions (range, 26%-53%, P = 0. 0001), the specific paediatric section in which the child was hospital ized (range, 24%-70%, P = 0.0002), and the causative micro-organism (r ange, 15%-75%, P < 0.0001). Four clinical variables that independently and significantly affected the rate of inappropriate antibiotic treat ment were identified by multivariate stepwise logistic regression anal ysis (odds ratios in parentheses): hospital-acquired bacteraemia (2.3) , age of 1- to 5-years (2.1), cytotoxic therapy (1.8) and presence of central IV line (1.6). Conclusion We defined bacteraemic children who are at risk of inappropriate empiric antibiotic therapy. Special effor ts are needed to improve their treatment and consequently their outcom e.