Risk Factors Associated With Prolonged Antibiotic Use in Pediatric Bacterial Meningitis

Cuiyao He; Xiaogang Hu; Tingsong Li; Qing Wu; Jisan Fan; Yan Zhou; Li Jiang; Siqi Hong; Yuanyuan Luo

doi:10.3389/fphar.2022.904322

Risk Factors Associated With Prolonged Antibiotic Use in Pediatric Bacterial Meningitis

Front Pharmacol. 2022 Jun 21:13:904322. doi: 10.3389/fphar.2022.904322. eCollection 2022.

Authors

Cuiyao He¹, Xiaogang Hu², Tingsong Li³, Qing Wu¹, Jisan Fan¹, Yan Zhou¹, Li Jiang⁴, Siqi Hong⁴, Yuanyuan Luo⁴

Affiliations

¹ Department of Pharmacy, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
² Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China.
³ Department of Rehabilitation, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
⁴ Department of Neurology, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.

Abstract

Objectives: To determine the risk factors associated with a prolonged antibiotic course for community-acquired bacterial meningitis (BM) in children. Methods: This retrospective cohort study included children aged 1 month to 18 years with community-acquired BM due to a confirmed causative pathogen from 2011 to 2021. Patients were divided into an antibiotic prolongation group and a nonprolongation group according to whether the antibiotic course exceeded 2 weeks of the recommended course for the causative pathogen. Associations of important clinical characteristics and laboratory and other parameters with antibiotic prolongation were assessed using univariate and multivariable regression logistic analyses. Results: In total, 107 patients were included in this study. Augmented renal clearance (ARC) (OR, 19.802; 95% CI, 7.178-54.628; p < 0.001) was associated with a prolonged antibiotic course; however, septic shock, causative pathogen, preadmission antibiotic use, peripheral white blood cell (WBC) count, initial cerebrospinal fluid (CSF) WBC count, CSF glucose, CSF protein, and surgical intervention were not associated with the prolonged antibiotic course. Patients with ARC had more total fever days (median time: 14 vs. 7.5 days), longer hospitalization (median time: 39 vs. 24 days), higher rates of complications (72.34% vs. 50.00%) and antibiotic adjustments (78.723% vs. 56.667%) than patients with normal renal function. Conclusion: ARC is an independent risk factor for prolonged antibiotic use in children with community-acquired BM. ARC may be associated with longer fever and hospitalization durations, higher rates of complications and antibiotic adjustments.

Keywords: antibiotic; augmented renal clearance; bacterial meningitis; children; infectious disease.