293 - Antibiotic use in non-intubated children with bronchiolitis in the intensive care unit

Poster Number: 293

Laura Ortmann, Children's Hospital & Medical Center, Omaha, NE, United States; Aleisha Nabower, Children's Hospital & Medical Center, Omaha, NE, United States; Melissa L. Cullimore, University of Nebraska Medical College, Omaha, NE, United States; Ellen K. Kerns, University of Nebraska Medical Center, Omaha, NE, United States

Background: Bronchiolitis guidelines recommend against treatment with antibiotics unless there is suspicion of bacterial infection. However, antibiotic use may shorten mechanical ventilation duration and length of stay for patients with bronchiolitis that require intubation.

Objective: The goal of this study was to evaluate whether early antibiotic use improved outcomes for children who were initially on non-invasive respiratory support in the intensive care unit (ICU).

Design/Methods: The Pediatric Health Information Systems (PHIS) database was queried for children less than 2 years of age with a diagnosis of bronchiolitis who were admitted to the pediatric ICU. Patients were excluded if they were intubated on the first ICU day, had chronic medical conditions as defined by PHIS, bacteremia, urinary tract infection, meningitis, or immunodeficiency. Three groups were analyzed: 1) Early antibiotics defined as antibiotics started on the first day of ICU stay. 2) No antibiotics defined as no antibiotics the first 7 days in the ICU. 3) Late antibiotics defined as antibiotics started on day 2 – 7 of the ICU stay. Primary outcome was length of ICU stay. Multivariate analysis was done with factors known to impact outcomes including sex, race/ethnicity, season, rurality, and day 1 respiratory support.

Results: A total of 11,029 ICU admissions met criteria, 2,522 (23%) in the early antibiotic group, 7,119 (65%) in the no antibiotic group, and 1,388 (13%) in the late antibiotic group. The use of early antibiotics varied by center from 10 to 54%. Children in the early antibiotic group were older than the no and late antibiotic groups [median (IQR) 5.7 months (2-12) vs. 3.9 (1.9-9.6) vs. 4.3 (1.9-10.4), p < 0.001] and more likely to require non-invasive positive pressure ventilation the first ICU day than nasal cannula (30% vs. 22% vs. 23%, p < 0.0001). In multivariate analysis the early and late antibiotic groups both had longer length of ICU stay than the no antibiotic group [early RR (95% CI) 1.19 (1.15-1.22); late RR 1.98 (1.91-2.06)]. The early and late groups also had longer length of hospital stay [early RR (95% CI) 1.14 (1.11-1.17); late RR 1.76 (1.7-1.81)] and higher adjusted cost per day [early RR (95% CI) 1.06 (1.05-1.08); late RR 1.07 (1.07-1.11)].Conclusion(s): Children who were admitted to the ICU for non-invasive respiratory support for bronchiolitis and were started on antibiotics within the first 7 days had worse outcomes compared to those who received no antibiotics during this time.