Etiology of XXXX and opportunities for reduction of antibiotic use in a pediatric intensive care unit.

@entity1 @entity1800 @entity221
OBJECTIVE: To determine the cause of @entity221 in critically ill @entity1 and to identify opportunities for reducing antibiotic use in this population. DESIGN: Prospective case series. SETTING: A tertiary-care medical-surgical pediatric intensive care unit (PICU). @entity1 : @entity1 admitted to the PICU who experienced @entity221 (axillary temperature >38.3 degrees C). MEASUREMENTS: Consecutive @entity1 who were febrile at any point in their PICU stay were investigated over two winter seasons. Etiology of the @entity221 was determined by physical examination and routine microbiology and radiographic tests. Three subgroups were reviewed to approximate the number of antibiotic-days that could have been reduced; namely, those with an indeterminate source, those with a documented @entity1800 , and those receiving a prolonged course of antibiotics. A set of standards reflecting common antibiotic use then was applied to these three @entity1 groups. RESULTS: Of 211 subjects, the majority (83.3%) had either a definitive or suspected focus for their @entity221 , and nearly all of these @entity1 were judged to have an infectious etiology. The study population received a total of 2,036 antibiotic-days. Despite the high incidence of infectious causes of @entity221 in our subjects, however, approximately 15% of total antibiotic-days could have been reduced by applying common-use standards. CONCLUSIONS: Fever in the PICU was usually of defined focus and infectious in origin. However, among febrile @entity1 in the PICU, substantial opportunity exists for reduction of antibiotic use. Trials determining the safety of antibiotic reduction in this population should be pursued vigorously.
