Antibiotic treatment duration for bloodstream infections in critically ill children—A survey of pediatric infectious diseases and critical care clinicians for clinical equipoise

Pong, Sandra; Fowler, Robert; Murthy, Srinivas; Pernica, Jeffrey M.; Gilfoyle, Elaine; Fontela, Patricia; Mitsakakis, Nicholas; Bowen, Asha C; Seto, Winnie; Science, Michelle; Hutchison, James S.; Jouvet, Philippe; Rishu, Asgar; Daneman, Nick

doi:10.1371/journal.pone.0272021

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…There were 106 survey respondents: 65 (61%) critical care clinicians, 28 (26%) ID physicians, and 13 (12%) intensive care– or ID-focused pharmacists. 6 Respondents had a broad range of clinical experience: ≤5 y (6%), 6 to 10 y (22%), 11 to 15 y (24%), 16 to 20 y (23%), and ≥21 y (26%).…”

Section: Resultsmentioning

confidence: 99%

“…We conducted this study in conjunction with a bacteremia antibiotic treatment duration survey among pediatric infectious diseases (ID) and critical care clinicians in Canada, Australia, and New Zealand in winter 2020–2021. 6 Critical care clinicians and pharmacists in Canadian pediatric intensive care units were contacted by email with invitations to participate in the anonymous, online web-based survey via SurveyMonkey. The ID clinicians surveyed belonged to the Paediatric Investigators Collaborative Network on Infections in Canada, and the Australia and New Zealand Paediatric Infectious Diseases Group (ANZPID) of the Australasian Society of Infectious Diseases (ASID).…”

Section: Methodsmentioning

confidence: 99%

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Noninferiority Margin Size and Acceptance of Trial Results: Contingent Valuation Survey of Clinician Preferences for Noninferior Mortality

et al. 2022

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Objectives We used modified contingent valuation methodology to determine how noninferiority margin sizes influence clinicians’ willingness to accept clinical trial results that compare mortality in critically ill children. Methods We surveyed pediatric infectious diseases and critical care clinicians in Canada, Australia, and New Zealand and randomized respondents to review 1 of 9 mock abstracts describing a noninferiority trial of bacteremic critically ill children assigned to 7 or 14 d of antibiotics. Each scenario showed higher mortality in the 7-d group but met noninferiority criterion. We explored how noninferiority margins and baseline mortality rates influenced respondent acceptance of results. Results There were 106 survey respondents: 65 (61%) critical care clinicians, 28 (26%) infectious diseases physicians, and 13 (12%) pharmacists. When noninferiority margins were 5% and 10%, 73% (24/33) and 79% (27/33) respondents would accept shorter treatment, compared with 44% (17/39) when the margin was 20% ( P = 0.003). Logistic regression adjusted for baseline mortality showed 5% and 10% noninferiority margins were more likely to be associated with acceptance of shorter treatment compared with 20% margins (odds ratio [OR] 3.5, 95% confidence interval [CI]: 1.3–9.6, P = 0.013; OR 5.1, 95% CI: 1.8–14.6, P = 0.002). Baseline mortality was not a significant predictor of acceptance of shorter treatment. Conclusions Clinicians are more likely to accept shorter treatment when noninferiority margins are ≤10%. However, nearly half of respondents who reviewed abstracts with 20% margins were still willing to accept shorter treatment. This is a novel application of contingent valuation methodology to elicit acceptance of research results among end users of the medical literature. Highlights Clinicians are more likely to accept shorter treatment durations based on noninferior mortality results when the noninferiority margin is 5% or 10% than if the margin is 20%. However, nearly half of clinicians would still accept shorter-duration treatment as noninferior with margins of 20%. Baseline mortality does not independently predict acceptance of shorter-duration treatment. Contingent valuation is a novel approach to elicit the acceptance of research design parameters from the perspective of endusers of the medical literature.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Noninferiority Margin Size and Acceptance of Trial Results: Contingent Valuation Survey of Clinician Preferences for Noninferior Mortality

et al. 2022

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Fixed versus individualized treatment for five common bacterial infectious syndromes: a survey of the perspectives and practices of clinicians

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Fowler

et al. 2023

JAC-Antimicrobial Resistance

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Background Traditionally, bacterial infections have been treated with fixed-duration antibiotic courses; however, some have advocated for individualized durations. It is not known which approach currently predominates. Methods We conducted a multinational clinical practice survey asking prescribers their approach to treating skin and soft tissue infection (SSTI), community-acquired pneumonia (CAP), pyelonephritis, cholangitis and bloodstream infection (BSI) of an unknown source. The primary outcome was self-reported treatment approach as being fully fixed duration, fixed minimum, fixed maximum, fixed minimum and maximum, or fully individualized durations. Secondary questions explored factors influencing duration of therapy. Multivariable logistic regression with generalized estimating equations was used to examine predictors of use of fully fixed durations. Results Among 221 respondents, 170 (76.9%) completed the full survey; infectious diseases physicians accounted for 60.6%. Use of a fully fixed duration was least common for SSTI (8.5%) and more common for CAP (28.3%), BSI (29.9%), cholangitis (35.7%) and pyelonephritis (36.3%). Fully individualized therapy, with no fixed minimum or maximum, was used by only a minority: CAP (4.9%), pyelonephritis (5.0%), cholangitis (9.9%), BSI (13.6%) and SSTI (19.5%). In multivariable analyses, a fully fixed duration approach was more common among Canadian respondents [adjusted OR (aOR) 1.76 (95% CI 1.12–2.76)] and for CAP (aOR 4.25, 95% CI 2.53–7.13), cholangitis (aOR 6.01, 95% CI 3.49–10.36), pyelonephritis (aOR 6.08, 95% CI 3.56–10.39) and BSI (aOR 4.49, 95% CI 2.50–8.09) compared with SSTI. Conclusions There is extensive practice heterogeneity in fixed versus individualized treatment; clinical trials would be helpful to compare these approaches.

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Antibiotic treatment duration for bloodstream infections in critically ill children—A survey of pediatric infectious diseases and critical care clinicians for clinical equipoise

Cited by 2 publications

References 23 publications

Noninferiority Margin Size and Acceptance of Trial Results: Contingent Valuation Survey of Clinician Preferences for Noninferior Mortality

Noninferiority Margin Size and Acceptance of Trial Results: Contingent Valuation Survey of Clinician Preferences for Noninferior Mortality

Fixed versus individualized treatment for five common bacterial infectious syndromes: a survey of the perspectives and practices of clinicians

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