Evaluation of Antimicrobial Utilization in the Pediatric Drowning Population

Abstract

Background Management of pediatric drowning often includes evaluation and treatment of infectious disease. There are few data describing the infections associated with pediatric drowning. Methods A descriptive retrospective study was designed, and patients aged < 19 years admitted for > 24 hours to our institution after a drowning were included from January 2011 through June 30, 2017. Data collection included patient demographics, submersion injury details, resuscitation details, patient admission details, chest radiograph on admission, use of intubation and mechanical ventilation, hospital length of stay, culture data, antimicrobial use, and mortality. Descriptive statistical methods (mean and standard deviation, median and range, percentage) were used to characterize the patient population, and Fisher exact test was used to evaluate the association between antimicrobial use in the first 72 hours of admission and mortality. Results A total of 114 patients met study criteria (male, 59.7%; median age, 3.7 years [range, 0.15–17.79 years]). Median hospital length of stay was 2 days (range, 1–60 days). Intensive care unit admission occurred in 80.7%, intubation occurred in 46.5%, and mortality was 18.4%. The most common submersion location was a pool (76.3% [n = 87]) with water primarily characterized as freshwater (82.5% [n = 94]). Reported submersion time for the majority of patients was < 5 minutes (54.4%) with cardiopulmonary resuscitation in 78.1%. In the first 72 hours after admission, culture were obtained in 40 patients (35.1%), and 27.5% of these cultures were positive. The primary organisms identified were consistent oropharyngeal flora. Antimicrobials were initiated in 50% of the patient population with clindamycin as most common. There was not a significant association between antimicrobial use in the first 72 hours after admission and mortality (17.2% vs 19.6%, P = .81). Conclusions Infectious disease associated with pediatric drowning in pools is uncommon. Empiric use of antimicrobials does not appear to affect outcomes.

Drowning in Children and Predictive Parameters

“…These data differ from those of literature where 12% of drowned patients received an antibiotic and mostly after drowning in lakes or rivers 32,33 . This is probably due to the fact that fresh water is potentially contaminated 34 . In our cohort, few children drowned in fresh water and this result could be secondary to the fact that our centers are geographically located near the sea.…”

“…32,33 This is probably due to the fact that fresh water is potentially contaminated. 34 In our cohort, few children drowned in fresh water and this result could be secondary to the fact that our centers are geographically located near the sea. Regardless of the site, the use of prophylactic antibiotics in nearly drowned patients is not recommended and it does not reduce pulmonary infections nor improve survival.…”

“…In our cohort, few children drowned in fresh water and this result could be secondary to the fact that our centers are geographically located near the sea. Regardless of the site, the use of prophylactic antibiotics in nearly drowned patients is not recommended and it does not reduce pulmonary infections nor improve survival 34 . In addition, organisms causing pneumonia were frequently resistant to the administered antibiotics 35 .…”

“…Regardless of the site, the use of prophylactic antibiotics in nearly drowned patients is not recommended and it does not reduce pulmonary infections nor improve survival. 34 In addition, organisms causing pneumonia were frequently resistant to the administered antibiotics. 35 Steroid therapy was administered in less than a quarter of our population, mostly in ICU patients, and its use was related to radiological findings as well.…”