Expert Perspectives on the Diagnosis and Management of Infections in the Pediatric Intensive Care Unit: A Cross-sectional Survey of Indian Clinicians

Vollständiger Abstract

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Objective: To assess clinicians perspectives on the diagnosis and management of infections in the pediatric intensive care unit (PICU) in India, with a focus on common pathogens, diagnostic and therapeutic approaches, meropenem usage, antimicrobial stewardship, and clinicians' perceptions of the efficacy, safety, and clinical outcomes of meropenem therapy. Methods: Clinicians across India participated in a cross-sectional survey using a structured 23-item questionnaire that assessed pathogen profile, diagnostic and therapeutic practices, meropenem usage, antimicrobial stewardship, and clinicians' perceptions of efficacy, safety, and clinical outcomes. Data were analyzed using descriptive statistics. Results: Among the 205 clinicians who participated in the survey, more than three-quarters (76.59%) identified bacterial infections as the most common cause of pediatric infections in the PICU. Nearly two-thirds (63.90%) reported that newborns and infants were the age group at the highest risk of developing severe infections in the PICU. Most clinicians (78.05%) recognized sepsis as the most common complication associated with ventilator-associated pneumonia in pediatric patients. Additionally, 74% preferred antibiotics as the initial treatment for critically ill pediatric patients with confirmed septic shock. Meropenem was the preferred antimicrobial agent for both empirical and targeted therapy, depending on the clinical scenario, as reported by 80% of respondents. Approximately three-quarters (75.61%) identified inadequate awareness of antibiotic stewardship as the primary factor contributing to the misuse or overuse of meropenem. Furthermore, 87% considered meropenem's broad-spectrum activity against both Gram-positive and Gram-negative organisms to be its greatest therapeutic advantage. Based on the 5-point Global Improvement Scale, 69% reported marked improvement in clinical outcomes following meropenem therapy. Conclusion: The survey emphasizes the importance of early antibiotic therapy, appropriate meropenem use, and antimicrobial stewardship. Meropenem is perceived as an effective broad-spectrum agent, with favorable clinical outcomes reported by most clinicians, supporting its role in the management of severe pediatric infections.