Tình hình sử dụng kháng sinh và các yếu tố liên quan đến kết quả điều trị tại Khoa Hồi sức tích cực và Chống độc Bệnh viện Nhi Đồng 2 giai đoạn 2022–2023

Inappropriate antibiotic use is a growing global health concern, driving antimicrobial resistance and complicating patient management, especially in critical care settings. Pediatric Intensive Care Units (ICUs) face unique challenges due to the vulnerability of young patients and the complexity of infections. Effective antibiotic therapy is crucial for treatment effectiveness in this population, yet misuse contributes significantly to adverse outcomes, including increased healthcare costs and prolonged hospital stays. Understanding the nuances of antibiotic prescription and patient response within this critical environment is paramount. This study investigates the patterns of antibiotic therapy and factors influencing treatment outcomes in the pediatric ICU of Children's Hospital 2, aiming to identify areas for improvement in clinical practice and enhance patient care.

Medical professionals in pediatrics and critical care, pharmacists, infectious disease specialists, healthcare administrators, and public health researchers.

The global rise of antimicrobial resistance necessitates a critical evaluation of antibiotic prescribing practices, particularly in vulnerable populations such as pediatric patients in the Intensive Care Unit (ICU). This study addresses the gap in understanding antibiotic utilization and its impact on treatment effectiveness in this specific setting, providing valuable insights for clinical improvement. A descriptive cross-sectional, retrospective study was conducted, analyzing 350 medical records of children hospitalized in the ICU of Children's Hospital 2 between June 2022 and June 2023. This approach allowed for a comprehensive assessment of antibiotic therapy patterns and the identification of associated factors. Key findings revealed that vancomycin (83.4%) and carbapenem (78%) were the most frequently used antibiotics. Out of 3,103 medical orders evaluated, 7.7% were deemed inappropriate in antibiotic selection and 5.7% in dosage, indicating areas for improvement in adherence to guidelines. The overall treatment effectiveness, measured by a success rate of 88.6%, was encouraging, but further analysis identified critical risk factors for treatment failure. Multivariate analysis highlighted three significant factors: the presence of septic shock (OR 4.63), the need for renal replacement therapy (OR 6.53), and suspected or confirmed invasive fungal infection (OR 6.43 and OR 18.62, respectively). These results underscore that while antibiotic prescriptions generally adhered to current guidelines, specific patient conditions significantly increase the risk of adverse outcomes. The findings underscore the importance of continuous optimization of antibiotic therapy in pediatric ICU settings. Healthcare professionals should pay increased attention to patients with septic shock, those requiring renal replacement therapy, and those with suspected or confirmed invasive fungal infections, as these groups are at a significantly higher risk of treatment failure. The study emphasizes the need for multidisciplinary collaboration and updated guidelines to improve patient outcomes and combat antimicrobial resistance in critical care. This research offers actionable data to enhance antibiotic stewardship programs, refine treatment protocols, and ultimately improve the prognosis for critically ill children.