{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T13:45:08Z","timestamp":1776087908345,"version":"3.50.1"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T00:00:00Z","timestamp":1655769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p><jats:bold>Objectives:<\/jats:bold> To determine the risk factors associated with a prolonged antibiotic course for community-acquired bacterial meningitis (BM) in children.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> This retrospective cohort study included children aged 1\u00a0month to 18\u00a0years with community-acquired BM due to a confirmed causative pathogen from 2011 to 2021. Patients were divided into an antibiotic prolongation group and a nonprolongation group according to whether the antibiotic course exceeded 2\u00a0weeks of the recommended course for the causative pathogen. Associations of important clinical characteristics and laboratory and other parameters with antibiotic prolongation were assessed using univariate and multivariable regression logistic analyses.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> In total, 107 patients were included in this study. Augmented renal clearance (ARC) (OR, 19.802; 95% CI, 7.178\u201354.628; <jats:italic>p<\/jats:italic> &amp;lt; 0.001) was associated with a prolonged antibiotic course; however, septic shock, causative pathogen, preadmission antibiotic use, peripheral white blood cell (WBC) count, initial cerebrospinal fluid (CSF) WBC count, CSF glucose, CSF protein, and surgical intervention were not associated with the prolonged antibiotic course. Patients with ARC had more total fever days (median time: 14 vs. 7.5\u00a0days), longer hospitalization (median time: 39 vs. 24\u00a0days), higher rates of complications (72.34% vs. 50.00%) and antibiotic adjustments (78.723% vs. 56.667%) than patients with normal renal function.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> ARC is an independent risk factor for prolonged antibiotic use in children with community-acquired BM. ARC may be associated with longer fever and hospitalization durations, higher rates of complications and antibiotic adjustments.<\/jats:p>","DOI":"10.3389\/fphar.2022.904322","type":"journal-article","created":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T06:13:28Z","timestamp":1655792008000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Risk Factors Associated With Prolonged Antibiotic Use in Pediatric Bacterial Meningitis"],"prefix":"10.3389","volume":"13","author":[{"given":"Cuiyao","family":"He","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaogang","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tingsong","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qing","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jisan","family":"Fan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siqi","family":"Hong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanyuan","family":"Luo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1007\/s40262-018-0636-7","article-title":"Augmented Renal Clearance in Critically Ill Patients: A Systematic Review","volume":"57","author":"Bilbao-Meseguer","year":"2018","journal-title":"Clin. Pharmacokinet."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2162","DOI":"10.1016\/S0140-6736(12)60820-4","article-title":"National, Regional, and Worldwide Estimates of Preterm Birth Rates in the Year 2010 with Time Trends since 1990 for Selected Countries: a Systematic Analysis and Implications","volume":"379","author":"Blencowe","year":"2012","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1128\/CMR.00070-09","article-title":"Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis","volume":"23","author":"Brouwer","year":"2010","journal-title":"Clin. Microbiol. Rev."},{"key":"B4","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1016\/j.ijantimicag.2017.11.013","article-title":"Association between Augmented Renal Clearance, Antibiotic Exposure and Clinical Outcome in Critically Ill Septic Patients Receiving High Doses of \u03b2-lactams Administered by Continuous Infusion: a Prospective Observational Study","volume":"51","author":"Carri\u00e9","year":"2018","journal-title":"Int. J. Antimicrob. Agents"},{"key":"B5","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1111\/j.1468-1331.2008.02193.x","article-title":"EFNS Guideline on the Management of Community-Acquired Bacterial Meningitis: Report of an EFNS Task Force on Acute Bacterial Meningitis in Older Children and Adults","volume":"15","author":"Chaudhuri","year":"2008","journal-title":"Eur. J. Neurol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1016\/j.jcrc.2013.03.003","article-title":"Augmented Renal Clearance Is a Common Finding with Worse Clinical Outcome in Critically Ill Patients Receiving Antimicrobial Therapy","volume":"28","author":"Claus","year":"2013","journal-title":"J. Crit. care"},{"key":"B7","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1002\/phar.2231","article-title":"Augmented Renal Clearance","volume":"39","author":"Cook","year":"2019","journal-title":"Pharmacotherapy"},{"key":"B8","doi-asserted-by":"publisher","first-page":"7027","DOI":"10.1128\/AAC.01368-15","article-title":"Augmented Renal Clearance Implies a Need for Increased Amoxicillin-Clavulanic Acid Dosing in Critically Ill Children","volume":"59","author":"De Cock","year":"2015","journal-title":"Antimicrob. Agents Chemother."},{"key":"B9","doi-asserted-by":"publisher","first-page":"728075","DOI":"10.3389\/fphar.2021.728075","article-title":"Case Report: Subtherapeutic Vancomycin and Meropenem Concentrations Due to Augmented Renal Clearance in a Patient with Intracranial Infection Caused by Streptococcus Intermedius","volume":"12","author":"Fransson","year":"2021","journal-title":"Front. Pharmacol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e00634","DOI":"10.1128\/AAC.00634-19","article-title":"High-Dose Ceftriaxone for Bacterial Meningitis and Optimization of Administration Scheme Based on Nomogram","volume":"63","author":"Gr\u00e9goire","year":"2019","journal-title":"Antimicrob. Agents Chemother."},{"key":"B11","doi-asserted-by":"publisher","first-page":"e0089721","DOI":"10.1128\/AAC.00897-21","article-title":"Population. Pharmacokinetics and Dosing Optimization of Vancomycin in Infants, Children, and Adolescents with Augmented Renal Clearance","volume":"65","author":"He","year":"2021","journal-title":"Antimicrob. Agents Chemother."},{"key":"B12","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1097\/FTD.0000000000000270","article-title":"Augmented Renal Clearance in Pediatric Patients with Febrile Neutropenia Associated with Vancomycin Clearance","volume":"38","author":"Hirai","year":"2016","journal-title":"Ther. Drug Monit."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1093\/brain\/awg113","article-title":"Pneumococcal Meningitis in Adults: Spectrum of Complications and Prognostic Factors in a Series of 87 Cases","volume":"126","author":"Kastenbauer","year":"2003","journal-title":"Brain a J. Neurol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/S1473-3099(09)70306-8","article-title":"Acute Bacterial Meningitis in Infants and Children","volume":"10","author":"Kim","year":"2010","journal-title":"Lancet. Infect. Dis."},{"key":"B15","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1186\/1471-2369-13-124","article-title":"High Creatinine Clearance in Critically Ill Patients with Community-Acquired Acute Infectious Meningitis","volume":"13","author":"Lautrette","year":"2012","journal-title":"BMC Nephrol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/j.jped.2012.10.001","article-title":"A Prospective Study of Risk Factors. For Neurological Complications in Childhood Bacterial Meningitis","volume":"89","author":"Namani","year":"2013","journal-title":"J. Pediatr."},{"key":"B17","doi-asserted-by":"publisher","first-page":"e20170476","DOI":"10.1542\/peds.2017-0476","article-title":"The Epidemiology, Management, and Outcomes of Bacterial Meningitis in Infants","volume":"140","author":"Ouchenir","year":"2017","journal-title":"Pediatrics"},{"key":"B18","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1186\/s13063-016-1689-2","article-title":"Canadian Critical Care Trials Group and the Canadian Critical Care Translational Biology GroupA Trial to Determine whether Septic Shock-Reversal Is Quicker in Pediatric Patients Randomized to an Early Goal-Directed Fluid-Sparing Strategy versus Usual Care (SQUEEZE): Study Protocol for a Pilot Randomized Controlled Trial","volume":"17","author":"Parker","year":"2016","journal-title":"Trials"},{"key":"B19","doi-asserted-by":"publisher","first-page":"238","DOI":"10.1016\/j.jiph.2017.07.007","article-title":"Risk Factors for. Poor Prognosis in Children with Refractory Purulent Meningitis and the Discharge Criteria","volume":"11","author":"Peng","year":"2018","journal-title":"J. Infect. Public Health"},{"key":"B20","doi-asserted-by":"publisher","first-page":"106569","DOI":"10.1016\/j.ijantimicag.2022.106569","article-title":"Recommended Antibiotic Dosage Regimens in Critically Ill Patients with Augmented Renal Clearance: A Systematic Review","volume":"59","author":"Silva","year":"2022","journal-title":"Int. J. Antimicrob. Agents"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2165\/11318140-000000000-00000","article-title":"Augmented Renal Clearance: Implications for Antibacterial Dosing in the Critically Ill","volume":"49","author":"Udy","year":"2010","journal-title":"Clin. Pharmacokinet."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1016\/S0140-6736(12)61186-6","article-title":"Advances in Treatment of Bacterial Meningitis","volume":"380","author":"van de Beek","year":"2012","journal-title":"Lancet (London, Engl.)"},{"key":"B23","doi-asserted-by":"publisher","first-page":"S37","DOI":"10.1016\/j.cmi.2016.01.007","article-title":"ESCMID Guideline: Diagnosis and Treatment of Acute Bacterial Meningitis","volume":"22","author":"van de Beek","year":"2016","journal-title":"Clin. Microbiol. Infect."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1007\/s00467-019-04205-x","article-title":"Augmented Renal Clearance: a Common Condition in Critically Ill Children","volume":"34","author":"Van Der Heggen","year":"2019","journal-title":"Pediatr. Nephrol. Berl. Ger."},{"key":"B25","doi-asserted-by":"publisher","first-page":"3087","DOI":"10.1093\/jac\/dky314","article-title":"Therapeutic. Drug Monitoring of \u03b2-lactam Antibiotics in the Critically Ill: Direct Measurement of Unbound Drug Concentrations to Achieve Appropriate Drug Exposures","volume":"73","author":"Wong","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"B26","doi-asserted-by":"publisher","first-page":"835557","DOI":"10.3389\/fphar.2022.835557","article-title":"Augmented Renal Clearance in. Severe Infections-An Important Consideration in Vancomycin Dosing: A Narrative Review","volume":"13","author":"Xiao","year":"2022","journal-title":"Front. Pharmacol."}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2022.904322\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T06:13:31Z","timestamp":1655792011000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2022.904322\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,21]]},"references-count":26,"alternative-id":["10.3389\/fphar.2022.904322"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2022.904322","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,21]]},"article-number":"904322"}}