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The Impact of Antibiotic Initiation Timing in Children with Severe Community-Acquired Pneumonia: A Post-Hoc Analysis of an Observational Study

Loh SW 1 , Wong JJ 2 , Abbas Q 3 , Angurana SK 4 , Cho HJ 5 , Dang H 6 Show all authors , Efar P 7 , Phan PH 8 , Lee PC 9 , Liu C 10 , Fan L 11 , Pukdeetraipop M 12 , Wang JQY 13 , Yuliarto S 14 , Zhu MX 15 , Sultana R 16 , Lee JH 2 , Paediatric Acute Critical Care Asian Network (PACCMAN)

Affiliations 

  • 1 Children's Intensive Care Unit, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. xinweiloh87@gmail.com
  • 2 Children's Intensive Care Unit, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
  • 3 Aga Khan University Hospital, Karachi, Pakistan
  • 4 Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
  • 5 Chonnam National University Children's Hospital and Medical School, Gwangju, South Korea
  • 6 Children's Hospital of Chongqing Medical University, Chongqing, China
  • 7 Harapan Kita Women's and Children's Hospital, West Jakarta, Indonesia
  • 8 Vietnam National Children's Hospital, Hanoi, Vietnam
  • 9 University Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
  • 10 Shengjing Hospital of China Medical University, Shenyang, China
  • 11 National University Hospital, Singapore, Singapore
  • 12 King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • 13 University Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 14 Saiful Anwar Hospital, Malang, Indonesia
  • 15 Children's Hospital of Fudan University, Shanghai, China
  • 16 Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
Pulm Ther, 2026 Oct 27.
PMID: 42944981 DOI: 10.1007/s41030-026-00398-3

Abstract

INTRODUCTION: The aim of this study was to examine the association between early antibiotic initiation and clinical outcomes in children admitted to the paediatric intensive care unit (PICU) with severe community-acquired pneumonia (CAP).

METHODS: We conducted a post-hoc analysis of a multicentre observational study across nine Asian PICUs. Children with severe CAP were categorized into early (≤ 6 h) or late (> 6 h) antibiotic initiation groups (early and late antibiotic groups, respectively) relative to PICU admission. The primary outcome was PICU mortality; secondary outcomes were 28-day ventilation-free days (VFD) and intensive care unit-free days (IFD). Multivariable analyses adjusted for country as fixed effect, age, Paediatric Index of Mortality 3 (PIM 3) score and comorbidities, when feasible.

RESULTS: Among the 544 paediatric patients included in the analysis, median age was 14.0 [interquartile range (IQR) 4.0-34.0] months and the PIM 3 score was 0.3 (IQR 0.0-6.8) %. Viral and bacterial pathogens were isolated in 206 (37.9%) and 145 (26.7%) patients, respectively. Almost all patients [537 (98.7%)] received antibiotics, with 475 (87.3%) and 62 (11.4%) patients in the early and late antibiotic groups, respectively. Late antibiotic initiation was associated with higher PICU mortality [adjusted odds ratio (aOR) 5.19, 95% confidence interval (CI) 1.94-13.88, P 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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