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