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Aboza Garcia M, Goycochea-Valdivia W, Peñalva G, Falcon Neyra L, Moleón Ruiz M, Rodriguez-Villodres A, Montero Valladares C, Olbrich P, Sánchez-Valderrabanos E, Jiménez F, Molina M, Moreno Madueño G, Valencia Martin R, Gil Navarro MV, Molina J, Neth O, Cisneros JM. Long-term outcomes of an educational paediatric antimicrobial stewardship programme: a quality improvement study. Arch Dis Child 2024; 109:144-151. [PMID: 37940361 DOI: 10.1136/archdischild-2022-323802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Antimicrobial stewardship programmes (ASPs) have resulted in antimicrobial consumption (AMC) reduction and quality of prescription (QOP) improvement. However, evidence of ASP impact in paediatrics is still limited. This study aims to assess a paediatric ASP long-term outcomes. METHODS A quality improvement study assessed by a interrupted time series analysis was conducted in a paediatric tertiary hospital. QOP expressed as proportion of adequate prescriptions, AMC measured by defined daily dose incidence per 1000 occupied bed days, incidence density of bloodstream infections (BSIs) and its related all-cause crude death rate (CDR) were compared between pre (from January 2013 to December 2015) and post (from January 2016 to December 2019) ASP activities intensification, which included a dedicated paediatric infectious diseases physician to actively perform educational interviews with prescribers. RESULTS Inappropriate prescribing showed a significant downward shift associated to the intervention with a -51.4% (-61.2% to -41.8%) reduction with respect to the expected values. Overall AMC showed no trend change after the intervention. For neonatology a28.8% (-36.8% to -20.9%) reduction was observed. Overall anti-pseudomonal cephalosporin use showed a -51.2% (-57.0% to -45.4%) reduction. Decreasing trends were observed for carbapenem use, with a quarterly per cent change (QPC) of -2.4% (-4.3% to -0.4%) and BSI-related CDR (QPC=-3.6%; -5.4% to -1.7%) through the study period. Healthcare-associated multi-drug-resistant BSI remained stable (QPC=2.1; -0.6 to 4.9). CONCLUSIONS Intensification of counselling educational activities within an ASP suggests to improve QOP and to partially reduce AMC in paediatric patients. The decreasing trends in mortality remained unchanged.
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Affiliation(s)
- Marta Aboza Garcia
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, UniversityHospital Virgen del Rocío, Institute of Biomedicine of Seville (IBIS)/ Universidad deSevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica, Seville, Spain
| | - Walter Goycochea-Valdivia
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, UniversityHospital Virgen del Rocío, Institute of Biomedicine of Seville (IBIS)/ Universidad deSevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica, Seville, Spain
| | - Germán Peñalva
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocio, Spanish National Research Council, University of Seville, Seville, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Lola Falcon Neyra
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, UniversityHospital Virgen del Rocío, Institute of Biomedicine of Seville (IBIS)/ Universidad deSevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica, Seville, Spain
| | - Marta Moleón Ruiz
- Department of Pharmacy, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Angel Rodriguez-Villodres
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocio, Spanish National Research Council, University of Seville, Seville, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Peter Olbrich
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, UniversityHospital Virgen del Rocío, Institute of Biomedicine of Seville (IBIS)/ Universidad deSevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica, Seville, Spain
| | | | - Francisco Jiménez
- Department of Neonatology, University Hospital Virgen del Rocío, Seville, Spain
| | - Maria Molina
- Department of Paediatric Surgery, University Hospital Virgen del Rocío, Seville, Spain
| | | | | | - Maria Victoria Gil Navarro
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Pharmacy, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - Jose Molina
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocio, Spanish National Research Council, University of Seville, Seville, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, UniversityHospital Virgen del Rocío, Institute of Biomedicine of Seville (IBIS)/ Universidad deSevilla/CSIC, Red de Investigación Traslacional en Infectología Pediátrica, Seville, Spain
| | - Jose Miguel Cisneros
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocio, Spanish National Research Council, University of Seville, Seville, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Barker CIS, Kipper K, Lonsdale DO, Wright K, Thompson G, Kim M, Turner MA, Johnston A, Sharland M, Standing JF. The Neonatal and Paediatric Pharmacokinetics of Antimicrobials study (NAPPA): investigating amoxicillin, benzylpenicillin, flucloxacillin and piperacillin pharmacokinetics from birth to adolescence. J Antimicrob Chemother 2023; 78:2148-2161. [PMID: 37531085 PMCID: PMC10477139 DOI: 10.1093/jac/dkad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/09/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Pharmacokinetic (PK) data underlying paediatric penicillin dosing remain limited, especially in critical care. OBJECTIVES The primary objective of the Neonatal and Paediatric Pharmacokinetics of Antimicrobials study (NAPPA) was to characterize PK profiles of commonly used penicillins using data obtained during routine care, to further understanding of PK variability and inform future evidence-based dosing. METHODS NAPPA was a multicentre study of amoxicillin, co-amoxiclav, benzylpenicillin, flucloxacillin and piperacillin/tazobactam. Patients were recruited with informed consent. Antibiotic dosing followed standard of care. PK samples were obtained opportunistically or at optimal times, frozen and analysed using UPLC with tandem MS. Pharmacometric analysis was undertaken using NONMEM software (v7.3). Model-based simulations (n = 10 000) tested PTA with British National Formulary for Children (BNFC) and WHO dosing. The study had ethical approval. RESULTS For the combined IV PK model, 963 PK samples from 370 participants were analysed simultaneously incorporating amoxicillin, benzylpenicillin, flucloxacillin and piperacillin data. BNFC high-dose regimen simulations gave these PTA results (median fT>MIC at breakpoints of specified pathogens): amoxicillin 100% (Streptococcus pneumoniae); benzylpenicillin 100% (Group B Streptococcus); flucloxacillin 48% (MSSA); and piperacillin 100% (Pseudomonas aeruginosa). Oral population PK models for flucloxacillin and amoxicillin enabled estimation of first-order absorption rate constants (1.16 h-1 and 1.3 h-1) and bioavailability terms (62.7% and 58.7%, respectively). CONCLUSIONS NAPPA represents, to our knowledge, the largest prospective combined paediatric penicillin PK study undertaken to date, and the first paediatric flucloxacillin oral PK model. The PTA results provide evidence supportive of BNFC high-dose IV regimens for amoxicillin, benzylpenicillin and piperacillin.
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Affiliation(s)
- Charlotte I S Barker
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
- Paediatric Infectious Diseases Department, St George’s University Hospitals NHS Foundation Trust, London, UK
- Infection, Immunity and Inflammation Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Medical & Molecular Genetics, King’s College London, London, UK
| | - Karin Kipper
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
- Analytical Services International, St George’s, University of London, London, UK
- Analytical Chemistry Department, Epilepsy Society, Chesham Lane, Chalfont St Peter, Buckinghamshire, UK
- Institute of Chemistry, University of Tartu, Tartu, Estonia
| | - Dagan O Lonsdale
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
- Paediatric Infectious Diseases Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Kirstie Wright
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
| | - Georgina Thompson
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
| | - Min Kim
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
- Infection, Immunity and Inflammation Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Mark A Turner
- Department of Women’s and Children’s Health, University of Liverpool, Liverpool Health Partners, Liverpool, UK
| | - Atholl Johnston
- Analytical Services International, St George’s, University of London, London, UK
- Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Mike Sharland
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
- Paediatric Infectious Diseases Department, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Joseph F Standing
- Centre for Neonatal and Paediatric Infection, Level 2 Jenner Wing, Institute for Infection and Immunity, St George’s, University of London SW17 0RE, London, UK
- Infection, Immunity and Inflammation Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Pharmacy Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
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Goycochea-Valdivia WA, Melendo Pérez S, Aguilera-Alonso D, Escosa-Garcia L, Martínez Campos L, Baquero-Artigao F. Position statement of the Spanish Society of Paediatric Infectious Diseases on the introduction, implementation and assessment of antimicrobial stewardship programmes in paediatric hospitals. An Pediatr (Barc) 2022; 97:351.e1-351.e12. [PMID: 36243665 DOI: 10.1016/j.anpede.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023] Open
Abstract
In the past few years, antimicrobial resistance has increased, becoming a serious public health problem. The irrational use of antimicrobials is one of the main contributors to antimicrobial resistance. The paediatric population is not free from this problem, as antimicrobials are widely prescribed in this age group, often inappropriately. The introduction of antimicrobial stewardship programmes (ASPs) has proven crucial in curbing the emergence of antimicrobial resistance. At the international level, the need to develop specific paediatric ASPs has been recognised on account of the differences between adult and paediatric patients as concerns infection and approaches to diagnosis and treatment. For this reason, paediatric ASPs should be multidisciplinary programmes led by paediatric infectious disease specialists and use specific paediatric indicators (such as days of treatment, antimicrobial susceptibility patterns in the paediatric population, or clinical indicators) to help identify areas of improvement and develop effective targeted interventions. On the other hand, the support and leadership of the pertinent scientific societies are also essential. The purpose of this document is to present the position of the Sociedad Española de Infectología Pediátrica (SEIP, Spanish Society of Paediatric Infectious Diseases) concerning the implementation of paediatric ASPs in hospitals in Spain and to provide tools to facilitate their application in hospitals throughout the regional health care systems in the country.
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Affiliation(s)
| | - Susana Melendo Pérez
- Unidad de Patología infecciosa e Inmunodeficiencias de Pediatría, Servicio de Pediatría, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - David Aguilera-Alonso
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital Universitario Gregorio Marañón, Madrid. CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Escosa-Garcia
- Servicio de Pediatría Hospitalaria, Enfermedades Infecciosas y Tropicales, Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid. CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Fernando Baquero-Artigao
- Servicio de Pediatría Hospitalaria, Enfermedades Infecciosas y Tropicales, Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Madrid. CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Posicionamiento de la Sociedad Española de Infectología Pediátrica sobre la implementación, ejecución y monitorización de los programas de optimización de uso de antimicrobianos en pediatría hospitalaria. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Yin K, Liu L, Fan G. Classification and Drug Resistance Analysis of Pathogenic Bacteria in Patients with Bacterial Pneumonia in Emergency Intensive Care Unit. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:6980091. [PMID: 36262997 PMCID: PMC9546695 DOI: 10.1155/2022/6980091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/29/2022] [Accepted: 07/27/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to compare the identification efficiency of metagenome next generation sequencing (mNGS) and traditional methods in detecting pathogens in patients with severe bacterial pneumonia (BP) and further analyze the drug resistance of common pathogens. METHODS A total of 180 patients with severe BP who were admitted to our hospital from June 2017 to July 2020 were selected as the research objects. Alveolar lavage fluid from the patients were collected, and pathogens were detected by the mNGS technology and traditional etiological detection technology. Common pathogens detected by mNGS were tested for the drug sensitivity test. The difference between mNGS and traditional detection method in the identification of pathogenic bacteria in severe BP patients was compared, and the distribution characteristics and drug resistance of pathogenic bacteria were analyzed. RESULTS The positive rate of mNGS detection was 92.22%, which was significantly higher than that of the traditional culture method (58.33%, P < 0.05). 347 strains of pathogenic bacteria were detected by mNGS, including 256 strains of Gram-negative bacteria (G-), 89 strains of Gram-positive bacteria (G+), and 2 strains of fungi. Among G- bacteria, Acinetobacter baumannii had higher resistance to piperacillin/tazobactam, ceftazidime, imipenem, levofloxacin, amikacin, ciprofloxacin, gentamicin, and the lowest resistance to tigecycline. The resistance of Klebsiella pneumoniae to piperacillin/tazobactam and ceftazidime was higher. Pseudomonas aeruginosa had low resistance to all the drugs. Escherichia coli had high drug resistance to most drugs, and the drug resistant rates to cefoperazone/sulbactam, piperacillin/tazobactam, ceftazidime, imipenem, and gentamicin were all more than 50.00%. G+ bacteria had high resistance to penicillin, azithromycin, amoxicillin and levofloxacin, and amoxicillin and levofloxacin had high resistance, up to 100.00%. CONCLUSION mNGS has high sensitivity for the identification of pathogenic bacteria in patients with BP. G- bacteria were the main pathogens of BP, but both G- and G+ bacteria had high resistance to a variety of antibacterial drugs.
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Affiliation(s)
- Kai Yin
- Department of Emergency, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Ling Liu
- Department of Pneumology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Guofeng Fan
- Department of Emergency, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
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An AI-based auxiliary empirical antibiotic therapy model for children with bacterial pneumonia using low-dose chest CT images. Jpn J Radiol 2021; 39:973-983. [PMID: 34101118 PMCID: PMC8490241 DOI: 10.1007/s11604-021-01136-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/13/2021] [Indexed: 11/27/2022]
Abstract
Purpose To construct an auxiliary empirical antibiotic therapy (EAT) multi-class classification model for children with bacterial pneumonia using radiomics features based on artificial intelligence and low-dose chest CT images. Materials and methods Data were retrospectively collected from children with pathogen-confirmed bacterial pneumonia including Gram-positive bacterial pneumonia (122/389, 31%), Gram-negative bacterial pneumonia (159/389, 41%) and atypical bacterial pneumonia (108/389, 28%) from January 1 to June 30, 2019. Nine machine-learning models were separately evaluated based on radiomics features extracted from CT images; three optimal submodels were constructed and integrated to form a multi-class classification model. Results We selected five features to develop three radiomics submodels: a Gram-positive model, a Gram-negative model and an atypical model. The comprehensive radiomics model using support vector machine method yielded an average area under the curve (AUC) of 0.75 [95% confidence interval (CI), 0.65–0.83] and accuracy (ACC) of 0.58 [sensitivity (SEN), 0.57; specificity (SPE), 0.78] in the training set, and an average AUC of 0.73 (95% CI 0.61–0.79) and ACC of 0.54 (SEN, 0.52; SPE, 0.75) in the test set. Conclusion This auxiliary EAT radiomics multi-class classification model was deserved to be researched in differential diagnosing bacterial pneumonias in children.
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Abstract
Antimicrobial resistance is of global concern, and preserving the ability of many antimicrobials to kill disease-causing bacteria is likely to become more challenging over time. However, we are speeding up this process dramatically by using antibiotics too much or in the wrong way. Respecting simple key principles of optimal antibiotic prescribing together with commitment to further research in this area from the pediatric community is essential to extend the lifeline of antibiotics for the most vulnerable patients without limiting access to antibiotics for those children who require treatment.
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