Evaluating current practice and knowledge about antibiotic stewardship principles in paediatric tertiary hospitals to identify target areas for future teaching activities

PURPOSE

Antibiotic exposure among hospitalized children is very high. With inappropriate antimicrobial use resulting in increased rates of antimicrobial resistance, the implementation of antibiotic stewardship programs is critically needed. This survey study aimed to identify current practice and knowledge about antibiotic stewardship and infection control among paediatricians in tertiary care paediatric hospitals in and around Munich, Germany.

METHODS

A prospective cross-sectional study based on an anonymous questionnaire, structured into different sub-sections regarding antibiotic use, antimicrobial resistance, antibiotic stewardship and infection control, was conducted between 1st of May and 30th of June 2016 in five paediatric hospitals.

RESULTS

In total, 111 paediatricians across all grades were eligible for participation. The overall proportion of correct answers for all sub-sections of the survey ranged from 54.1% correct answers in the antibiotic handling and bacterial resistance section to 72.9% correct answers in the hospital hygiene/infection control section. In general, knowledge across all categories was similar for junior doctors, middle-grade doctors or consultants. Advocating empiric use of narrow-spectrum instead of broad-spectrum antibiotics was considered to be the most difficult measure to implement in daily practice (36.9%). De-escalation from broad-spectrum empirical therapy to targeted treatment was considered the easiest measure to achieve (43.2%).

CONCLUSION

Our results demonstrate that principles of antimicrobial stewardship and aspects of hospital hygiene/infection control are not satisfactorily known among hospital-based paediatricians in and around Munich. We identified four important target areas for future educational interventions that should play a more prominent role in both pre- and postgraduate medical training.

Abstract A28: Donor lymphocyte infusion after allogeneic stem cell transplantation is a feasible therapy option with acceptable toxicity rates in patients with refractory Ewing’s sarcoma and rhabdomyosarcoma

Background: New therapy options are urgently needed for patients with treatment-refractory Ewing’s sarcoma (ES) or rhabdomyosarcoma (RMS). In these subgroups, the role of allogeneic stem cell transplantation (allo-SCT) to induce a graft-versus-tumor effect (GvT) remains unclear. Here, we describe our experience and the general feasibility of donor lymphocyte infusion (DLI) following allo-SCT for those patients.

Patients and Methods: We retrospectively evaluated data of eight patients with treatment-refractory ES (ES #1-4) and RMS (RMS #1-4) after DLI following allo-SCT. Data were individually evaluated for presence of graft-versus-host disease (GvHD), relapse-free survival (RFS), and overall survival (OS). Three of four ES and one of four RMS patients had received haploidentical grafts; the remaining patients received HLA-matched grafts prior to DLI. Patients received donor lymphocytes ranging from 2.5 x 104 to 1 x 108 CD3+ cells/kg body weight.

Results: ES #4 and RMS #4 developed acute GvHD after DLI. Limited chronic GvHD was observed in RMS #3. In two patients, DLI was associated with stable disease for nine (ES #2) and six months (ES #4), respectively. RMS #4 showed partial remission lasting for eight months after one dose of DLI with 1 x 106 CD3+ cells/kg combined with local hyperthermia and chemotherapy. ES #4 had residual disease before allo-SCT and was converted to CR after DLI. Altogether, seven patients died of disease and none of toxicity. RMS #2 received seven doses up to 1 x 108 CD3+ cells/kg and IL-2 including surgery and chemotherapy and remained in CR for 97 months at the date of data assessment. Median follow-up after allo-SCT was 27.5 months.

Conclusion: DLI after allo-SCT is a feasible therapy option for treatment-refractory ES and RMS patients. In this analysis, DLI-related toxicity is acceptable. These findings have to be evaluated in prospective analyses.

Citation Format: Sebastian J. Schober, Maximilian Steinhauser, Angela Wawer, Irene Teichert-von Luettichau, Christoph Salat, Rolf D. Issels, Wolfgang Schwinger, Marek Ussowicz, Petar Antunovic, Luca Castagna, Hans-Jochem Kolb, Stefan E.G. Burdach, Uwe Thiel. Donor lymphocyte infusion after allogeneic stem cell transplantation is a feasible therapy option with acceptable toxicity rates in patients with refractory Ewing’s sarcoma and rhabdomyosarcoma [abstract]. In: Proceedings of the AACR Special Conference: Pediatric Cancer Research: From Basic Science to the Clinic; 2017 Dec 3-6; Atlanta, Georgia. Philadelphia (PA): AACR; Cancer Res 2018;78(19 Suppl):Abstract nr A28.

Donor lymphocyte infusions in adolescents and young adults for control of advanced pediatric sarcoma

Background

Allogeneic stem cell transplantation (allo-SCT) and donor lymphocyte infusions (DLI) may induce a graft-versus-tumor effect in pediatric sarcoma patients. Here, we describe general feasibility, toxicity and efficacy of DLI after allo-SCT.

Results

4 of 8 patients responded. ES#4 had stable disease (SD) for 9 months after DLI and RMS#4 partial response for 8 months with combined hyperthermia/chemotherapy. In ES#4, DLI led to SD for 6 months and reverted residual disease before allo-SCT into complete remission. After DLI, ES#4 and RMS#4 developed acute GvHD (°III-°IV), ES#4 also developed chronic GvHD. 5 patients including ES#4 lived longer than expected. Median survival after allo-SCT was 2.3 years, post-relapse survival (PRS) was 13 months. Off note, HLA-mismatched DLI were associated with a trend towards increased survival after allo-SCT and increased PRS compared to HLA-matched DLI (23 versus 3 months).

Materials and Methods

We studied eight adolescents and young adults (AYAs) with advanced Ewing sarcoma (ES#1-4) and rhabdomyosarcoma (RMS#1-4) who received DLI. Escalating doses ranged from 2.5 × 10⁴ to 1 × 10⁸ CD3⁺ cells/kg body weight. AYAs were evaluated for response to DLI, graft-versus-host disease (GvHD) and survival.

Conclusions

DLI after allo-SCT may control advanced pediatric sarcoma in AYAs with controllable toxicity.

Brain stem cell division and maintenance studied using multi-isotope imaging mass spectrometry (MIMS)

New neurons are continuously produced from neural stem cells in specific regions of the adult brain of animals and humans. In the hippocampus, a region crucial for cognitive function, neurogenesis responds to a multitude of extrinsic stimuli; emerging evidence indicates that it may be important for behavior, pathophysiology, brain repair, and response to drugs. We have developed an approach to identify and quantify the cellular targets of pro- and anti-neurogenic stimuli, based on reporter transgenic mouse lines in which neural stem and progenitor cells or their progeny are marked by fluorescent proteins. Here, we demonstrate the feasibility of using MIMS for studying adult neurogenesis.

Hyperfine splitting in positronium to O(α(7)m(e)): one photon annihilation contribution

We present the complete result for the O(α7me) one photon annihilation contribution to the hyperfine splitting of the ground state energy levels in positronium. Numerically it increases the prediction of quantum electrodynamics by 217±1  kHz.

Quark and gluon form factors to three loops

We compute the form factors of the photon-quark-anti-quark vertex and the effective vertex of a Higgs-boson and two gluons to three-loop order within massless perturbative quantum chromodynamics. These results provide building blocks for many third-order cross sections. Furthermore, this is the first calculation of complete three-loop vertex corrections.

Higgs boson mass in supersymmetry to three loops

Within the minimal supersymmetric extension of the standard model, the mass of the light CP-even Higgs boson is computed to three-loop accuracy, taking into account the next-to-next-to-leading order effects from supersymmetric quantum chromodynamics. We consider two different scenarios for the mass hierarchies of the supersymmetric spectrum. Our numerical results amount to corrections of about 500 MeV, which is of the same order as the experimental accuracy expected at the CERN Large Hadron Collider.

Estimate of B(B(over) -->Xgamma) at O(alpha(s)2)

Combining our results for various O(alpha[s]) corrections to the weak radiative B-meson decay, we are able to present the first estimate of the branching ratio at the next-to-next-to-leading order in QCD. We find B(B[over ]-->X[s]gamma)=(3.15+/-0.23) x 10(-4) for Egamma>1.6 GeV in the B[over ]-meson rest frame. The four types of uncertainties:nonperturbative (5%), parametric (3%), higher-order (3%), and m(c)-interpolation ambiguity (3%) have been added in quadrature to obtain the total error.

On attentional control as a source of residual shift costs: evidence from two-component task shifts

It is widely assumed that supervisory or attentional control plays a role only in the preparatory reconfiguration of the mental system in task shifting. The well-known fact that residual shift costs are still present even after extensive preparation is usually attributed to passive mechanisms such as cross talk. The authors question this view and suggest that attentional control is also responsible for residual shift costs. The authors hypothesize that, under shift conditions, tasks are executed in a controlled mode to guarantee reliable performance. Consequently, the control of 2 task components should require more resources than the control of only 1. A series of 4 experiments with 2-component tasks was conducted to test this hypothesis. As expected, more residual shift costs were observed when 2 components rather than 1 varied across trials. Interference effects and sequential effects could not account for these results.