Welcome to the ESPID 2021 Meeting Calendar
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Introduction (ID 2336)
How to determine duration of treatment? (ID 227)
Phage therapy as options for difficult-to-treat infections in pediatrics (ID 228)
EFFECTS OF A NUDGE-BASED ANTIMICROBIAL STEWARDSHIP PROGRAM IN A PEDIATRIC PRIMARY EMERGENCY MEDICAL CENTER (ID 92)
Abstract
Background
Outpatient medical facilities tend to have high antimicrobial prescription rates, and are therefore major targets for antimicrobial stewardship programs. Previous studies have shown high rates of unnecessary antimicrobial prescriptions in outpatient settings (e.g., emergency departments, urgent care clinics, retail clinics, and medical centers). Pediatric primary emergency medical centers in Japan have difficulties in implementing conventional antimicrobial stewardship programs due to the low continuity of stewardship. Accordingly, there is a need to develop effective antimicrobial stewardship program models for these facilities.
Methods
We conducted a single-center, quasi-experimental study to evaluate the effects of a nudge-based antimicrobial stewardship program in reducing unnecessary third-generation cephalosporin prescriptions in a pediatric primary emergency care center. The implemented antimicrobial stewardship program utilizes monthly newsletters that report current antimicrobial use patterns and prescribing targets. We compared the monthly third-generation cephalosporin prescription numbers and proportions of unnecessary prescriptions before and after the program was implemented. The trends in third-generation cephalosporin prescriptions were examined using an interrupted time-series analysis.
Results
The numbers of patients before and after program implementation were 129,156 and 28,834, respectively. The number of unnecessary third-generation cephalosporin prescriptions decreased by 67.2% in the year after program implementation. The interrupted time-series analysis showed that the program was significantly associated with a reduction in third-generation cephalosporin prescriptions (regression coefficient: -0.58, P< 0.001).
Conclusions
The nudge-based antimicrobial stewardship program was effective in reducing third-generation cephalosporin use in a Japanese pediatric primary emergency care center. This simple and inexpensive approach may have applications in other outpatient facilities.
A HOST-BASED ASSAY COMPRISING TRAIL, IP-10 AND CRP CAN IMPROVE ANTIBIOTIC TREATMENT DECISIONS FOR VIRAL PCR POSITIVE CHILDREN BY ACCURATELY RULING OUT CO-INFECTION (ID 1360)
Abstract
Background
Identifying infectious disease etiology is essential for appropriate patient management, including antibiotic use. A known limitation of viral detection is that it does not rule out bacterial co-infection. Previous studies showed that a host assay comprising TNF-related apoptosis induced ligand (TRAIL), interferon gamma induced protein-10 (IP-10) and C-reactive protein (CRP) accurately differentiates bacterial from viral infections with negative predictive value >98%.
Methods
Children aged >90 days with fever without source or respiratory tract infection were prospectively recruited at pediatric emergency departments in Germany and Italy (AutoPilot-Dx; grant #701088; NCT03052088). Infection etiology was adjudicated by three independent experts based on clinical, laboratory, radiological and follow-up data. Viruses were detected using multiplex PCR on nasopharyngeal swabs. The host assay was conducted, giving three possible outcomes: viral, bacterial or equivocal.
Results
Out of 1,140 children recruited, 530 met inclusion criteria and had at least one viral detection. 483 of the viral PCR positive children were adjudicated as viral (blue circle) and 47 as bacterial (red dot). Children with bacterial infections were older (mean 3.9 years (SD 2.3) vs. 2.9 (3.0); p<0.001), had higher fever (mean 39.6°C (SD 0.7) vs. 39.2 (0.8); p=0.001), and were more likely to be admitted (93.6%) vs. 70.2%); p<0.001). To estimate the assay’s impact on antibiotic misuse, the observed treatment was considered the current practice, and a contraindicative assay result was assumed to trigger a change in practice, with current practice occurring in cases of equivocal results. In this model, the host assay potentially reduces antibiotic treatment of viral infections 3.75-fold (from 143 to 38 children; p<0.001), while also slightly reducing underuse (p=0.5).
Conclusions
The TRAIL/IP-10/CRP assay has the potential to improve antibiotic stewardship practices.
Clinical Trial Registration
Clinical trial registration: ClinicalTrials.gov NCT03052088
ANTIBIOTIC CONSUMPTION IN THE PAEDIATRIC INTENSIVE CARE UNIT: THE IMPACT OF 5 YEARS OF PAEDIATRIC ANTIBIOTIC STEWARDSHIP PROGRAM (ID 1003)
Abstract
Background
Paediatric intensive care units (PICU) are challenging settings for paediatric Antibiotic Stewardship Programs (p-ASP), in relation with critically ill patients, multidrug-resistant (MDR) microorganisms and healthcare-acquired infections. Since 2015, our non-restrictive p-ASPperforms biweekly audits, guidelines development and MDR monitoring in our hospital’s PICU. Our aim was to describe the evolution of antibiotic consumption in PICU from the pASP outset.
Methods
Antibiotic prescription data was collected retrospectively from the electronic prescription program (Centricity Care®), January 2015 to December 2019. Antibiotic consumption was defined as Days of therapy (DOT) per 100 occupied bed-days (OBD). Proportion of broad-spectrum antibiotics (glycopeptides, 3rd-and4th-generation cephalosporins, monobactams, carbapenems, fluoroquinolones, polymyxins, piperacillin-tazobactam, oxazolindiones, daptomycin) was also assessed. Statistical significance of antibiotic consumption trends was evaluated using linear regression.
Results
Overall consumption of antibacterials significantly decreased from 132.19 to 64.11 DOT/100 OBD from 2015 to 2019. The most frequently used antibacterial were combinations of penicillins incl. beta-lactamase inhibitors (29%), glycopeptides (15.3%) and carbapenems (12.8%). A statistically significant decrease was observed for overall broad-spectrum antibacterials, combinations of penicillins incl. beta-lactamase inhibitors, glycopeptides and fluoroquinolones. Carbapenems, aminoglycosides and 3rd-generation cephalosporins showed a non- significant decrease(figure1). Due to a greater decrease of overall use of antibacterials than in those with broader spectrum, a non-significant increase in the proportion of the latter was observed.
Conclusions
After pASP implementation, significant changes in antibiotic consumption occurred in PICU. Changes were consistent with pASP actions, that aimed to reduce the length and the spectrum of empiric antibiotics. An extra effort is needed to consolidate the decrease in carbapenems and aminoglycosides due to their usefulness in the treatment of MDR microorganisms in critically ill patients.