Aakash Khanijau (United Kingdom)

University of Liverpool Institute of Infection, Veterinary and Ecological Sciences
I am a Medical Doctor based in the United Kingdom. I graduated from The University of Oxford in 2018, and completed my first two years of post-graduate training at Whiston Hospital in Merseyside. I am currently undertaking a Clinical Research Fellow post at the University of Liverpool, where I am working as part of the H2020 funded PERFORM and DIAMONDS consortia. My clinical and academic interests are in Infectious Diseases and Medical Microbiology, particularly in improving the diagnosis of infection and antimicrobial stewardship.

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ANTIBIOTIC USE IN DEFINITE VIRAL AND DEFINITE BACTERIAL PHENOTYPES FROM THE PERFORM BIVA-STUDY ACROSS EUROPE (ID 563)

Session Name
2505 - PARALLEL SYMPOSIUM 11: MANAGING “TRIVIAL” INFECTIONS (YOUNG ESPID) (ID 101)
Lecture Time
10:08 - 10:15
Room
Hall 03
Presenter

Abstract

Background

Over prescription of antibiotics in paediatric Emergency Departments (EDs) leads to increased antimicrobial resistance. Optimisation of antibiotic prescription is a critical goal for antimicrobial stewardship initiatives.

Methods

Using the European PERFORM (www.perform2020.org) BIVA-database of febrile children attending the ED who had blood tests performed, cases were phenotyped using the PERFORM bacterial/viral probability algorithm. We determined empiric antibiotic use in children in view of the individual’s final phenotype of definite bacterial (DB) or definite viral (DV) infection. Antibiotics prescribed were classified according to WHO AWaRe (Access, Watch, Reserve).

Results

Of 1080 febrile children with a definite final diagnosis, 582 were assigned a DB and 498 a DV final phenotype. Of note, initial working diagnoses were largely similar between DB and DV phenotypes, except urinary tract infection and respiratory tract infection.

initial diagnoses.png

A total of 542 (93.1%) DB and 281 (57.0%) DV were prescribed empiric antibiotics during admission. In the DB group, 55 (10.2%) children received oral and 487 (89.9%) intravenous/intramuscular (IV/IM) antibiotics. In comparison, 67 (23.8%) children with a DV phenotype received oral and 214 (76.2%) IV/IM antibiotics (p<0.00001). The top 3 antibiotics were third-generation cephalosporins, penicillins and penicillin/beta-lactamase inhibitor combinations in both DB and DV. A total of 408 (75.3%) DB and 212 (75.4%) DV had ≥ 1 WHO Watch antibiotics prescribed.

Conclusions

Differentiating bacterial/viral aetiology of febrile illness is difficult on initial presentation to the ED. A significant proportion of children with a final DV phenotype received antibiotics during admission, predominantly classified as WHO Watch. Rapid and accurate point-of-care tests in the ED differentiating between DB and DV could significantly reduce antibiotic prescribing, thereby improving antimicrobial stewardship.

Acknowledgements

This project received funding from the European Union’s Horizon2020 programme under grant agreement 668303.

Clinical Trial Registration

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