Welcome to the ESPID 2022 Meeting Calendar

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Displaying One Session

Session Type
Oral Presentations Session
Date
Thu, 12.05.2022
Session Time
10:00 - 11:30
Room
MC 2 HALL

INDIVIDUALISED VANCOMYCIN DOSING IN YOUNG INFANTS: PROSPECTIVE CLINICAL VALIDATION OF A NOVEL ONLINE DOSING CALCULATOR

Date
Thu, 12.05.2022
Session Time
10:00 - 11:30
Session Type
Oral Presentations Session
Room
MC 2 HALL
Lecture Time
10:02 - 10:12

Abstract

Backgrounds:

In the majority of young infants, current empiric vancomycin dosing regimens fail to achieve the target concentrations required to treat sepsis. Individualised model-based dosing may improve attainment of therapeutic concentrations by accounting for the factors attributing to interindividual variability. This study assessed the performance of an online dosing calculator (Vanc App) based on a published pharmacokinetic model in achieving target trough vancomycin concentrations of 10 to 20 mg/L at first steady state level (24 to 48 hours) and an AUC24 between 400 and 650 mg/L.h.

Methods

Multicentre study in four Australian tertiary paediatric hospitals over a 17-month period. Infants aged between 0 to 90 days of age with suspected Gram-positive sepsis were eligible. The Vanc App was used to generate a dose based on the infant’s postmenstrual age (PMA), weight, creatinine level and target vancomycin trough concentration.

Results:

Overall, 40 young infants were enrolled, 40% female with a median weight of 2505 (range 700-4460) grams and PMA 37.4 (range 25.7-49) weeks. The median recommended vancomycin dose using Vanc App was 44.5 (range 24 to 79) mg/kg/day. All infants had trough vancomycin concentrations measured at 24 hours and 30 (75%, 95% CI 62%-88%) achieved target trough concentrations, with five each having supratherapeutic (3 between 20-25 mg/L and 2 >25 mg/L) and subtherapeutic concentrations. Target AUC24 was achieved in 32 (80%) for AUC0-24. There were no episodes of vancomycin infusion reaction or nephrotoxicity (defined as creatinine level >2 times baseline).

Conclusions/Learning Points:

Individualised vancomycin dosing using a model-based online calculator resulted in 75% and 80% of young infants achieving target trough and AUC24 targets, respectively at the first steady-state level with no significant vancomycin-related adverse effects.

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ANTIBIOTIC THERAPY ON THE PAEDIATRIC ENVIN-HELICS DATA BASE

Date
Thu, 12.05.2022
Session Time
10:00 - 11:30
Session Type
Oral Presentations Session
Room
MC 2 HALL
Lecture Time
10:12 - 10:22

Abstract

Backgrounds:

Healthcare-associated infections (HAI) are a major public-health problem. The aim of this study is to compare the evolution of antibiotics used for HAI diagnosed in Paediatric Intensive Care Units (PICU) from the Spanish registry Paediatric-ENVIN-HELICS.

Methods

Multicentre, prospective and observational study of HAI diagnosed in 28 Spanish PICU, during a three-month period from 2014–2020. The ENVIN diagnostic criteria adapted to paediatrics were used, based on CDC recommendations.

Results:

Total number of patients was 10972. In 2020 the rate of antibiotics use was 67%. Comparing 2020 with 2014, this rate decreased 12% (p<0.001). The Antimicrobial Stewardship Programs (ASP) were implemented in 26 PICUs (92%) in 2020, compared with 9 (32%) in 2014.

Comparing the last and the firts year of the registry, antibiotic stewardship was 17.7% higher (p<0.001). Early suspension antibiotic rate increased (2.4%, p>0.05). Antibiotic modifications due to side effects decreased (0.9%), but modifications due to new resistances during treatment increased (0.1%), not statistically significant differences were found.

There was an increase in meropenem use compared with the previous year (p>0.05): for HAI previous PICU admission of 5.1% and for PICU HAI of 4.1%.

Conclusions/Learning Points:

The rate of antibiotics use was high, but results showed a significant decrease during 2020. Despite the implementation of ASP, the use of carbapenems for HAI increased in 2020. The improvement in antibiotic use policies is evident thanks to the increase of antibiotic de-escalation and early suspension rate. In 2020 there was a reduction on the modifications of the antibiotic regime due to adverse events, but an upturn of the emergence of new resistant microorganisms.

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IMPACT IN ANTIBIOTIC USE AFTER IMPLEMENTATION OF AN ANTIMICROBIAL STEWARDSHIP PROGRAM AND A JOINT PROTOCOL WITH ELECTRONIC PRESCRIPTION FOR APPENDICITIS/PERITONITIS IN PEDIATRICS

Date
Thu, 12.05.2022
Session Time
10:00 - 11:30
Session Type
Oral Presentations Session
Room
MC 2 HALL
Lecture Time
10:22 - 10:32

Abstract

Backgrounds:

Initial antibiotic treatment in appendicitis/peritonitis significantly reduces wound infection and intra-abdominal abscess formation in patients with gangrenous or perforated appendicitis. Randomized controlled trials have shown that the use of lower-spectrum antibiotic combinations is as effective in preventing abscesses or surgical wound infections as broad-spectrum regimens.

Methods

Observational, retrospective study of patients <16 years of age admitted for appendicitis and/or peritonitis from Jan/2014 to Dec/2019 in a tertiary university hospital in Madrid, Spain. Three study periods were established: P1 2014-2015 (before Antimicrobial Stewardship Programme (ASP)), P2 2016-2018 (ASP implemented) and P3 Jan/2019-Dec/2019 (ASP and implementation of an appendicitis/peritonitis protocol with electronic prescription, including lower-spectrum antibiotic combinations and selected and clinically guided use after surgery). Antimicrobial use was analysed with the days of therapy/1000 admissions days (DOT/1000) and start of treatment/1000 hospital admissions (SOT/1000).

Results:

During the study period a total of 1619 patients met inclusion criteria. The proportion of patients without antibiotic therapy after surgery during P1, P2 and P3 was 5.6%, 3.7%, and 38.6% respectively. [C1] The evolution of antibiotic use expressed by DOT / 1000 is shown in Figure 1. SOT/1000 of ampicillin, gentamicin and metronidazole rose from 162, 190 and 190 in 2014 to 386, 402 and 409 in 2019. DOT/1000 of meropenem drop to 64.85 in 2014 to 0 in 2019.

dot:1000.png

Conclusions/Learning Points:

The implementation of an ASP and a low-spectrum antibiotic protocol with electronic prescribing, reduced the antimicrobial use in children with appendicitis/peritonitis. The proportion of patients without antibiotic therapy after surgery increased and the use of carbapenems and other broad-spectrum antibiotics was reduced after the intervention. These improvements were observed when an electronically available protocol was added to the ASP implementation.

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DURATION OF ANTIBIOTIC PRESCRIPTION AMONG YOUNG CHILDREN IN BRITISH COLUMBIA (BC), CANADA: ROOM FOR IMPROVEMENT

Date
Thu, 12.05.2022
Session Time
10:00 - 11:30
Session Type
Oral Presentations Session
Room
MC 2 HALL
Lecture Time
10:32 - 10:42

Abstract

Backgrounds:

Antibiotic overuse, including unnecessary prescription as well as longer than necessary duration of therapy (DOT), contributes to antibiotic resistance. This study examined the DOT for common infections among children <10 years in BC, Canada.

Methods

In this population-based, retrospective cohort study, prescription and physician billing data generated during 2019 were anonymously linked to determine prescriptions associated with specific diagnoses for children < 10 years of age. These included community acquired pneumonia (CAP), acute otitis media (AOM), cystitis, acute bronchitis, pyelonephritis, and cellulitis. The linked data accounts for >85% community prescriptions with the remainder contributed by other professions who do not use the physician billing system. Median (Q1; first quartile, Q3; third quartile) DOT were examined for the study population, across select diagnoses and stratified by age (<1, 1–4 and 5–9), gender and antibiotic class.

Results:

duration of prescription.pngIn 2019, the overall median (Q1, Q2) DOT, as well as for diagnoses of interest was 7 (7, 10) days. However, the DOT distribution skewed further right for AOM, cellulitis, cystitis and acute bronchitis. Median (Q1, Q3) DOT was 7 (7, 7) days for CAP, 7 (6, 7) days for cystitis, and 7 (7, 10) days for pyelonephritis, acute bronchitis, and suppurative and non-suppurative otitis media. Each DOT distribution was also informed by which antibiotic was used (see figure). For CAP and acute bronchitis, azithromycin was mostly prescribed for 5 days, whereas 26.9% amoxicillin was prescribed for ≥10 days. 84.6%amoxicillin prescribed for otitis media (suppurative and nonsuppurative) among children 5-9 years was ≥ 7 days.

Conclusions/Learning Points:

Antibiotic DOT in children for many indications was longer than current guidelines. Opportunities are present to further reduce unnecessary antibiotic exposure by emphasizing shorter DOT where evidence supports equivalent outcomes.

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ANTIMICROBIAL ACTIVITY OF GOLD NANOPARTICLES COATED WITH CERAGENIN CSA-13 AGAINST HIGHLY-VIRULENT AND ANTIBIOTIC-RESISTANT ACINETOBACTER BAUMANNII

Date
Thu, 12.05.2022
Session Time
10:00 - 11:30
Session Type
Oral Presentations Session
Room
MC 2 HALL
Lecture Time
10:42 - 10:52

Abstract

Backgrounds:

The overuse of antibiotics has led to the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacteria, and as a result very often we lack effective therapeutic options for infections caused by these strains. This study was designed to determine in vitro antimicrobial activities of nanosystems containing gold nanoparticles and ceragenin (cationic steroidal antimicrobial) CSA-13 against Acinetobacter baumannii strain.

Methods

The clinical strain (A. baumannii resistant to carbapenems, aminoglycosides and fluoroquinolones) was subjected to treatment with rod- (AuR), peanut- (AuP), and star-shaped (AuS) gold nanoparticles (Au NPs) coated with CSA-13. Minimal inhibitory and bactericidal concentrations, colony counting assays and a resazurin-based proliferation assays were used to determine bactericidal efficacy. Additionally, adherence and internalization of the pathogens to lung-derived cells (A549) as well as biocompatibility of the tested compounds were evaluated.

Results:

AuR NPs@CSA-13, AuP NPs@CSA-13 and AuS NPs@CSA-13 shown high antimicrobial activity, regardless of the identified mechanism of drug resistance. Both internalization and adherence of the tested strain were restricted and dose-dependent in a cell culture model. Importantly, tested compounds at bactericidal concentrations were characterized by satisfactory biocompatibility.

Conclusions/Learning Points:

The applied gold nanosystems exhibit strong antimicrobial activity against a MDR A. baumannii strain, which makes them promising agents to develop as new therapeutic options to eradicate multidrug-resistant pathogens.

The project was funded by the National Science Centre granted under contract number UMO-2018/31/B/NZ6/02476

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THE RESULTS OF THE TIARA TRIAL- TREATING IMPETIGO WITH ANTISEPTICS, REPLACING ANTIBIOTICS: A RANDOMISED CONTROLLED TRIAL COMPARING TOPICAL TREATMENTS OF IMPETIGO

Date
Thu, 12.05.2022
Session Time
10:00 - 11:30
Session Type
Oral Presentations Session
Room
MC 2 HALL
Lecture Time
10:52 - 11:02

Abstract

Backgrounds:

Impetigo is a superficial bacterial skin infection with a high incidence in New Zealand (NZ). Prescribing of topical antibiotic fusidic acid (FA) in NZ has induced FA resistance and selection of methicillin resistant S. aureus (MRSA). In response, antiseptics are replacing antibiotics, in both NZ and UK, despite limited evidence. This randomised single-blind non-inferiority trial compares topical FA with antiseptic (hydrogen peroxide) and with cleaning and covering the lesions.

Methods

Children aged 5-13 years, presenting to school health clinics in Auckland with mild-to-moderate impetigo were randomised to receive one of three treatments; FA, hydrogen peroxide or wound care for five days. Primary outcome was based on analysis of photographs taken before and after treatment, by three independent graders, blinded to treatment arm. Bacterial swabs were taken pre- and post-treatment.

Results:

84% (132/157) and 79% (134/169) of impetigo improved after 5 days of treatment with FA and antiseptic respectively. 64% (48/74) of those treated with wound care improved. Including all lesions, non-inferiority of antiseptic was not shown. Stratified-analysis of impetigo limited to a single body region, demonstrated non-inferiority of antiseptic compared to FA. Wound care was not shown to be non-inferior to FA. All treatments were acceptable with no severe adverse reactions. Higher rates of bacteria were seen on lesions following treatment with antiseptic and clean and cover than FA.

Conclusions/Learning Points:

Overall antiseptic is neither inferior or non-inferior to topical antibiotics. However, it is non-inferior where impetigo is limited to a single region of the body. Wound care is inferior to FA. Although antiseptic produced clinical resolution for most, higher rates of bacteria remain following treatment with antiseptic. Questions remain over whether this has clinical impact such as recurrence, subsequent skin-related admission or future risks of post-streptococcal phenomena.

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PATTERNS AND TRENDS OF ANTIBACTERIAL AND ANTIFUNGAL USE IN A PEDIATRIC ONCOLOGY DEPARTMENT

Date
Thu, 12.05.2022
Session Time
10:00 - 11:30
Session Type
Oral Presentations Session
Room
MC 2 HALL
Lecture Time
11:02 - 11:12

Abstract

Backgrounds:

Monitoring of antibacterial and antifungal use is essential for antimicrobial stewardship strategies. We studied patterns and time trends of antibacterial and antifungal use in a pediatric oncology department.

Methods

A retrospective analysis of monthly antibacterial and antifungal use was conducted in a 20-bed pediatric oncology department of a tertiary-level hospital from January 2018 to May 2020 (29 months). Data of antimicrobial and antifungal consumption was obtained from the hospital pharmacy and expressed as defined daily doses per 100 bed-days (DDD/100BD). Number of bed-days was obtained from Hospital Office of Statistics.

Results:

During study period there was a median monthly rate of 301 bed-days. Total consumption of antibacterials had a median monthly rate of 108 DDD/100BD and of antifungals 94 DDD/100BD showing significant increases (p=0.015 and p<0.001, respectively). Glycopeptides (vancomycin/teicoplanin) constituted the most common used antibacterial class (29.5 DDD/100BD). Carbapenems were the second most used antibacterial agents (15.2 DDD/100BD) with a significant increase (p=0.009). Consumption of aminoglycosides and combination of piperacillin with tazobactam followed with 13.8 DDD/100BD and 11.7 DDD/100BD, respectively. Consumption of cotrimoxazole was 9.3 DDD/100BD, followed by metronidazole (6.4 DDD/100BD), colistin (4 DDD/100BD) and quinolones (3.8 DDD/100BD). Utilization of 3rd generation cephalosporins was relatively low (3.7 DDD/100BD). Voriconazole constituted the most common used antifungal agent (45 DOT/100BD). Micafungin was the second most commonly used antifungal agent (18 DOT/100BD) with a significant increase (p=0.028).

Conclusions/Learning Points:

High consumption of glycopeptides and carbapenems combined by constant use of colistin is of concern. Emergence of antimicrobial resistance in pediatric oncology patients could explain this pattern. High voriconazole and micafungin use mainly reflects antifungal prophylaxis practices. These results may guide antimicrobial and antifungal stewardship activities.

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