Elisavet Chorafa (Greece)

Aristotle University of Thessaloniki Infectious Diseases Unit, 3rd Pediatric Department

Author Of 2 Presentations

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.

Hide

ANTIFUNGAL USE IN EUROPEAN PEDIATRIC INTENSIVE CARE UNITS (PICUS): A 12-WEEK MULTICENTER MODIFIED POINT PREVALENCE STUDY (CALYPSO)

Date
Thu, 12.05.2022
Session Time
08:00 - 09:30
Session Type
Parallel Symposium
Room
MC 2 HALL
Lecture Time
09:07 - 09:17

Abstract

Backgrounds:

Knowledge of antifungal use in PICUs across Europe, while frequently prescribed, is limited. A 12-wk modified point-prevalence study was conducted to record antifungal use in Εuropean PICUs.

Methods

All patients hospitalized in the participating PICUs and receiving systemic antifungals were included. Information about ward demographics was collected once at the beginning; weekly ward and patient data were collected prospectively for the 12-wk study period and entered in REDCap database.

Results:

table 1.antifungal agents in picus.png

18 PICUs (15 hospitals), in 10 European countries participated. 8/18 (44%) of PICUs followed prophylactic practices for patients with immunocompromise/neutropenia, long-term parenteral nutrition or central lines, 7/18 (39%) had an antifungal stewardship program implemented and the majority (16/18) used biomarkers (15/16 galactomannan, 12/16 each beta-D-glucan and Cryptococcal antigen). 101 patients with ages ≤90d (14 patients), 3-60mo (44pts) and >5yrs (43pts) were recorded. Malignancy was the most common underlying condition among patients aged >90d (28%) followed by surgery/trauma (25%), whereas all patients ≤90d had previous surgery. Indication for antifungal prescribing was prophylaxis in 38% and treatment in 62% [empirical (57%), preemptive (13%) and targeted (30%)]. Fluconazole was the most common agent both for prophylaxis [45%, median dose: 6 (range 2-9) mg/kg/d] and empirical treatment [53%, median dose: 10 (range 1-12) mg/kg/d], whereas LAMB was the most frequent agent for targeted treatment [37%, median dose: 5 (range 3-6) mg/kg/d] (Table 1). Common reasons for empirical and targeted treatment were persistent fever in high-risk patients (58%) and candidiasis (100%), respectively. For targeted treatment, the most frequent pathogens were Candida albicans (37%) and Candida parapsilosis (32%).

Conclusions/Learning Points:

The majority of antifungal prescriptions across European PICUs were for prophylaxis or empirical treatment. These data will be valueable for guiding antifungal stewardship strategies in PICUs

Hide

Presenter Of 1 Presentation

ANTIFUNGAL USE IN EUROPEAN PEDIATRIC INTENSIVE CARE UNITS (PICUS): A 12-WEEK MULTICENTER MODIFIED POINT PREVALENCE STUDY (CALYPSO)

Date
Thu, 12.05.2022
Session Time
08:00 - 09:30
Session Type
Parallel Symposium
Room
MC 2 HALL
Lecture Time
09:07 - 09:17

Abstract

Backgrounds:

Knowledge of antifungal use in PICUs across Europe, while frequently prescribed, is limited. A 12-wk modified point-prevalence study was conducted to record antifungal use in Εuropean PICUs.

Methods

All patients hospitalized in the participating PICUs and receiving systemic antifungals were included. Information about ward demographics was collected once at the beginning; weekly ward and patient data were collected prospectively for the 12-wk study period and entered in REDCap database.

Results:

table 1.antifungal agents in picus.png

18 PICUs (15 hospitals), in 10 European countries participated. 8/18 (44%) of PICUs followed prophylactic practices for patients with immunocompromise/neutropenia, long-term parenteral nutrition or central lines, 7/18 (39%) had an antifungal stewardship program implemented and the majority (16/18) used biomarkers (15/16 galactomannan, 12/16 each beta-D-glucan and Cryptococcal antigen). 101 patients with ages ≤90d (14 patients), 3-60mo (44pts) and >5yrs (43pts) were recorded. Malignancy was the most common underlying condition among patients aged >90d (28%) followed by surgery/trauma (25%), whereas all patients ≤90d had previous surgery. Indication for antifungal prescribing was prophylaxis in 38% and treatment in 62% [empirical (57%), preemptive (13%) and targeted (30%)]. Fluconazole was the most common agent both for prophylaxis [45%, median dose: 6 (range 2-9) mg/kg/d] and empirical treatment [53%, median dose: 10 (range 1-12) mg/kg/d], whereas LAMB was the most frequent agent for targeted treatment [37%, median dose: 5 (range 3-6) mg/kg/d] (Table 1). Common reasons for empirical and targeted treatment were persistent fever in high-risk patients (58%) and candidiasis (100%), respectively. For targeted treatment, the most frequent pathogens were Candida albicans (37%) and Candida parapsilosis (32%).

Conclusions/Learning Points:

The majority of antifungal prescriptions across European PICUs were for prophylaxis or empirical treatment. These data will be valueable for guiding antifungal stewardship strategies in PICUs

Hide