David Torres (Spain)

HOSPITAL 12 DE OCTUBRE PAEDIATRICS

Author Of 2 Presentations

 Conference Calendar

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
Session Name
0650 - ORAL PRESENTATION SESSION 06: Antimicrobials & Antibiotic Stewardship (ID 87)
Room
MC 2 HALL
Presenter
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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EPIDEMIOLOGY AND OUTCOMES OF GRAM-NEGATIVE BACTEREMIA IN A TERTIARY UNIVERSITY HOSPITAL IN MADRID, SPAIN (2018-2020).

Date
Wed, 11.05.2022
Session Time
13:40 - 15:10
Session Type
Parallel Symposium
Session Name
0375 - PARALLEL SYMPOSIUM: Treatment Of MDR Gram (-) Infections in Children - Prevention is Best (ID 57)
Room
NIKOS SKALKOTAS HALL
Presenter
Lecture Time
14:47 - 14:57

Abstract

Backgrounds:

Gram-negative bacteremia (GNB) is associated with a significant rate of morbidity and mortality in adults. Moreover, resistances to antibiotics are increasingly described in surveillance reports. However, the epidemiology and outcomes of GNB in children are not well known. We aimed to analyze GNB bacteremia in pediatric patients in a tertiary hospital over a three years period.

Methods

A retrospective, observational study of bacteremia episodes caused by Enterobacteriaceae or non-fermentative GNB in pediatric patients between January of 2018 and December 2020 in a Tertiary Hospital from Madrid, Spain, was carried out through microbiology charts and clinical records. Demography, comorbidities, risk factors and infection characteristics were recorded, and bacterial strain and antibiotic resistance were registered. Three primary endpoints were defined: mortality, bacteremia persistence and recurrence. A statistical analysis was applied to assess differences in these outcomes according to the risk factors. A multivariable logistic regression analysis was used to assess the association between bacteria resistance and mortality.

Results:

One hundred eighteen cases of GNB in one hundred and seven patients were included. The characteristics of the patients are shown in Table 1. In fifty-three cases (44.9%) GNB presented resistance to at least one group of antibiotic and in nine (7.6%) were multidrug-resistant (Table 1). The incidence of resistance rates by years were stable. Indwelling urinary catheterization was a risk factor associated to mortality [OR 3.48 (1.20-10.6)] and parenteral nutrition was related to persistent bacteremia [OR 7.69 (1.1-209)]. No relation between drug resistance and mortality was observed in multivariable analysis.

img bgn.jpg

Conclusions/Learning Points:

GNB represented an important problem in our institution, mainly related to neonatal intensive care and heart surgery. Antibiotic resistance was common. Patients that carried invasive care devices presented higher rates of bacteremia persistence and mortality.

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Poster Author Of 2 e-Posters

 e-Posters
AS13. COVID 19 and MIS-C

EP484 - PAPILLEDEMA IN PATIENTS WITH MULTISYSTEM INFLAMMATORY SYNDROME: IS AN OPHTALMOLOGICAL EXAM USEFUL? (ID 360)

Session Name
0772 - E-Poster Viewing (ID 124)
Presenter
Authors
AS01.d. Antibiotic Stewardship

PD091 - CLINICAL IMPACT AFTER IMPLEMENTATION OF AN ANTIMICROBIAL STEWARDSHIP PROGRAM AND A JOINT ELECTRONIC PROTOCOL FOR THE MANAGEMENT OF PATIENTS WITH APPENDICITIS AND/OR PERITONITIS IN PEDIATRICS (ID 775)

Session Name
0330 - Poster Discussion Session 05: Antimicrobials & Antibiotic Stewardship (ID 6)
Presenter
Authors