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Evaluation of Antimicrobial Therapy of Blood Culture Positive Healthcare-Associated Infections in Children.

Laine N, Vaara M, Anttila VJ, Hoppu K, Laaksonen R, Airaksinen M, Saxen H - PLoS ONE (2015)

Bottom Line: Three (3/13, 23%) of these patients received antimicrobials which were totally ineffective according to in vitro data.Approximately 17% of the selected cohort received inappropriate AMT.More attention should be paid to the appropriate use of antimicrobials, and training of prescribers should be urgently provided.

View Article: PubMed Central - PubMed

Affiliation: ChildrenĀ“s Hospital, Helsinki University Central Hospital (HUCH), Helsinki, Finland.

ABSTRACT

Aim: Knowledge of the quality of antimicrobial therapy (AMT) used for invasive healthcare-associated infections (HAIs) in paediatrics is scarce. Influence of the final information about the isolated pathogen on the subsequent targeted AMT was investigated in our study.

Methods: Data on 149 children (0-17 years) with blood culture positive HAIs were collected. The causative microbes under investigation were Staphylococcus aureus, Staphylococcus epidermidis, streptococci, Gram negative rods, and mixed infections were likewise included. For adjusting the antimicrobial regimen, an expert panel evaluated the quality of the targeted AMT and the delay of 72 hours after final microbiology results. AMT was regarded as inappropriate if the pathogen was totally resistant to the used antimicrobials (i) or if the chosen therapy was of not optimal efficacy against the pathogen (ii).

Results: 17% of the patients received inappropriate AMT. Half of these infections 13/26 (50%) were treated with an antimicrobial to which the isolate was resistant. Three (3/13, 23%) of these patients received antimicrobials which were totally ineffective according to in vitro data. Suboptimal or too broad spectrum AMT was administered to 13/26 (50%) patients. The most common causes of inappropriate use were the use of beta-lactams in oxacillin-resistant Staphylococcus epidermidis infections and vancomycin given in oxacillin-sensitive Staphylococcus aureus infections.

Conclusion: Approximately 17% of the selected cohort received inappropriate AMT. More attention should be paid to the appropriate use of antimicrobials, and training of prescribers should be urgently provided.

No MeSH data available.


Related in: MedlinePlus

Flow chart of patients selected for the study.The five pathogen groups chosen for the study were: Gram negative bacteria, Polymicrobial infections, Staphylococcus aureus, Staphylococcus epidermidis and streptococcal species.
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pone.0141555.g001: Flow chart of patients selected for the study.The five pathogen groups chosen for the study were: Gram negative bacteria, Polymicrobial infections, Staphylococcus aureus, Staphylococcus epidermidis and streptococcal species.

Mentions: Data from patients who suffered from infections caused by S. aureus, S. epidermidis, streptococci, Gram negative rods and polymicrobial infections were collected retrospectively in the order of appearance from June 2012 backwards (Fig 1). Due to the fact that S. epidermidis infections may often be caused by contaminants from the skin, patients with this bacterium were screened carefully into this study in order to include only those patients who had a blood culture positive infection (in most cases: fever and elevated leukocytes were present). Infections caused by fungi and anaerobes were uncommon, and were therefore not analyzed.


Evaluation of Antimicrobial Therapy of Blood Culture Positive Healthcare-Associated Infections in Children.

Laine N, Vaara M, Anttila VJ, Hoppu K, Laaksonen R, Airaksinen M, Saxen H - PLoS ONE (2015)

Flow chart of patients selected for the study.The five pathogen groups chosen for the study were: Gram negative bacteria, Polymicrobial infections, Staphylococcus aureus, Staphylococcus epidermidis and streptococcal species.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4635017&req=5

pone.0141555.g001: Flow chart of patients selected for the study.The five pathogen groups chosen for the study were: Gram negative bacteria, Polymicrobial infections, Staphylococcus aureus, Staphylococcus epidermidis and streptococcal species.
Mentions: Data from patients who suffered from infections caused by S. aureus, S. epidermidis, streptococci, Gram negative rods and polymicrobial infections were collected retrospectively in the order of appearance from June 2012 backwards (Fig 1). Due to the fact that S. epidermidis infections may often be caused by contaminants from the skin, patients with this bacterium were screened carefully into this study in order to include only those patients who had a blood culture positive infection (in most cases: fever and elevated leukocytes were present). Infections caused by fungi and anaerobes were uncommon, and were therefore not analyzed.

Bottom Line: Three (3/13, 23%) of these patients received antimicrobials which were totally ineffective according to in vitro data.Approximately 17% of the selected cohort received inappropriate AMT.More attention should be paid to the appropriate use of antimicrobials, and training of prescribers should be urgently provided.

View Article: PubMed Central - PubMed

Affiliation: ChildrenĀ“s Hospital, Helsinki University Central Hospital (HUCH), Helsinki, Finland.

ABSTRACT

Aim: Knowledge of the quality of antimicrobial therapy (AMT) used for invasive healthcare-associated infections (HAIs) in paediatrics is scarce. Influence of the final information about the isolated pathogen on the subsequent targeted AMT was investigated in our study.

Methods: Data on 149 children (0-17 years) with blood culture positive HAIs were collected. The causative microbes under investigation were Staphylococcus aureus, Staphylococcus epidermidis, streptococci, Gram negative rods, and mixed infections were likewise included. For adjusting the antimicrobial regimen, an expert panel evaluated the quality of the targeted AMT and the delay of 72 hours after final microbiology results. AMT was regarded as inappropriate if the pathogen was totally resistant to the used antimicrobials (i) or if the chosen therapy was of not optimal efficacy against the pathogen (ii).

Results: 17% of the patients received inappropriate AMT. Half of these infections 13/26 (50%) were treated with an antimicrobial to which the isolate was resistant. Three (3/13, 23%) of these patients received antimicrobials which were totally ineffective according to in vitro data. Suboptimal or too broad spectrum AMT was administered to 13/26 (50%) patients. The most common causes of inappropriate use were the use of beta-lactams in oxacillin-resistant Staphylococcus epidermidis infections and vancomycin given in oxacillin-sensitive Staphylococcus aureus infections.

Conclusion: Approximately 17% of the selected cohort received inappropriate AMT. More attention should be paid to the appropriate use of antimicrobials, and training of prescribers should be urgently provided.

No MeSH data available.


Related in: MedlinePlus