Improving empiric antibiotic prescribing in pediatric bloodstream infections: a potential application of weighted-incidence syndromic combination antibiograms (WISCA).
Expert Rev Anti Infect Ther
; 20(3): 445-456, 2022 03.
Article
in En
| MEDLINE
| ID: mdl-34424116
ABSTRACT
BACKGROUND:
Increasing antibiotic resistance to WHO-recommended first- and second-line treatments of pediatric sepsis requires adaptation of prescribing guidelines. We discuss the potential and limitations of a weighted-incidence syndromic combination antibiogram (WISCA) as a practical tool for incorporating local microbiology data when assessing empiric coverage of commonly used antibiotics. RESEARCH DESIGN ANDMETHODS:
A brief questionnaire of 18 clinically significant isolates from pediatric blood cultures (Jan-Dec 2018) was sent to a global network of pediatric hospitals in July 2019. Weighted coverage estimates of non-antipseudomonal third-generation cephalosporins (3GC) and meropenem were estimated using Monte-Carlo simulation for each site reporting >100 isolates.RESULTS:
52 hospitals in 23 countries in 5 WHO regions responded to the questionnaire; 13 sites met the sample size requirement. The most common isolates were S. aureus, Klebsiella spp., E. coli and Enterococcus spp. Coverage of 3GC ranged from 39% [95%CrI 34-43%] to 73% (two sites [95%CrI 65-80%]; [95%CrI 68-86%]) and meropenem coverage ranged from 54% [95%CrI 47-60%] to 88% [95%CrI84-91%].CONCLUSIONS:
A WISCA is a data-driven, clinically intuitive tool that can be used to compare empiric antibiotic regimens for pediatric sepsis using existing large datasets. The estimates can be further refined using more complex meta-analytical methods and patient characteristics.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Sepsis
/
Anti-Bacterial Agents
Type of study:
Guideline
/
Incidence_studies
/
Prognostic_studies
/
Qualitative_research
/
Risk_factors_studies
Limits:
Child
/
Humans
Language:
En
Year:
2022
Type:
Article