[Pediatric sepsis - new national recommendations for recognition and initial treatment]. / Sepsis hos barn ­ nya nationella rekommendationer.

A task force appointed by the Swedish Society of Pediatric Infectious Diseases developed national treatment recommendations for pediatric sepsis. It is limited to previously healthy children between 28 days (corrected) to 18 years of age and presented as a flow chart. Sepsis should be thought of as a life-threatening organ dysfunction caused by a dysregulated host response to infection. If the child is in shock, e.g. tachycardia with signs of decreased perfusion, sepsis treatment should be initiated immediately. If not in shock, but sepsis is very likely, sepsis treatment should be initiated as soon as possible. If the child is stable and sepsis is suspected, attempts should be made to revert symptoms not associated with the suspected primary infection and basic work-up performed. If no improvement is seen within three hours, sepsis treatment should be initiated. Sepsis treatment consists of fluids and antibiotics, sometimes with vasopressors, corticosteroids and/or immunomodulatory drugs.

Education, decision support, feedback and a minor reward: a novel antimicrobial Stewardship intervention in a Swedish paediatric emergency setting.

Background: Sweden enjoys a favourable situation with regard to antimicrobial resistance. However, healthcare costs are expected to increase exponentially, along with increased morbidity and mortality, due to the emergence of resistant bacterial strains. Our aim was to design an antimicrobial stewardship programme suitable for Scandinavian settings. Methods: A quasi-experimental pre-post study was conducted in a Swedish paediatric emergency department, evaluating adherence to national guidelines for acute otitis media and acute tonsillitis. The programme consisted of educational outreach, decision support, feedback, and a minor reward upon reaching a pre-defined adherence rate. Results: The largest impact, significant for both diagnoses, was on the practice of refraining from antibiotic use when recommended. The other variables evaluated showed no significant improvement for either condition; however, in most cases, pre-interventional adherence was already high. Conclusions: This relatively easily implementable ASP intervention showed a significant effect on correctly refraining from the use of antibiotics. Previous interventions in Scandinavia either failed to accomplish this or have been more logistically difficult. The combination of education, decision support, email-based feedback and a minor reward, offers an alternative. Future research will be needed to assess whether the result is sustainable, as well as to identify additional barriers to the judicious use of antibiotics not addressed in this study.