Pediatric Antimicrobial Stewardship

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (31 August 2023) | Viewed by 16845

Special Issue Editors

Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy & Arkansas Children’s Hospital, Little Rock, AR 72205, USA
Interests: pediatric infectious diseases; antimicrobial stewardship; developmental pharmacokinetics/pharmacodynamics/pharmacogenomics
Children’s Medical Center, Dallas, TX 75235, USA
Interests: pediatric infectious diseases; antimicrobial stewardship; pharmacokinetics

Special Issue Information

Dear Colleagues,

Since the first paper published in 2004 by the Infectious Diseases Society of America, entitled “Bad Bugs, No Drugs”, antimicrobial stewardship has seen a slow uptake across the world. Now, 17 years later, the field of pediatric antimicrobial stewardship is growing rapidly in response to increasing antibiotic resistance worldwide. Appropriate antibiotic utilization is everyone’s responsibility, from the provider to the parent who is administering the medicine. Pediatric antimicrobial stewardship is truly an interprofessional practice in personalized medicine that engages both institutional and community health care providers to provide the best antibiotics when appropriate, at the right dose, for the right duration, to a specific child.

This Special Issue seeks manuscript submissions that further demonstrate how we can continue to improve pediatric antimicrobial utilization, dosing, de-escalation, and duration in both the hospital and ambulatory settings to enhance patient clinical outcomes. In addition, manuscripts that focus on the science of understanding the behaviors that drive health care providers to make the antibiotic decisions that they make and understanding parents’ expectations are also welcome.

Dr. Holly D. Maples
Dr. Karisma Patel
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pediatrics
  • antimicrobial stewardship
  • rapid diagnostics
  • ambulatory
  • hospital
  • interprofessional

Published Papers (7 papers)

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34 pages, 506 KiB  
Article
Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention
by Aniello Meoli, Lorenzo Ciavola, Sofia Rahman, Marco Masetti, Tommaso Toschetti, Riccardo Morini, Giulia Dal Canto, Cinzia Auriti, Caterina Caminiti, Elio Castagnola, Giorgio Conti, Daniele Donà, Luisa Galli, Stefania La Grutta, Laura Lancella, Mario Lima, Andrea Lo Vecchio, Gloria Pelizzo, Nicola Petrosillo, Alessandro Simonini, Elisabetta Venturini, Fabio Caramelli, Gaetano Domenico Gargiulo, Enrico Sesenna, Rossella Sgarzani, Claudio Vicini, Mino Zucchelli, Fabio Mosca, Annamaria Staiano, Nicola Principi, Susanna Esposito and on behalf of the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Groupadd Show full author list remove Hide full author list
Antibiotics 2022, 11(7), 863; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics11070863 - 27 Jun 2022
Cited by 4 | Viewed by 3171
Abstract
A surgical site infection (SSI) is an infection that occurs in the incision created by an invasive surgical procedure. Although most infections are treatable with antibiotics, SSIs remain a significant cause of morbidity and mortality after surgery and have a significant economic impact [...] Read more.
A surgical site infection (SSI) is an infection that occurs in the incision created by an invasive surgical procedure. Although most infections are treatable with antibiotics, SSIs remain a significant cause of morbidity and mortality after surgery and have a significant economic impact on health systems. Preventive measures are essential to decrease the incidence of SSIs and antibiotic abuse, but data in the literature regarding risk factors for SSIs in the pediatric age group are scarce, and current guidelines for the prevention of the risk of developing SSIs are mainly focused on the adult population. This document describes the current knowledge on risk factors for SSIs in neonates and children undergoing surgery and has the purpose of providing guidance to health care professionals for the prevention of SSIs in this population. Our aim is to consider the possible non-pharmacological measures that can be adopted to prevent SSIs. To our knowledge, this is the first study to provide recommendations based on a careful review of the available scientific evidence for the non-pharmacological prevention of SSIs in neonates and children. The specific scenarios developed are intended to guide the healthcare professional in practice to ensure standardized management of the neonatal and pediatric patients, decrease the incidence of SSIs and reduce antibiotic abuse. Full article
(This article belongs to the Special Issue Pediatric Antimicrobial Stewardship)
11 pages, 368 KiB  
Article
Epidemiology, Risk Factors and Outcome Due to Multidrug Resistant Organisms in Paediatric Liver Transplant Patients in the Era of Antimicrobial Stewardship and Screening
by Anita Verma, Sunitha Vimalesvaran and Anil Dhawan
Antibiotics 2022, 11(3), 387; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics11030387 - 15 Mar 2022
Cited by 8 | Viewed by 2355
Abstract
(1) Background: Multidrug-resistant organisms (MDRO) are a growing problem in liver transplant recipients (LTR), associated with high morbidity and mortality. We reviewed the impact of antimicrobial stewardship (AMS) and active screening of MDRO on the epidemiology and outcomes in paediatric LTR. (2) Methods: [...] Read more.
(1) Background: Multidrug-resistant organisms (MDRO) are a growing problem in liver transplant recipients (LTR), associated with high morbidity and mortality. We reviewed the impact of antimicrobial stewardship (AMS) and active screening of MDRO on the epidemiology and outcomes in paediatric LTR. (2) Methods: Single-centre retrospective review of paediatric LTR from January 2017 to December 2018. (3) Results: Ninety-six children were included; 32 (33%) patients were colonised with ≥1 MDRO and 22 (23%) patients had MDRO infections. Median (IQR) duration for start of infection was 9.5 (1.8–16.0) days. Colonisation rate with Gram-positive MDRO was 15.6%, with infection rate of 6.2%; majority due to Vancomycin-Resistant Enterococcus faecium (VRE). Colonisation with Gram-negative MDRO was 27.0%, with infection rate of 16.6%; majority due to extended-spectrum β-lactamase producing Enterobacteriaceae. Colonisation and infection rate due to Carbapenem-resistant Enterobacteriaceae was 6% and 3%, respectively, during screening and AMS, compared to historical control of 25% and 30%, respectively, without screening and AMS. There was significant reduction in VRE and CRE infection during AMS period in comparison to historical control. Pre-transplant risk factors including bacterial infections pre-transplant (p < 0.01), diagnosis of biliary atresia (p = 0.03), exposure to antibiotics (p < 0.01), EBV viraemia (p = 0.01), and auxiliary transplantation (p < 0.01) were associated with post-transplant MDRO infections. Patients with MDRO infections had longer length of hospital and paediatric intensive care unit stay days (p < 0.01) but associated with no mortality. (4) Conclusions: Our results demonstrate low incidence of colonisation and infections with MDRO, which were associated with high morbidity but no mortality in paediatric LTR. There was significant reduction in MRSA, VRE, and CRE during AMS period compared to pre-AMS era. Some risk factors are unavoidable but antibiotic overuse, early initiation of appropriate antibiotic therapy and effective infection prevention strategies can be monitored with multifaceted approach of AMS and screening of MDRO. With limited therapeutic options for MDRO and efficacy data of newer antibiotics in paediatric LTR, robust infection control practices are of paramount importance. Full article
(This article belongs to the Special Issue Pediatric Antimicrobial Stewardship)
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12 pages, 552 KiB  
Article
Determining the Clinical Utility of 16S rRNA Sequencing in the Management of Culture-Negative Pediatric Infections
by Peter Paul C. Lim, Lisa M. Stempak, Sindhoosha Malay, LeAnne N. Moore, Sree Sarah S. Cherian and Ankita P. Desai
Antibiotics 2022, 11(2), 159; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics11020159 - 26 Jan 2022
Cited by 2 | Viewed by 2756
Abstract
The use of 16S rRNA sequencing in culture-negative infections has improved identification of bacterial pathogens in select scenarios, but its clinical impact requires further elucidation, especially in the pediatric population. This retrospective study aims to determine the clinical utility of 16S rRNA sequencing [...] Read more.
The use of 16S rRNA sequencing in culture-negative infections has improved identification of bacterial pathogens in select scenarios, but its clinical impact requires further elucidation, especially in the pediatric population. This retrospective study aims to determine the clinical utility of 16S rRNA sequencing on the clinical management of pediatric culture-negative infections in our institution. Significant clinical utility was identified in 30 (40.5%) of 74 clinical samples (p < 0.0001). Of all specimens, pulmonary samples yielded the most clinical utility (n = 9, 30%), followed equally by joint fluid (n = 6, 20%) and bone (n = 6, 20%), with no difference between fluid and fresh tissue specimens (p = 0.346). Although the difference was not statistically significant (p = 0.4111), the overall use of broad-spectrum coverage was decreased. The median number of antibiotics was decreased from two to one (p < 0.0001) based on 16S rRNA sequencing results. The results suggest that 16S rRNA sequencing has a significant impact on decreasing the number of antibiotics used in the treatment of pediatric culture-negative infections. 16S rRNA sequencing performed on pulmonary specimens has the highest likelihood of identifying a pathogen compared to other specimen types. Additional cost–benefit analysis needs to be completed to further determine clinical benefit. Full article
(This article belongs to the Special Issue Pediatric Antimicrobial Stewardship)
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11 pages, 619 KiB  
Article
Newborns with Bloody Stools—At the Crossroad between Efficient Management of Necrotizing Enterocolitis and Antibiotic Stewardship
by Marie Heyne-Pietschmann, Dirk Lehnick, Johannes Spalinger, Franziska Righini-Grunder, Michael Buettcher, Markus Lehner and Martin Stocker
Antibiotics 2021, 10(12), 1467; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10121467 - 29 Nov 2021
Cited by 1 | Viewed by 1793
Abstract
The onset of bloody stools in neonates often results in antibiotic treatment for suspected necrotizing enterocolitis (NEC). Food protein-induced allergic proctocolitis (FPIAP) is an often-neglected differential diagnosis. We performed a retrospective analysis of antibiotic exposure at our tertiary center from 2011 to 2020 [...] Read more.
The onset of bloody stools in neonates often results in antibiotic treatment for suspected necrotizing enterocolitis (NEC). Food protein-induced allergic proctocolitis (FPIAP) is an often-neglected differential diagnosis. We performed a retrospective analysis of antibiotic exposure at our tertiary center from 2011 to 2020 that included three time periods of differing antimicrobial stewardship goals. We compared these data with the conventional treatment guidelines (modified Bell’s criteria). In our cohort of 102 neonates with bloody stools, the length of antibiotic exposure was significantly reduced from a median of 4 to 2 days. The proportion of treated neonates decreased from 100% to 55% without an increase in negative outcomes. There were 434 antibiotic days. Following a management strategy according to modified Bell’s criteria would have led to at least 780 antibiotic days. The delayed initiation of antibiotic treatment was observed in 7 of 102 cases (6.9%). No proven NEC case was missed. Mortality was 3.9%. In conclusion, with FPIAP as a differential diagnosis of NEC, an observational management strategy in neonates with bloody stools that present in a good clinical condition seems to be justified. This may lead to a significant reduction of antibiotic exposure. Further prospective, randomized trials are needed to prove the safety of this observational approach. Full article
(This article belongs to the Special Issue Pediatric Antimicrobial Stewardship)
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7 pages, 203 KiB  
Communication
Utility of Methicillin-Resistant Staphylococcus aureus Nares Screening in Hospitalized Children with Acute Infectious Disease Syndromes
by Ashley Sands, Nicole Mulvey, Denise Iacono, Jane Cerise and Stefan H. F. Hagmann
Antibiotics 2021, 10(12), 1434; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10121434 - 23 Nov 2021
Cited by 6 | Viewed by 1769
Abstract
Studies in adults support the use of a negative methicillin-resistant Staphylococcus aureus (MRSA) nares screening (MNS) to help limit empiric anti-MRSA antibiotic therapy. We aimed to evaluate the use of MNS for anti-MRSA antibiotic de-escalation in hospitalized children (<18 years). Records of patients [...] Read more.
Studies in adults support the use of a negative methicillin-resistant Staphylococcus aureus (MRSA) nares screening (MNS) to help limit empiric anti-MRSA antibiotic therapy. We aimed to evaluate the use of MNS for anti-MRSA antibiotic de-escalation in hospitalized children (<18 years). Records of patients admitted between 1 January 2015 and 31 December 2020 with a presumed infectious diagnosis who were started on anti-MRSA antibiotics, had a PCR-based MNS, and a clinical culture performed were retrospectively reviewed. A total of 95 children were included with a median age (range) of 2 (0–17) years. The top three diagnosis groups were skin and soft tissue infections (n = 38, 40%), toxin-mediated syndromes (n = 17, 17.9%), and osteoarticular infections (n = 14, 14.7%). Nasal MRSA colonization and growth of MRSA in clinical cultures was found in seven patients (7.4%) each. The specificity and the negative predictive value (NPV) of the MNS to predict a clinical MRSA infection were both 95.5%. About half (n = 55, 57.9%) had anti-MRSA antibiotics discontinued in-house. A quarter (n = 14, 25.5%) were de-escalated based on the negative MNS test alone, and another third (n = 21, 38.2%) after negative MNS test and negative culture results became available. A high NPV suggests that MNS may be useful for limiting unnecessary anti-MRSA therapy and thereby a useful antimicrobial stewardship tool for hospitalized children. Prospective studies are needed to further characterize the utility of MNS for specific infectious diagnoses. Full article
(This article belongs to the Special Issue Pediatric Antimicrobial Stewardship)
8 pages, 1977 KiB  
Article
A Culture Change: Impact of a Pediatric Antimicrobial Stewardship Program Based on Guideline Implementation and Prospective Audit with Feedback
by Bindiya Bagga, Jeremy S. Stultz, Sandra Arnold and Kelley R. Lee
Antibiotics 2021, 10(11), 1307; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10111307 - 27 Oct 2021
Cited by 4 | Viewed by 1691
Abstract
Reports analyzing the impact of pediatric antimicrobial stewardship programs (ASP) over long periods of time are lacking. We thus report our ASP experience in a pediatric tertiary referral center over a long-term period from 2011 to 2018. Our ASP was implemented in 2011. [...] Read more.
Reports analyzing the impact of pediatric antimicrobial stewardship programs (ASP) over long periods of time are lacking. We thus report our ASP experience in a pediatric tertiary referral center over a long-term period from 2011 to 2018. Our ASP was implemented in 2011. The program was based primarily on guideline development with key stakeholders, engaging and educating providers, followed by prospective audit with feedback (PAF). Monitored antibiotics included meropenem, piperacillin–tazobactam, and cefepime, followed by the addition of ceftriaxone, ceftazidime, cefotaxime, ciprofloxacin, levofloxacin, linezolid, and vancomycin at various time points. Specifically, the program did not implemented the core strategy of formulary restriction with prior authorization. Process- and outcome-related ASP measures were analyzed. We saw a 32% decrease in overall antibiotic utilization, a 51% decrease in the utilization of antibiotics undergoing PAF, and a 72% reduction in the use of broad-spectrum antibiotics such as meropenem. There was a concomitant increase in organism susceptibility and a reduction in yearly drug purchasing costs of over USD 560,000 from baseline without changes in sepsis-related mortality. Our study highlights that a pediatric ASP based primarily on the principles of guideline development and PAF can improve antibiotic utilization and institutional bacterial susceptibilities without a detrimental impact on patient outcomes by changing the culture of antimicrobial utilization within the institution. Full article
(This article belongs to the Special Issue Pediatric Antimicrobial Stewardship)
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21 pages, 494 KiB  
Systematic Review
Paediatric Antimicrobial Stewardship for Respiratory Infections in the Emergency Setting: A Systematic Review
by Keshani Weragama, Poonam Mudgil and John Whitehall
Antibiotics 2021, 10(11), 1366; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10111366 - 08 Nov 2021
Cited by 4 | Viewed by 2089
Abstract
Antimicrobial resistance occurs due to the propensity of microbial pathogens to develop resistance to antibiotics over time. Antimicrobial stewardship programs (ASPs) have been developed in response to this growing crisis, to limit unnecessary antibiotic prescription through initiatives such as education-based seminars, prescribing guidelines, [...] Read more.
Antimicrobial resistance occurs due to the propensity of microbial pathogens to develop resistance to antibiotics over time. Antimicrobial stewardship programs (ASPs) have been developed in response to this growing crisis, to limit unnecessary antibiotic prescription through initiatives such as education-based seminars, prescribing guidelines, and rapid respiratory pathogen (RRP) testing. Paediatric patients who present to the emergency setting with respiratory symptoms are a particularly high-risk population susceptible to inappropriate antibiotic prescribing behaviours and are therefore an ideal cohort for focused ASPs. The purpose of this systematic review was to assess the efficacy and safety of ASPs in this clinical context. A systematic search of PubMed, Medline, EMBASE and the Cochrane Database of Systematic Reviews was conducted to review the current evidence. Thirteen studies were included in the review and these studies assessed a range of stewardship interventions and outcome measures. Overall, ASPs reduced the rates of antibiotic prescription, increased the prescription of narrow-spectrum antibiotics, and shortened the duration of antibiotic therapy. Multimodal interventions that were education-based and those that used RRP testing were found to be the most effective. Whilst we found strong evidence that ASPs are effective in reducing antibiotic prescribing, further studies are required to assess whether they translate to equivalent clinical outcomes. Full article
(This article belongs to the Special Issue Pediatric Antimicrobial Stewardship)
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