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

Niina Laine,Niina Laine,Raisa Laaksonen,Martti Vaara,Marja Airaksinen,Veli-Jukka Anttila,Harri Saxen,Kalle Hoppu

doi:10.1371/journal.pone.0141555

Niina Laine, Niina Laine + Show 6 more

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https://doi.org/10.1371/journal.pone.0141555

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Journal: PloS one	Publication Date: Nov 5, 2015
Citations: 2	License type: CC BY 4.0

Affiliation: Helsinki University Hospital, University of Helsinki

Abstract

AimKnowledge 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.MethodsData 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).Results17% 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.ConclusionApproximately 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.

Highlights

Bloodstream infections (BSIs) are among the most common healthcare-associated infections (HAIs) in pediatrics [1,2,3]. They cause substantial morbidity and mortality, increase health care costs and often result in a prolonged hospital stay [4]. They are caused by a vast variety of pathogens [5,6,7] and when a BSI is suspected, rapid initiation of empirical antimicrobial therapy (AMT) is of high importance
We focused on one hand on the vigilance of physicians in responding to microbiological results and on the other hand on the appropriateness of the targeted antimicrobial therapy
Our approach of using a selected cohort consisting of different causative pathogens did not allow us to calculate the total magnitude of inappropriate use of antimicrobials of all blood culture positive infections at our hospital

Summary

Introduction

Bloodstream infections (BSIs) are among the most common healthcare-associated infections (HAIs) in pediatrics [1,2,3] They cause substantial morbidity and mortality, increase health care costs and often result in a prolonged hospital stay [4]. They are caused by a vast variety of pathogens [5,6,7] and when a BSI is suspected, rapid initiation of empirical antimicrobial therapy (AMT) is of high importance. The selection of appropriate therapy is, challenging since it should cover the most likely causative pathogens. Multiple co-morbidities of the patients and several side effects of the antibiotics further complicate the choice of appropriate therapies

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