Paediatric Common Infections Pathways: improving antimicrobial stewardship and promoting ambulation for children presenting with common infections to hospitals in the UK and Ireland.

Carolyne Horner,Stéphane Paulus,Helen Green,Paddy Mcmaster,Sanjay Patel,Damian Roland,Alicia Demirjian,Robert Cunney,Conor Doherty,Mathew Mathai,Alasdair Munro

doi:10.1093/jacamr/dlab029

Abstract

Paediatric common infection pathways have been developed in collaboration between the BSAC and national paediatric groups, addressing the management of cellulitis, lymphadenitis/lymph node abscess, pneumonia/pleural empyema, pyelonephritis, tonsillitis/peritonsillar abscess, otitis media/mastoiditis, pre-septal/post-septal (orbital) cellulitis, and meningitis. Guidance for the management of a child presenting with a petechial/purpuric rash and the infant under 3 months of age with fever is also provided. The aim of these pathways is to support the delivery of high-quality infection management in children presenting to a hospital. The pathways focus on diagnostic approaches, including the recognition of red flags suggesting complex or severe infection requiring urgent intervention, approaches to antimicrobial stewardship (AMS) principles and guidance on safe and timely ambulation aligned with good practice of outpatient parenteral antimicrobial therapy (OPAT).

Highlights

Antimicrobial resistance (AMR) is an urgent and increasing threat, especially in children.[1,2,3,4,5] In the UK, approximately 41% of hospitalized children receive at least one antimicrobial agent during their admission.[6]
Antimicrobial stewardship (AMS) programmes have been implemented in the majority of children’s hospitals in the UK,[7] very little emphasis has been placed on paediatric antimicrobial stewardship in secondary care settings, despite most children receiving intravenous (IV) antibiotics in the UK being managed in secondary care centres
The rationale for these pathways was to support the delivery of highquality infection management in children presenting to hospital, focusing on diagnostic approaches including the recognition of red flags suggesting complex or severe infection requiring urgent intervention, approaches to management adhering to the principles of AMS and guidance on safe and timely ambulation aligned with the principles of outpatient parenteral antimicrobial therapy (OPAT)

Summary

Introduction

Antimicrobial resistance (AMR) is an urgent and increasing threat, especially in children.[1,2,3,4,5] In the UK, approximately 41% of hospitalized children receive at least one antimicrobial agent during their admission.[6] antimicrobial stewardship (AMS) programmes have been implemented in the majority of children’s hospitals in the UK,[7] very little emphasis has been placed on paediatric antimicrobial stewardship in secondary care settings, despite most children receiving intravenous (IV) antibiotics in the UK being managed in secondary care centres. This may lead to confusion within teams and patient risk

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Conclusion