Raising AWaRe-ness of antimicrobial stewardship challenges in pediatric emergency care: results from the PERFORM study assessing consistency and appropriateness of antibiotic prescribing across Europe
<p><strong>Background</strong></p> Optimization of antimicrobial stewardship is key to tackling antimicrobial resistance, which is exacerbated by overprescription of antibiotics in pediatric emergency departments (EDs). We described patterns of empiric antibiotic use in Europ...
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| Fformat: | Journal article |
| Iaith: | English |
| Cyhoeddwyd: |
Oxford University Press
2023
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| _version_ | 1826313060939202560 |
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| author | Kolberg, L Khanijau, A van der Velden, FJS Herberg, J De, T Galassini, R Cunnington, AJ Wright, V Shah, P Kaforou, M Wilson, C Kuijpers, T Martinón-Torres, F Rivero-Calle, I Moll, H Vermont, C Pokorn, M Kolnik, M Pollard, AJ Agyeman, PKA Schlapbach, LJ Tsolia, MN Yeung, S Zavadska, D Zenz, W Schweintzger, NA van der Flier, M de Groot, R Usuf, E Voice, M Calvo-Bado, L Mallet, F Fidler, K Levin, M Carrol, ED Emonts, M von Both, U PERFORM Consortium |
| author_facet | Kolberg, L Khanijau, A van der Velden, FJS Herberg, J De, T Galassini, R Cunnington, AJ Wright, V Shah, P Kaforou, M Wilson, C Kuijpers, T Martinón-Torres, F Rivero-Calle, I Moll, H Vermont, C Pokorn, M Kolnik, M Pollard, AJ Agyeman, PKA Schlapbach, LJ Tsolia, MN Yeung, S Zavadska, D Zenz, W Schweintzger, NA van der Flier, M de Groot, R Usuf, E Voice, M Calvo-Bado, L Mallet, F Fidler, K Levin, M Carrol, ED Emonts, M von Both, U PERFORM Consortium |
| author_sort | Kolberg, L |
| collection | OXFORD |
| description | <p><strong>Background</strong></p>
Optimization of antimicrobial stewardship is key to tackling antimicrobial resistance, which is exacerbated by overprescription of antibiotics in pediatric emergency departments (EDs). We described patterns of empiric antibiotic use in European EDs and characterized appropriateness and consistency of prescribing.
<p><strong>Methods</strong></p>
Between August 2016 and December 2019, febrile children attending EDs in 9 European countries with suspected infection were recruited into the PERFORM (Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management) study. Empiric systemic antibiotic use was determined in view of assigned final “bacterial” or “viral” phenotype. Antibiotics were classified according to the World Health Organization (WHO) AWaRe classification.
<p><strong>Results</strong></p>
Of 2130 febrile episodes (excluding children with nonbacterial/nonviral phenotypes), 1549 (72.7%) were assigned a bacterial and 581 (27.3%) a viral phenotype. A total of 1318 of 1549 episodes (85.1%) with a bacterial and 269 of 581 (46.3%) with a viral phenotype received empiric systemic antibiotics (in the first 2 days of admission). Of those, the majority (87.8% in the bacterial and 87.0% in the viral group) received parenteral antibiotics. The top 3 antibiotics prescribed were third-generation cephalosporins, penicillins, and penicillin/β-lactamase inhibitor combinations. Of those treated with empiric systemic antibiotics in the viral group, 216 of 269 (80.3%) received ≥1 antibiotic in the “Watch” category.
<p><strong>Conclusions</strong></p>
Differentiating bacterial from viral etiology in febrile illness on initial ED presentation remains challenging, resulting in a substantial overprescription of antibiotics. A significant proportion of patients with a viral phenotype received systemic antibiotics, predominantly classified as WHO Watch. Rapid and accurate point-of-care tests in the ED differentiating between bacterial and viral etiology could significantly improve antimicrobial stewardship. |
| first_indexed | 2024-03-07T08:10:59Z |
| format | Journal article |
| id | oxford-uuid:569f3e1d-7447-4fcf-b14d-db14696a8f1d |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-09-25T04:06:54Z |
| publishDate | 2023 |
| publisher | Oxford University Press |
| record_format | dspace |
| spelling | oxford-uuid:569f3e1d-7447-4fcf-b14d-db14696a8f1d2024-05-30T11:15:50ZRaising AWaRe-ness of antimicrobial stewardship challenges in pediatric emergency care: results from the PERFORM study assessing consistency and appropriateness of antibiotic prescribing across EuropeJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:569f3e1d-7447-4fcf-b14d-db14696a8f1dEnglishSymplectic ElementsOxford University Press2023Kolberg, LKhanijau, Avan der Velden, FJSHerberg, JDe, TGalassini, RCunnington, AJWright, VShah, PKaforou, MWilson, CKuijpers, TMartinón-Torres, FRivero-Calle, IMoll, HVermont, CPokorn, MKolnik, MPollard, AJAgyeman, PKASchlapbach, LJTsolia, MNYeung, SZavadska, DZenz, WSchweintzger, NAvan der Flier, Mde Groot, RUsuf, EVoice, MCalvo-Bado, LMallet, FFidler, KLevin, MCarrol, EDEmonts, Mvon Both, UPERFORM Consortium<p><strong>Background</strong></p> Optimization of antimicrobial stewardship is key to tackling antimicrobial resistance, which is exacerbated by overprescription of antibiotics in pediatric emergency departments (EDs). We described patterns of empiric antibiotic use in European EDs and characterized appropriateness and consistency of prescribing. <p><strong>Methods</strong></p> Between August 2016 and December 2019, febrile children attending EDs in 9 European countries with suspected infection were recruited into the PERFORM (Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management) study. Empiric systemic antibiotic use was determined in view of assigned final “bacterial” or “viral” phenotype. Antibiotics were classified according to the World Health Organization (WHO) AWaRe classification. <p><strong>Results</strong></p> Of 2130 febrile episodes (excluding children with nonbacterial/nonviral phenotypes), 1549 (72.7%) were assigned a bacterial and 581 (27.3%) a viral phenotype. A total of 1318 of 1549 episodes (85.1%) with a bacterial and 269 of 581 (46.3%) with a viral phenotype received empiric systemic antibiotics (in the first 2 days of admission). Of those, the majority (87.8% in the bacterial and 87.0% in the viral group) received parenteral antibiotics. The top 3 antibiotics prescribed were third-generation cephalosporins, penicillins, and penicillin/β-lactamase inhibitor combinations. Of those treated with empiric systemic antibiotics in the viral group, 216 of 269 (80.3%) received ≥1 antibiotic in the “Watch” category. <p><strong>Conclusions</strong></p> Differentiating bacterial from viral etiology in febrile illness on initial ED presentation remains challenging, resulting in a substantial overprescription of antibiotics. A significant proportion of patients with a viral phenotype received systemic antibiotics, predominantly classified as WHO Watch. Rapid and accurate point-of-care tests in the ED differentiating between bacterial and viral etiology could significantly improve antimicrobial stewardship. |
| spellingShingle | Kolberg, L Khanijau, A van der Velden, FJS Herberg, J De, T Galassini, R Cunnington, AJ Wright, V Shah, P Kaforou, M Wilson, C Kuijpers, T Martinón-Torres, F Rivero-Calle, I Moll, H Vermont, C Pokorn, M Kolnik, M Pollard, AJ Agyeman, PKA Schlapbach, LJ Tsolia, MN Yeung, S Zavadska, D Zenz, W Schweintzger, NA van der Flier, M de Groot, R Usuf, E Voice, M Calvo-Bado, L Mallet, F Fidler, K Levin, M Carrol, ED Emonts, M von Both, U PERFORM Consortium Raising AWaRe-ness of antimicrobial stewardship challenges in pediatric emergency care: results from the PERFORM study assessing consistency and appropriateness of antibiotic prescribing across Europe |
| title | Raising AWaRe-ness of antimicrobial stewardship challenges in pediatric emergency care: results from the PERFORM study assessing consistency and appropriateness of antibiotic prescribing across Europe |
| title_full | Raising AWaRe-ness of antimicrobial stewardship challenges in pediatric emergency care: results from the PERFORM study assessing consistency and appropriateness of antibiotic prescribing across Europe |
| title_fullStr | Raising AWaRe-ness of antimicrobial stewardship challenges in pediatric emergency care: results from the PERFORM study assessing consistency and appropriateness of antibiotic prescribing across Europe |
| title_full_unstemmed | Raising AWaRe-ness of antimicrobial stewardship challenges in pediatric emergency care: results from the PERFORM study assessing consistency and appropriateness of antibiotic prescribing across Europe |
| title_short | Raising AWaRe-ness of antimicrobial stewardship challenges in pediatric emergency care: results from the PERFORM study assessing consistency and appropriateness of antibiotic prescribing across Europe |
| title_sort | raising aware ness of antimicrobial stewardship challenges in pediatric emergency care results from the perform study assessing consistency and appropriateness of antibiotic prescribing across europe |
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