Background: Increasing antibiotic resistance to WHO-recommended first- and second-line treatments of pediatric sepsis requires adaptation of prescribing guidelines. We discuss the potential and limitations of a weighted-incidence syndromic combination antibiogram (WISCA) as a practical tool for incorporating local microbiology data when assessing empiric coverage of commonly used antibiotics. Research design and methods: A brief questionnaire of 18 clinically significant isolates from pediatric blood cultures (Jan-Dec 2018) was sent to a global network of pediatric hospitals in July 2019. Weighted coverage estimates of non-antipseudomonal third-generation cephalosporins (3GC) and meropenem were estimated using Monte–Carlo simulation for each site reporting >100 isolates. Results: 52 hospitals in 23 countries in 5 WHO regions responded to the questionnaire; 13 sites met the sample size requirement. The most common isolates were S. aureus, Klebsiella spp., E. coli and Enterococcus spp. Coverage of 3GC ranged from 39% [95%CrI: 34–43%] to 73% (two sites: [95%CrI: 65–80%]; [95%CrI: 68–86%]) and meropenem coverage ranged from 54% [95%CrI: 47–60%] to 88% [95%CrI:84–91%]. Conclusions: A WISCA is a data-driven, clinically intuitive tool that can be used to compare empiric antibiotic regimens for pediatric sepsis using existing large datasets. The estimates can be further refined using more complex meta-analytical methods and patient characteristics.
Improving empiric antibiotic prescribing in pediatric bloodstream infections: a potential application of weighted-incidence syndromic combination antibiograms (WISCA) / Cook, A.; Sharland, M.; Yau, Y.; Bielicki, J.; Grimwood, K.; Cross, J.; Cheung, K.; Parbhoo, D.; Henriques Teixeira, C.; Berezin, E. N.; Barreto Da Silva, C.; Ales Leal, I.; Vieira Souza, C.; Carvalheiro, C. G.; De Souza, C. B. S.; Turner, P.; Miliya, T.; Wu, L.; Jin, P.; Deng, J.; Wang, H.; Feng, J.; Chen, Y.; Jurna, M.; Lutsar, I.; Koljalg, S.; Kirjavainen, V.; Kekomaki, S.; Darboe, S.; Okomo, U. A.; Ricardo Araujo Da Silva, A.; Hubner, J.; Christner, M.; Schulze-Sturm, U.; Hufnagel, M.; Bluemel, B.; Dimopoulou, D.; Papaevangelou, V.; Gkentzi, D.; Kolonitsiou, F.; Maraki, S.; Vergadi, E.; Singh, S.; George, A.; Dharmapalan, D.; Rai, R.; Shetty, K.; Yewale, V.; Iyer, R. N.; Alvarez-Uria, G.; Jinka, D. R.; Ashkenazi-Hoffnung, L.; Ben-Zvi, H.; De Luca, M.; Bernaschi, P.; Pansa, P.; Bianchini, S.; Esposito, S.; Horikoshi, Y.; Higuchi, H.; Castellanos-Cruz, M. D. C.; Pichardo-Villalon, L.; Gowin, E.; Pirumova, R.; Chan, S. M.; Chew, K. L.; Nana, T.; Bandini, R.; Dramowski, A.; Whitelaw, A.; Manzanares, A.; Orellana, M. A.; Martinon-Torres, F.; Dacosta Urbieta, A. I.; Olson, L.; Larsson, M.; Preedisripipat, K.; Cressey, T. R.; Anugulruengkitt, S.; Chatsuwan, T.; Lochindarat, S.; Mutitanon, S.; Ssengooba, W.; Tasimwa, H. B.; Musoke, P.; Shaw, F.; Riordan, A.; Fidler, K.; Schilling, W.; Hatcher, J.; Bamford, A.; Mcmaster, P.; Harkensee, C.; Moore, J.; Speirs, L.; Moriarty, P.; Chesshyre, E.; Auckland, C.; Hindocha, A.; Ashcroft, P.; Thompson, S.; Patel, S.; Browning, D.; Tran Minh, D.; Hoang Thi Bich, N.. - In: EXPERT REVIEW OF ANTI-INFECTIVE THERAPY. - ISSN 1478-7210. - 20:3(2022), pp. 445-456. [10.1080/14787210.2021.1967145]
Improving empiric antibiotic prescribing in pediatric bloodstream infections: a potential application of weighted-incidence syndromic combination antibiograms (WISCA)
Chen Y.;Bianchini S.;Esposito S.;Bandini R.;
2022-01-01
Abstract
Background: Increasing antibiotic resistance to WHO-recommended first- and second-line treatments of pediatric sepsis requires adaptation of prescribing guidelines. We discuss the potential and limitations of a weighted-incidence syndromic combination antibiogram (WISCA) as a practical tool for incorporating local microbiology data when assessing empiric coverage of commonly used antibiotics. Research design and methods: A brief questionnaire of 18 clinically significant isolates from pediatric blood cultures (Jan-Dec 2018) was sent to a global network of pediatric hospitals in July 2019. Weighted coverage estimates of non-antipseudomonal third-generation cephalosporins (3GC) and meropenem were estimated using Monte–Carlo simulation for each site reporting >100 isolates. Results: 52 hospitals in 23 countries in 5 WHO regions responded to the questionnaire; 13 sites met the sample size requirement. The most common isolates were S. aureus, Klebsiella spp., E. coli and Enterococcus spp. Coverage of 3GC ranged from 39% [95%CrI: 34–43%] to 73% (two sites: [95%CrI: 65–80%]; [95%CrI: 68–86%]) and meropenem coverage ranged from 54% [95%CrI: 47–60%] to 88% [95%CrI:84–91%]. Conclusions: A WISCA is a data-driven, clinically intuitive tool that can be used to compare empiric antibiotic regimens for pediatric sepsis using existing large datasets. The estimates can be further refined using more complex meta-analytical methods and patient characteristics.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
