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

PLoS One. 2015 Nov 5;10(11):e0141555. doi: 10.1371/journal.pone.0141555. eCollection 2015.

Abstract

Aim: Knowledge 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.

Methods: Data 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).

Results: 17% 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.

Conclusion: Approximately 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anti-Infective Agents / therapeutic use*
  • Bacteremia / drug therapy*
  • Bacteremia / microbiology
  • Child
  • Child, Preschool
  • Cross Infection / drug therapy*
  • Cross Infection / microbiology
  • Drug Resistance, Bacterial
  • Female
  • Humans
  • Inappropriate Prescribing / statistics & numerical data
  • Infant
  • Infant, Newborn
  • Male
  • Retrospective Studies
  • Staphylococcal Infections / drug therapy
  • Staphylococcus epidermidis / drug effects

Substances

  • Anti-Infective Agents

Grant support

The work was supported by The University Pharmacy of Finland (www.yliopistonapteekki.fi), The Foundation of Päivikki ja Sakari Sohlberg (www.pss-saatio.fi) and The University of Helsinki, Finland. The funding was salary for PhD student Niina Laine. It was not used on other purposes besides working (i.e., no materials/computers etc.).