Infection Journal - Targeted Empiric Antimicrobial Therapy

7/25/2019 Infection Journal - Targeted Empiric Antimicrobial Therapy

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Empirical antiobiotic therapy healthy children and children wcomorbidities. Should we dife

Dion Darius Samsudin

PPDS IKA Madya inesi


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PI!"

P# Empirical antibiotic therapy

I # Pre$iously heatlhy children

!# !hildren with comorbidities

"#Efecti$eness


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Introduction

In the %K& serious inection are responsible or around '

childhood deaths *al o the death occurin+ in children with underlyin+ co

hi+her ris o an inection related death in children withcomorbidities compared to healthy children

Diferent patho+ens in children with comorbidities +rabacteria and un+i

In southwest london# ',- o in$asi$e bacterial inection community onset& ',- o them occured in children with c

!urrently& the !hildren1s /ritish 2ational 3ormulary /23recommends speci4c antimicrobial therapy dependin+ osuspected inection& but does not diferentiate between

healthy children and children with comorbidities


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!hildren with comorbidities

5. 6he primary comorbidities or its treatment renchild immunode4cient and thus& more $ulnerab

'. 7eaenin+ o physical innate immune protecti2euromuscular disorder and recurrent respiratinections0

-. 8epeated hospital contact and e9posure to muand prolon+ed antibiotic courses

:. More speci4c symptoms and si+ns& leadin+ to ain dia+nosis and initiation o antimicrobial ther


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Aim o the study

6his study aimed to describe the aetiolo+y& comstatus& ocus o inection& treatment and outcomchildren with community onset I/I

6o determine whether the empiric antibiotic therreccomended in the /23c is appropriate or child

with comorbidities


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Methods !hildhood Acute /acterial Inection 2etwor !A/I20 collec

children a+ed one month to 5; years with a positi$e blood

cerebrospinal


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8esults

Durin+ '((= > '(55& there were -5= community I/I episodes in '( children

Ater e9cludin+ children with mali+nancy#

55= pre$iously healthy children e9perience a sinepisode

5 children with comorbidities had - I/I episod

-=) o the children with !B! had an indwellin+ -) had BP shunt in situ

5; children died& 55 =)0 in pre$iously healthy cand our )0 in children with comorbidities


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Patho+en responsible


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Pre$iously healthy children

6he etiolo+y o community onset I/I in healthy childa+e dependent

" the '( pneumococcal inection& :;) had pneumo'() had menin+itis& -;) had septicaemia

Staphylococcus aureus inection were predominantlybone,oint inection ()0& 3ollowed by sin and sotinection ')0

2one were methicillin resistant

Empiric antibiotics were not initiated in 5; children# children died prior to or on arri$al to hospital& othechildren did not recei$e antibiotics on admission bec

bacterial inection was not suspected


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!hildren with comorbidities

!hidren with no !B!6he patho+ens in this +roup were similar to those in health

children

Froup / streptococci '=)0 and S.pneumoniae '5)0 predin inants

S.aureus '5)0 and S.pneumoniae '5)0 were most comm

toddler and older children Antimicrobial sensiti$ity patterns were similar to those in h

children

"ut o ' who recei$ed antibiotics& 5) recei$ed /23crecommended antibiotics& and ') recei$ed alternati$e athat pro$ided adeGuate antimicrobial co$er


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!hidlren with comorbidities

!hildren with !B! !hildren in this +roup were more liely to ha$e multiple I/I e

and the patho+en responsible were diferent to those seen iother two +roups

In inants& E.coli was still common ::)0

In the other +roups& !"2S were predominant ':) in toddle

:) in older children0 A si+ni4cant proportion o I/I episodes occured in 6P2Cdepe

children with +astro intestinal disease& and children with li$e

Empiric antibiotic therapy was chan+ed within 4$e days in 'episodes compored with 55) in healthy children


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Discussion


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Discussion

6he !A/I2 studies hi+hli+hts the success o the national immpro+ramme

In$asi$e bacterial inection in healthy children are rare

Introduction o new $accine into the national immunisation pis liely to reduce incidence e$en urther

Maor dri$e to mana+e children with chronic comorbidities in community multiple and prolon+ed antibiotics therapy

6he current /23c recommends empiric antibiotic therapy depthe ocus o inection appropriate

Almost H o children recei$ed more than recommended antibmainly children who reGuired PI!% admission because they wseriously ill

*i+h proportion o deaths occurin+ prior or soon ater admissmissed opportunity or seein+ treatments


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imitations

5. I/I was uncommon& thereore ormal statisticalanalysis ater sub+roupin+ cases by a+e and riactors was limited

'. 7e only included blood, !S3 cultureCcon4rmedlocaliJed inections such as pneumonia and ur

tract inections and P!8 con4rmed cases are nincluded0

-. 6he case mi9 in our southwest london cohort mbe representati$e o the country as a whole


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!onclusion

6he traditional model o usin+ either community acGuired or hoacGuired I/I to predict patho+en& ris o antimicrobial resistance+uide to empiric therapy is no lon+er appropriate

8eccomendation#

!hildren 5C5 years0with chronic comorbidity presentin+ withcommunity acGuire septicaemia /road spectrum antipseudomlactam antibacterial

!hildren 5C5 years0with and without chronic comorbidity pwit hospital acGuire septicaemia /road spectrum antipseudolactam antibacterial

!hildren 5C5 years0with indwelling CVC and septicaemia to vascular catheter Flycopeptide should be considered ocommunity and hospital onset inections

!ritical appraisal


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!ritical appraisal5. Did the study address a clearly ocused issue? es

'. 7as the cohort recruited in an acceptable way?es

-. 7as the e9posure accurately measured to minimise bias? !ant

:. 7as the outcome accurately measured to minimise bias?!ant te;. *a$e the authors identi4ed all important conoundin+ actors?

. *a$e they taen into account the conoundin+ actors? 2o

. 7as the ollow up o subects complete enou+h? !ant tell

. 7as the ollow up on subects lon+ enou+h? !ant tell

=. 7hat are the result o this study?2ot clear5(.*ow precise are the result? 2ot clear

55.Do you belie$e the resultses

5'.!an the results be applied to the local population? 2o

5-.Do the results o this study 4t with other a$ailable e$idence? e

5:.7hat are the implication o this study or practice?

Infection Journal - Targeted Empiric Antimicrobial Therapy

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