Background Only a small fraction of paediatric healthcare-associated infections (HCAIs) give a positive blood culture. This retrospective study focused on the quality of the treatment of these infections. The purpose was to investigate how the final information on the isolated pathogen influenced the subsequent antimicrobial treatment (AMT).
Purpose To investigate retrospectively how the information from the blood culture isolate affected antimicrobial treatment (AMT) in suspected HCAIs.
Materials and methods The Hospital for Children and Adolescents, Helsinki University Central Hospital, is a tertiary-care paediatric centre with approximately 100 annual bloodstream infections. The inclusion criteria for our study were: age 0–17 years, a positive blood culture, HCAI and AMT given for thte infection. For this qualitative analysis we selected five different groups of pathogens S. aureus (n = 25), S. epidermidis (n = 33), streptococci (n = 30), Gram negative pathogens (n = 38), and polymicrobial infections (n = 23).
An expert panel of three physicians evaluated the targeted AMTs given 72 h post final blood culture results in order to determine whether the targeted antimicrobials chosen were appropriate or inappropriate. Inappropriate AMT was defined as two distinct categories: 1) the isolated pathogen was resistant to selected antimicrobials – result ignored 2) the isolated pathogen was subsequently treated with AMT with suboptimal efficacy.
Results According to our definitions, 27/149 (18%) of patients received inappropriate AMT. 13/149 (9%) of patients were treated with an antimicrobial or combination of antimicrobials to which the isolate was resistant. Three patients (2%) received antimicrobials that were totally ineffective according to in vitro data. Suboptimal AMT was administered to 14 (9%) of patients. Inappropriate AMT was not associated with increased mortality.
Conclusions The most common cause of suboptimal AMT was the use of vancomycin for infections caused by methicillin-sensitive Staphylococcus aureus (MSSA). De-escalation of the AMT should also be considered more frequently. Serious cases where selected inappropriate treatments were potentially life-threatening were relatively rare. The most common – and alarming – was the ignored result concerning susceptibility of pathogen to AMT. More attention should be given to appropriate prescription of antimicrobials and more training should be provided.
No conflict of interest.
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