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

Laura Kolberg, Aakash Khanijau, Fabian J.S. van der Velden, The PERFORM consortium (Personalized Risk assessment in febrile children to optimize Real-life Management across the European Union), Jethro Herberg, Tisham De, Rachel Galassini, Aubrey J. Cunnington, Victoria J. Wright, Priyen Shah, Myrsini Kaforou, Clare Wilson, Taco Kuijpers, Federico Martinón-Torres, Irene Rivero-Calle, Henriette Moll, Clementien Vermont, Marko Pokorn, Mojca Kolnik, Andrew J. PollardPhilipp K.A. Agyeman, Luregn J. Schlapbach, Maria N. Tsolia, Shunmay Yeung, Dace Zavadska, Werner Zenz, Nina A. Schweintzger, Michiel van der Flier, Ronald de Groot, Effua Usuf, Marie Voice, Leonides Calvo-Bado, François Mallet, Katy Fidler, Michael Levin, Enitan D. Carrol, Marieke Emonts, Ulrich von Both*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
15 Downloads (Pure)

Abstract

Background. 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. Methods. 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. Results. 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. Conclusions. Differentiating bacterial from viral etiology in febrile illness on initial ED presentation remains challenging, resulting in a substantial overprescription of antibiotics.

Original languageEnglish
Pages (from-to)526-534
Number of pages9
JournalClinical Infectious Diseases
Volume78
Issue number3
DOIs
Publication statusPublished - 15 Mar 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Fingerprint

Dive into the research topics of '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'. Together they form a unique fingerprint.

Cite this