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.

中文翻译：

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改善儿童血流感染中的经验性抗生素处方：加权发病综合征组合抗菌谱 (WISCA) 的潜在应用

摘要

背景

增加对 WHO 推荐的儿童脓毒症一线和二线治疗的抗生素耐药性需要调整处方指南。我们讨论了加权发病综合征组合抗菌谱 (WISCA) 作为在评估常用抗生素的经验覆盖率时整合当地微生物学数据的实用工具的潜力和局限性。

研究设计与方法

2019 年 7 月，向全球儿科医院网络发送了一份包含 18 种具有临床意义的儿科血培养分离物（2018 年 1 月至 12 月）的简短问卷。非抗假单胞菌第三代头孢菌素 (3GC) 和美罗培南的加权覆盖率估计使用了报告> 100个分离株的每个站点的蒙特卡罗模拟。

结果

世卫组织 5 个区域 23 个国家的 52 家医院对问卷作出答复；13 个站点满足样本量要求。最常见的分离株是金黄色葡萄球菌、克雷伯菌属、大肠杆菌和肠球菌属。3GC 的覆盖率从 39% [95%CrI: 34–43%] 到 73%（两个站点：[95%CrI: 65–80%]；[95%CrI: 68–86%]）和美罗培南覆盖范围从 54% [95%CrI: 47–60%] 到 88% [95%CrI:84–91%]。

结论

WISCA 是一种数据驱动的临床直观工具，可用于使用现有的大型数据集比较儿童脓毒症的经验性抗生素治疗方案。可以使用更复杂的元分析方法和患者特征进一步细化估计值。