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 van der Velden, Jethro Herberg, Tisham De, Rachel Galassini, Aubrey J. Cunnington, Victoria Wright, Priyen Shah, Myrsini Kaforou, Clare Wilson, Taco W. Kuijpers, Federico Martinón‐Torres, Irene Rivero‐Calle, Henriëtte A. Moll, Clementien Vermont, Marko Pokorn, Mojca Kolnik, Andrew J. Pollard, Philipp Agyeman, Luregn J. Schlapbach, Μαρία Τσολιά, 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, Michael Levin, Aubrey J. Cunnington, Tisham De, Jethro Herberg, Myrsini Kaforou, Victoria Wright, Lucas Baumard, Evangelos Bellos, Giselle D’Souza, Rachel Galassini, Dominic Habgood-Coote, Shea Hamilton, Clive Hoggart, Sara Hourmat, Heather Jackson, Naomi Lin, Ian Maconochie, Stephanie Menikou, Samuel Nichols, Ruud Nijman, Ivonne Pena Paz, Oliver Powell, Priyen Shah, Ortensia Vito, Clare Wilson, Molly M. Stevens, Eun-Jung Kim, Nayoung Kim, Amina Abdulla, Ladan Ali, Sarah Darnell, Rikke Jorgensen, Sobia Mustafa, Salina Persand, Katy Fidler, Julia Dudley, Vivien Richmond, Emma Tavliavini, Enitan D. Carrol, Elizabeth Cocklin, Rebecca B. Jennings, Joanne Johnston, Aakash Khanijau, Simon Leigh, Nadia Lewis-Burke, Karen Newall, Sam Romaine, Andrew J. Pollard, Rama Kandasamy, Stéphane Paulus, Michael J. Carter, Daniel O’Connor, Sagida Bibi, Dominic F. Kelly, Meeru Gurung, Stephen Thorson, Imran Shafique Ansari, David R. Murdoch, Shrijana Shrestha, Zoe Oliver, Marieke Emonts, Emma Lim, Lucille Valentine
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. A significant proportion of patients with a viral phenotype received systemic antibiotics, predominantly classified as WHO Watch. Rapid and accurate point-of-care tests in the ED differentiating between bacterial and viral etiology could significantly improve antimicrobial stewardship.