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Antibiotics
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Antibiotic Use and Antimicrobial Stewardship for Children in the Emergency...
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Antibiotic Use and Antimicrobial Stewardship for Children in the Emergency Department

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: 30 April 2024 | Viewed by 10926

Special Issue Editors

Dr. Michael Barrett

E-Mail Website
Guest Editor
Associate Clinical Professor, School of Medicine, University College Dublin, Dublin, Ireland
Interests: pediatric emergency, antimicrobial resistance; pediatric infectious diseases; medical education
Dr. Spyridon Karageorgos

E-Mail Website
Guest Editor
First Department of Pediatrics, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
Interests: pediatric emergency, antimicrobial resistance; pediatric infectious diseases; medical education
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The WHO has declared antimicrobial resistance (AMR) as one of the top 10 global health threats. Misuse and overuse of antimicrobials represent the main drivers in the development of AMR. The prescription rate of antibiotics for pediatric patients (e.g., febrile illness) presenting to the emergency department (ED) can contribute to AMR. A better understanding of the antibiotic prescription variability (indications, type, dose, route, and duration) in EDs that treat children is essential for the development of effective interventions with the aim to safely reduce and minimize antibiotic use. Development and implementation of antimicrobial stewardship programs (ASPs) is warranted to reduce the unnecessary or low value use of antibiotics in the ED. This Special Issue will focus on advances in the field of antimicrobial stewardship and judicious use of antibiotics for children in ED.

Dr. Michael Barrett
Dr. Spyridon Karageorgos
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pediatric ED
  • ambulatory
  • antimicrobial stewardship
  • antibiotic use
  • antimicrobial resistance
  • point-of-care testing

Published Papers (6 papers)

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Research

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14 pages, 1202 KiB  
Article
Antibiotic Drug Resistance Pattern of Uropathogens in Pediatric Patients in Pakistani Population
by Zakia Iqbal, Ahsan Sattar Sheikh, Anwaar Basheer, Hadiqa tul Hafsa, Mehboob Ahmed, Anjum Nasim Sabri and Samiah Shahid
Antibiotics 2023, 12(2), 395; https://doi.org/10.3390/antibiotics12020395 - 15 Feb 2023
Cited by 1 | Viewed by 1676
Abstract
The common prevalent diseases in the age of 0 to 6 are related to urinary tract infections. If not properly diagnosed, they will lead to urological and nephrological complications. Uropathogens are developing resistance against most drugs and are harder to treat. A study [...] Read more.
The common prevalent diseases in the age of 0 to 6 are related to urinary tract infections. If not properly diagnosed, they will lead to urological and nephrological complications. Uropathogens are developing resistance against most drugs and are harder to treat. A study was done on the inpatients and outpatients of the two hospitals located in Lahore. A total of 39,750 samples that were both male and female were collected. Escherichia and Klebsiella were found in 234 samples based on biochemical characterization, growth on CLED agar, and white blood cell/pus cell (WBC) microscopy. In comparison to males, female samples had a higher number of uropathogens (1:1.29). From the samples of Shaikh Zayed Hospital (SZH), the ratio of Klebsiella to Escherichia (1:1.93) was reported, while this ratio was 1.84:1 from the Children Hospital (CH). The incidence of UTI was higher in the month of September. Randomly selected Escherichia and Klebsiella were verified via a 16S rRNA sequence. Antibiotic resistance profiling of isolated bacterial strains was done against 23 antibiotics. The most efficient antibiotics against Klebsiella and Escherichia were colistin sulphate (100% sensitivity against bacteria from CH; 99.3% against strains from SZH) and polymyxin B (100% sensitivity against strains from SZH; 98.8% against strains from CH). Sensitivity of the total tested strains against meropenem (74%, SZH; 70% CH), Fosfomycin (68%, SZH; 73% CH strains), amikacin (74% SZH; 55% CH), and nitrofurantoin (71% SZH;67% CH) was found, Amoxicillin, ampicillin, and cefuroxime showed 100 to ≥90% resistance and are the least effective. Full article
(This article belongs to the Special Issue Antibiotic Use and Antimicrobial Stewardship for Children in the Emergency Department)
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Review

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12 pages, 563 KiB  
Review
An Overview of Antibiotic Therapy for Early- and Late-Onset Neonatal Sepsis: Current Strategies and Future Prospects
by Giovanni Boscarino, Rossana Romano, Carlotta Iotti, Francesca Tegoni, Serafina Perrone and Susanna Esposito
Antibiotics 2024, 13(3), 250; https://doi.org/10.3390/antibiotics13030250 - 10 Mar 2024
Viewed by 1566
Abstract
Neonatal sepsis is a clinical syndrome mainly associated with a bacterial infection leading to severe clinical manifestations that could be associated with fatal sequalae. According to the time of onset, neonatal sepsis is categorized as early- (EOS) or late-onset sepsis (LOS). Despite blood [...] Read more.
Neonatal sepsis is a clinical syndrome mainly associated with a bacterial infection leading to severe clinical manifestations that could be associated with fatal sequalae. According to the time of onset, neonatal sepsis is categorized as early- (EOS) or late-onset sepsis (LOS). Despite blood culture being the gold standard for diagnosis, it has several limitations, and early diagnosis is not immediate. Consequently, most infants who start empirical antimicrobial therapy do not have an underlying infection. Despite stewardship programs partially reduced this negative trend, in neonatology, antibiotic overuse still persists, and it is associated with several relevant problems, the first of which is the increase in antimicrobial resistance (AMR). Starting with these considerations, we performed a narrative review to summarize the main findings and the future prospects regarding antibiotics use to treat neonatal sepsis. Because of the impact on morbidity and mortality that EOS and LOS entail, it is essential to start an effective and prompt treatment as soon as possible. The use of targeted antibiotics is peremptory as soon as the pathogen in the culture is detected. Although prompt therapy is essential, it should be better assessed whether, when and how to treat neonates with antibiotics, even those at higher risk. Considering that we are certainly in the worrying era defined as the “post-antibiotic era”, it is still essential and urgent to define novel strategies for the development of antibacterial compounds with new targets or mechanisms of action. A future strategy could also be to perform well-designed studies to develop innovative algorithms for improving the etiological diagnosis of infection, allowing for more personalized use of the antibiotics to treat EOS and LOS. Full article
(This article belongs to the Special Issue Antibiotic Use and Antimicrobial Stewardship for Children in the Emergency Department)
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10 pages, 733 KiB  
Review
Conundrums in the Management of Febrile Infants under Three Months of Age and Future Research
by Helena Wilcox, Etimbuk Umana, Emmanuelle Fauteux-Lamarre, Roberto Velasco and Thomas Waterfield
Antibiotics 2024, 13(1), 88; https://doi.org/10.3390/antibiotics13010088 - 16 Jan 2024
Viewed by 1144
Abstract
Febrile infants under three months of age pose a diagnostic challenge to clinicians. Unlike in older children, the rates of invasive bacterial infections (IBIs), such as bacteraemia or meningitis, are high. This greater risk of IBI combined with the practical challenges of assessing [...] Read more.
Febrile infants under three months of age pose a diagnostic challenge to clinicians. Unlike in older children, the rates of invasive bacterial infections (IBIs), such as bacteraemia or meningitis, are high. This greater risk of IBI combined with the practical challenges of assessing young infants results in a cautious approach with many febrile infants receiving parenteral antibiotics “just in case”. However, there is a range of validated tailored care guidelines that support targeted investigation and management of febrile infants, with a cohort identified as lower risk suitable for fewer invasive procedures and observation without parenteral antibiotics. This manuscript outlines five common conundrums related to the safe application of tailored-care guidelines for the assessment and management of febrile infants under three months of age. It also explores future research which aims to further refine the management of febrile infants. Full article
(This article belongs to the Special Issue Antibiotic Use and Antimicrobial Stewardship for Children in the Emergency Department)
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19 pages, 603 KiB  
Review
Antibiotic Use for Common Infections in Pediatric Emergency Departments: A Narrative Review
by Spyridon Karageorgos, Owen Hibberd, Patrick Joseph William Mullally, Roberto Segura-Retana, Shenelle Soyer and Dani Hall
Antibiotics 2023, 12(7), 1092; https://doi.org/10.3390/antibiotics12071092 - 22 Jun 2023
Viewed by 2328
Abstract
Antibiotics are one of the most prescribed medications in pediatric emergency departments. Antimicrobial stewardship programs assist in the reduction of antibiotic use in pediatric patients. However, the establishment of antimicrobial stewardship programs in pediatric EDs remains challenging. Recent studies provide evidence that common [...] Read more.
Antibiotics are one of the most prescribed medications in pediatric emergency departments. Antimicrobial stewardship programs assist in the reduction of antibiotic use in pediatric patients. However, the establishment of antimicrobial stewardship programs in pediatric EDs remains challenging. Recent studies provide evidence that common infectious diseases treated in the pediatric ED, including acute otitis media, tonsillitis, community-acquired pneumonia, preseptal cellulitis, and urinary-tract infections, can be treated with shorter antibiotic courses. Moreover, there is still controversy regarding the actual need for antibiotic treatment and the optimal dosing scheme for each infection. Full article
(This article belongs to the Special Issue Antibiotic Use and Antimicrobial Stewardship for Children in the Emergency Department)
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12 pages, 5945 KiB  
Review
Regional Perspective of Antimicrobial Stewardship Programs in Latin American Pediatric Emergency Departments
by Adriana Yock-Corrales and Gabriela Naranjo-Zuñiga
Antibiotics 2023, 12(5), 916; https://doi.org/10.3390/antibiotics12050916 - 16 May 2023
Cited by 1 | Viewed by 1429
Abstract
Antibiotic stewardship (AS) programs have become a priority for health authorities to reduce the number of infections by super-resistant microorganisms. The need for these initiatives to minimize the inadequate use of antimicrobials is essential, and the election of the antibiotic in the emergency [...] Read more.
Antibiotic stewardship (AS) programs have become a priority for health authorities to reduce the number of infections by super-resistant microorganisms. The need for these initiatives to minimize the inadequate use of antimicrobials is essential, and the election of the antibiotic in the emergency department usually impacts the choice of treatment if the patients need hospital admission, becoming an opportunity for antibiotic stewardship. In the pediatric population, broad-spectrum antibiotics are more likely to be overprescribed without any evidence-based management, and most of the publications have focused on the prescription of antibiotics in ambulatory settings. Antibiotic stewardship efforts in pediatric emergency departments in Latin American settings are limited. The lack of literature on AS programs in the pediatric emergency departments in Latin America (LA) limits the information available. The aim of this review was to give a regional perspective on how pediatric emergency departments in LA are working towards antimicrobial stewardship. Full article
(This article belongs to the Special Issue Antibiotic Use and Antimicrobial Stewardship for Children in the Emergency Department)
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Other

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8 pages, 643 KiB  
Perspective
Decision Challenges for Managing Acute Paediatric Infections: Implications for Antimicrobial Resistance
by Eva M. Krockow, Sanjay Patel and Damian Roland
Antibiotics 2023, 12(5), 828; https://doi.org/10.3390/antibiotics12050828 - 28 Apr 2023
Viewed by 1653
Abstract
Overprescribing of antibiotics in paediatrics accounts for a significant proportion of inappropriate antibiotic use in human healthcare, thereby contributing to the global health emergency of antimicrobial resistance. Antimicrobial stewardship efforts are complicated by the unique social dynamics in paediatric healthcare, with a specific [...] Read more.
Overprescribing of antibiotics in paediatrics accounts for a significant proportion of inappropriate antibiotic use in human healthcare, thereby contributing to the global health emergency of antimicrobial resistance. Antimicrobial stewardship efforts are complicated by the unique social dynamics in paediatric healthcare, with a specific challenge being the prominent role of parents and carers who act as intermediaries between prescribers and paediatric patients. In this Perspective article concentrating on healthcare of the United Kingdom, we describe this complicated interplay of different decision stakeholders (patients, parents and prescribers), outline four dimensions of decision challenges (social, psychological, systemic and specific diagnostic and treatment challenges) and provide a number of theory-based strategies for supporting different stakeholders during the decision process, ultimately with the aim of improving antimicrobial stewardship. Key decision challenges for patients and carers include limited knowledge and experience of managing infections, which were exacerbated during the COVID-19 pandemic and frequently result in health anxiety and inappropriate health-seeking behaviours. Challenges for medical prescribers span societal pressures from prominent patient litigation cases, cognitive biases, and system pressures to specific diagnostic problems (e.g., age limitations of current clinical scoring systems). Strategies for mitigating decision challenges in paediatric infection management will need to include a range of context- and stakeholder-specific actions, including improvements of integrated care and public health education as well as better clinical decision tools and access to evidence-based guidelines. Full article
(This article belongs to the Special Issue Antibiotic Use and Antimicrobial Stewardship for Children in the Emergency Department)
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