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2000
Volume 21, Issue 1
  • ISSN: 1573-3963
  • E-ISSN: 1875-6336

Abstract

Background

Antibiotic de-escalation therapy plays a vital role in reducing the risk of bacterial resistance across the globe. This study elucidates the significance, determinants, and outcomes pertaining to Antibiotic De-escalation (ADE). The ADE is acknowledged as a crucial component within Antimicrobial Stewardship Programs (ASPs). The proliferation of antimicrobial-resistant bacteria arises as an anticipated outcome of the extensive utilization of antibiotics, heightening researchers' apprehensions regarding this global challenge.

Objective

The primary objective of the study was to evaluate the usage of antibiotics in terms of clinical outcomes (re-admission within 30 days and therapy outcomes upon discharge), adverse events, duration of de-escalation, and duration of hospitalizations among pediatric patients admitted to a tertiary care hospital due to various infectious diseases.

Methods

A retrospective study was conducted during a four-month period, from January 2022 to April 2023, at a tertiary care facility in Ajman, United Arab Emirates. Participants included in this study were based on specific inclusion and exclusion criteria.

Results

A total of 200 pediatric records were screened. The majority of participants, accounting for 66.0%, were female, and 54.0% were classified as Arabs in terms of race. The mean age was 7.5 years (± 2.8). The most prevalent symptoms reported were fever (98%), cough (75%), and sore throat (73%). Male participants were more inclined to present with bacterial infections (88.2%) compared to viral infections (3.8%), bacterial and viral co-illnesses (2.5%), or parasitic infections (1.3%) at the time of admission. Regarding clinical outcomes, 27% of patients were readmitted with the same infection type, while 52% did not experience readmission. The analysis also included information on the number of patients within each antibiotic therapy duration category, alongside the mean duration of antibiotic de-escalation in hours with standard deviation (± SD). The statistical significance of these associations was assessed using P-values, revealing a significant relationship ( < 0.0001) between the duration of antibiotic therapy and the time required for antibiotic de-escalation.

Conclusion

The study's analysis revealed that individuals readmitted to the hospital, irrespective of whether they presented with the same or a different infection type, exhibited prolonged durations of antibiotic de-escalation. This observation underscores the potential influence of the patient's clinical trajectory and the necessity for adjunctive therapeutic interventions on the duration of antibiotic de-escalation.

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2025-01-01
2024-11-22
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References

  1. VialeP. TedeschiS. ScudellerL. AttardL. BadiaL. BartolettiM. CascavillaA. CristiniF. DentaleN. FasuloG. LegnaniG. TrapaniF. TumiettoF. VerucchiG. VirgiliG. BerlingeriA. AmbrettiS. De MoloC. BriziM. CavazzaM. GiannellaM. Infectious diseases team for the early management of severe sepsis and septic shock in the emergency department.Clin. Infect. Dis.20176581253125910.1093/cid/cix54828605525
    [Google Scholar]
  2. MathieuC. PasteneB. CassirN. Martin-LoechesI. LeoneM. Efficacy and safety of antimicrobial de-escalation as a clinical strategy.Expert Rev. Anti Infect. Ther.2019172798810.1080/14787210.2019.156127530570361
    [Google Scholar]
  3. TabahA. BassettiM. KollefM.H. ZaharJ.R. PaivaJ.A. TimsitJ.F. RobertsJ.A. SchoutenJ. GiamarellouH. RelloJ. De WaeleJ. ShorrA.F. LeoneM. PoulakouG. DepuydtP. Garnacho-MonteroJ. Antimicrobial de-escalation in critically ill patients: A position statement from a task force of the European Society of Intensive Care Medicine (ESICM) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) critically Ill patients study group (ESGCIP).Intensive Care Med.202046224526510.1007/s00134‑019‑05866‑w31781835
    [Google Scholar]
  4. CharaniE. AhmadR. RawsonT.M. Castro-SanchèzE. TarrantC. HolmesA.H. The differences in antibiotic decision-making between acute surgical and acute medical teams: An ethnographic study of culture and team dynamics.Clin. Infect. Dis.2019691122010.1093/cid/ciy84430445453
    [Google Scholar]
  5. MurrayT.S. PeaperD.R. The contribution of extended-spectrum β-lactamases to multidrug-resistant infections in children.Curr. Opin. Pediatr.201527112413110.1097/MOP.000000000000018225565574
    [Google Scholar]
  6. LoganL.K. BraykovN.P. WeinsteinR.A. LaxminarayanR. CDC Epicenters Prevention Program Extended-spectrum β-lactamase–producing and third-generation cephalosporin-resistant Enterobacteriaceae in children: Trends in the United States, 1999–2011.J. Pediatric Infect. Dis. Soc.20143432032810.1093/jpids/piu01026625452
    [Google Scholar]
  7. DonàD. BarbieriE. DaverioM. LundinR. GiaquintoC. ZaoutisT. SharlandM. Implementation and impact of pediatric antimicrobial stewardship programs: A systematic scoping review.Antimicrob. Resist. Infect. Control2020912
    [Google Scholar]
  8. AlsulamiZ. ConroyS. ChoonaraI. Medication errors in the Middle East countries: A systematic review of the literature.Eur. J. Clin. Pharmacol.2013694995100810.1007/s00228‑012‑1435‑y23090705
    [Google Scholar]
  9. MathewR. SayyedH. BeheraS. MalekiK. PawarS. Evaluation of antibiotic prescribing pattern in pediatrics in a tertiary care hospital.Avicenna J. Med.2021111151910.4103/ajm.ajm_73_2033520784
    [Google Scholar]
  10. AndersonH. VuillerminP. JachnoK. AllenK.J. TangM.L.K. CollierF. KempA. PonsonbyA.L. BurgnerD. Barwon Infant Study Investigator Group Prevalence and determinants of antibiotic exposure in infants: A population-derived Australian birth cohort study.J. Paediatr. Child Health2017531094294910.1111/jpc.1361628749577
    [Google Scholar]
  11. BiezenR. PollackA.J. HarrisonC. BrijnathB. GrandoD. BrittH.C. MazzaD. Respiratory tract infections among children younger than 5 years: Current management in Australian general practice.Med. J. Aust.2015202526226510.5694/mja14.0009025758698
    [Google Scholar]
  12. FreedmanJ. LeibovitzE. SergienkoR. LevyA. Risk factors for hospitalization at the pediatric intensive care unit among infants and children younger than 5 years of age diagnosed with infectious diseases.Pediatr. Neonatol.202364213313910.1016/j.pedneo.2022.06.01236184529
    [Google Scholar]
  13. RuggieriA. AnticoliS. D’AmbrosioA. GiordaniL. VioraM. The influence of sex and gender on immunity, infection and vaccination.Ann. Ist. Super. Sanita201652219820427364394
    [Google Scholar]
  14. VelavanT.P. PallerlaS.R. RüterJ. AugustinY. KremsnerP.G. KrishnaS. MeyerC.G. Host genetic factors determining COVID-19 susceptibility and severity.EBioMedicine20217210362910.1016/j.ebiom.2021.10362934655949
    [Google Scholar]
  15. YowH.Y. GovindarajuK. LimA.H. Abdul RahimN. Optimizing antimicrobial therapy by integrating multi-omics with pharmacokinetic/pharmacodynamic models and precision dosing.Front. Pharmacol.20221391535510.3389/fphar.2022.91535535814236
    [Google Scholar]
  16. de CacquerayN. BoujaafarS. BilleE. MoulinF. GanaI. BenaboudS. HirtD. BérangerA. ToubianaJ. RenolleauS. TréluyerJ.M. OualhaM. Therapeutic drug monitoring of antibiotics in critically ill children: An observational study in a pediatric intensive care unit.Ther. Drug Monit.202244231932710.1097/FTD.000000000000091835292609
    [Google Scholar]
  17. HansenG.T. Continuous evolution: Perspective on the epidemiology of carbapenemase resistance among Enterobacterales and other Gram-negative bacteria.Infect. Dis. Ther.2021101759210.1007/s40121‑020‑00395‑233492641
    [Google Scholar]
  18. YakovlevS.V.Y. SuvorovaM.P.S. Rationale for the choice of an antibiotic for urinary tract infections with an emphasis on the environmental safety of therapy.Urologiia20214_202149710510.18565/urology.2021.4.97‑10534486282
    [Google Scholar]
  19. GiskeC.G. TurnidgeJ. CantónR. KahlmeterG. EUCAST Steering Committee Update from the European committee on antimicrobial susceptibility testing (EUCAST).J. Clin. Microbiol.2022603e00276-2110.1128/jcm.00276‑2134346716
    [Google Scholar]
  20. AldardeerN. QushmaqI. AlShehailB. IsmailN. AlHameedA. DamfuN. Al MusawaM. NadhreenR. KalkatawiB. SaberB. NasserM. RamdanA. ThabitA. AldhaeefiM. Al ShukairiA. Effect of broad-spectrum antibiotic de-escalation on critically ill patient outcomes: A retrospective cohort study.J. Epidemiol. Glob. Health202313344445210.1007/s44197‑023‑00124‑137296351
    [Google Scholar]
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