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Novel approach towards antimicrobial chemotherapy optimization in lower respiratory tract infections in children: An observational study
The use of local antibiogram in guiding clinical decisions is an integral part of the antimicrobial stewardship program. Conventional antibiograms are not disease-specific, ignore the distribution of microorganisms, obscure the in-vitro efficacy interrelationships, and have limited use in polymicrob...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483859/ https://www.ncbi.nlm.nih.gov/pubmed/34596107 http://dx.doi.org/10.1097/MD.0000000000026585 |
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author | Abramavicius, Silvijus Stundziene, Alina Jankauskaite, Lina Vitkauskiene, Astra Kowalski, Ireneusz M. Wojtkiewicz, Joanna Stankevicius, Edgaras |
author_facet | Abramavicius, Silvijus Stundziene, Alina Jankauskaite, Lina Vitkauskiene, Astra Kowalski, Ireneusz M. Wojtkiewicz, Joanna Stankevicius, Edgaras |
author_sort | Abramavicius, Silvijus |
collection | PubMed |
description | The use of local antibiogram in guiding clinical decisions is an integral part of the antimicrobial stewardship program. Conventional antibiograms are not disease-specific, ignore the distribution of microorganisms, obscure the in-vitro efficacy interrelationships, and have limited use in polymicrobial infections. We aimed to develop an in-house empiric, disease-specific, antimicrobial prescription auxiliary for the treatment of hospitalized pediatric pneumonia patients and to present the methods which help to choose the first and the second line antimicrobial therapy, while accounting for cost and safety aspects. A retrospective single center observational study was conducted on bronchoscopy obtained sputum culture. Analysis of probabilities, variance minimization, Boolean network modeling, and dominance analysis were applied to analyze antibiogram data. The Kirby–Bauer disk diffusion method was used to test the susceptibility of all isolates. Final optimization analysis included local drug acquisition cost (standardized to price per DDD) and safety profile. Data of 145 pediatric patients hospitalized with pneumonia with 218 isolates over 5 years was collected. A combination of statistical methods such as probabilities of drug efficacy, variance minimization, Boolean network modeling, and dominance analysis can help to choose the optimal first-line and the second-line antimicrobial treatment and optimize patient care. This research reveals that ampicillin is the optimal choice as the first-line drug and piperacillin-tazobactam is the second-line antimicrobial drug if the first one is not effective, while accounting for cost and safety aspects. The paper proposes a new methodology to adapt empiric antimicrobial therapy recommendations based on real world data and accout for costs and risk of adverse events. |
format | Online Article Text |
id | pubmed-8483859 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-84838592021-10-04 Novel approach towards antimicrobial chemotherapy optimization in lower respiratory tract infections in children: An observational study Abramavicius, Silvijus Stundziene, Alina Jankauskaite, Lina Vitkauskiene, Astra Kowalski, Ireneusz M. Wojtkiewicz, Joanna Stankevicius, Edgaras Medicine (Baltimore) 4400 The use of local antibiogram in guiding clinical decisions is an integral part of the antimicrobial stewardship program. Conventional antibiograms are not disease-specific, ignore the distribution of microorganisms, obscure the in-vitro efficacy interrelationships, and have limited use in polymicrobial infections. We aimed to develop an in-house empiric, disease-specific, antimicrobial prescription auxiliary for the treatment of hospitalized pediatric pneumonia patients and to present the methods which help to choose the first and the second line antimicrobial therapy, while accounting for cost and safety aspects. A retrospective single center observational study was conducted on bronchoscopy obtained sputum culture. Analysis of probabilities, variance minimization, Boolean network modeling, and dominance analysis were applied to analyze antibiogram data. The Kirby–Bauer disk diffusion method was used to test the susceptibility of all isolates. Final optimization analysis included local drug acquisition cost (standardized to price per DDD) and safety profile. Data of 145 pediatric patients hospitalized with pneumonia with 218 isolates over 5 years was collected. A combination of statistical methods such as probabilities of drug efficacy, variance minimization, Boolean network modeling, and dominance analysis can help to choose the optimal first-line and the second-line antimicrobial treatment and optimize patient care. This research reveals that ampicillin is the optimal choice as the first-line drug and piperacillin-tazobactam is the second-line antimicrobial drug if the first one is not effective, while accounting for cost and safety aspects. The paper proposes a new methodology to adapt empiric antimicrobial therapy recommendations based on real world data and accout for costs and risk of adverse events. Lippincott Williams & Wilkins 2021-10-01 /pmc/articles/PMC8483859/ /pubmed/34596107 http://dx.doi.org/10.1097/MD.0000000000026585 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) |
spellingShingle | 4400 Abramavicius, Silvijus Stundziene, Alina Jankauskaite, Lina Vitkauskiene, Astra Kowalski, Ireneusz M. Wojtkiewicz, Joanna Stankevicius, Edgaras Novel approach towards antimicrobial chemotherapy optimization in lower respiratory tract infections in children: An observational study |
title | Novel approach towards antimicrobial chemotherapy optimization in lower respiratory tract infections in children: An observational study |
title_full | Novel approach towards antimicrobial chemotherapy optimization in lower respiratory tract infections in children: An observational study |
title_fullStr | Novel approach towards antimicrobial chemotherapy optimization in lower respiratory tract infections in children: An observational study |
title_full_unstemmed | Novel approach towards antimicrobial chemotherapy optimization in lower respiratory tract infections in children: An observational study |
title_short | Novel approach towards antimicrobial chemotherapy optimization in lower respiratory tract infections in children: An observational study |
title_sort | novel approach towards antimicrobial chemotherapy optimization in lower respiratory tract infections in children: an observational study |
topic | 4400 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483859/ https://www.ncbi.nlm.nih.gov/pubmed/34596107 http://dx.doi.org/10.1097/MD.0000000000026585 |
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