Stewardship / Resistance Scan for Feb 23, 2018

Improper prescribing in kids
XDR Pseudomonas aeruginosa

Belgian study reports high rate of improper antibiotic prescribing in kids

Belgian researchers report that almost a third of prescriptions for fluoroquinolones written for hospitalized children were deemed inappropriate, according to a study today in BMC Infectious Diseases.

The investigators analyzed data on all 262 fluoroquinolone prescriptions from 2010 through 2013 at two university children's hospitals. They then employed univariate and multivariate logistic regression models to analyze risk factors for inadequate dosing.

The team found that 79 prescriptions (30.2%) were inappropriate, with 57.0% of improper prescribing classified as underdiagnosing. Only 16.8% of the drugs were prescribed for labeled indications, and only 35.1% were guided by bacteriologic findings. Infants and older preschoolers were at particular risk for dosing errors.

The authors conclude, "[Fluoroquinolone] prescriptions for children should be improved by specific pediatric antimicrobial stewardship teams. Furthermore, pharmacokinetic studies should optimise dosing recommendations for children."
Feb 23 BMC Infect Dis study


Researchers note high rate of extremely resistant Pseudomonas in Thailand

Among 255 patients with Pseudomonas aeruginosa infections, 56 (22.0%) had extensively drug-resistant P aeruginosa (XDR-PA) and 32 (12.5%) had the multidrug-resistant (MDR-PA) form, scientists from Thailand announced yesterday in PLoS One.

The investigators retrospectively studied patients hospitalized with PA infections from April to December of 2014. The combined XDR-PA and MDR-PA total represents a 34.5% incidence of drug resistance. The researchers said that receiving total parenteral nutrition, prior carbapenem use, and prior fluoroquinolone use were all associated with a higher rate of XDR-PA. Factors associated with mortality among all patients were sepsis or septic shock, admission to a medical department, receiving a central venous catheter, and having an XDR-PA infection.

The authors reported that all XDR-PA infections remained susceptible to colistin. They conclude, "The prompt administration of an appropriate empirical antibiotic should be considered when an XDR-PA infection is suspected."
Feb 22 PLoS One study

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