Application of the Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to guide the empiric antibiotic treatment of febrile neutropenia in oncological paediatric patients: experience from two paediatric hospitals in Northern Italy.

Empiric antibiotic treatment Febrile neutropenia Weighted-Incidence Syndromic Combination Antibiogram

Journal

Annals of clinical microbiology and antimicrobials
ISSN: 1476-0711
Titre abrégé: Ann Clin Microbiol Antimicrob
Pays: England
ID NLM: 101152152

Informations de publication

Date de publication:
15 Feb 2024
Historique:
received: 03 08 2023
accepted: 30 01 2024
medline: 16 2 2024
pubmed: 16 2 2024
entrez: 15 2 2024
Statut: epublish

Résumé

Guidelines about febrile neutropenia in paediatric patients are not homogeneous; the best empiric treatment of this condition should be driven by local epidemiology. The Weighted-Incidence Syndromic Combination Antibiogram (WISCA) addresses the need for disease-specific local susceptibility evidence that could guide empiric antibiotic prescriptions based on outcome estimates of treatment regimens obtained as a weighted average of pathogen susceptibilities. This study developed a WISCA model to inform empirical antibiotic regimen selection for febrile neutropenia (FN) episodes in onco-haematological paediatric patients treated at two Italian paediatric tertiary centres. We included blood cultures from patients with a bloodstream infection and neutropenia admitted to the Paediatric Haematology-Oncology wards in Padua and Genoa Hospitals from 2016 to 2021. WISCAs were developed by estimating the coverage of 20 antibiotics as monotherapy and of 21 combined regimens with a Bayesian probability distribution. We collected 350 blood cultures, including 196 g-negative and 154 g-positive bacteria. Considering the most used antibiotic combinations, such as piperacillin-tazobactam plus amikacin, the median coverage for the pool of bacteria collected in the study was 78%. When adding a glycopeptide, the median coverage increased to 89%, while the replacement of piperacillin-tazobactam with meropenem did not provide benefits. The developed WISCAs showed that no monotherapy offered an adequate coverage rate for the identified pathogens. The application of WISCA offers the possibility of maximizing the clinical utility of microbiological surveillance data derived from large hospitals to inform the choice of the best empiric treatment while contributing to spare broad-spectrum antibiotics.

Sections du résumé

BACKGROUND BACKGROUND
Guidelines about febrile neutropenia in paediatric patients are not homogeneous; the best empiric treatment of this condition should be driven by local epidemiology. The Weighted-Incidence Syndromic Combination Antibiogram (WISCA) addresses the need for disease-specific local susceptibility evidence that could guide empiric antibiotic prescriptions based on outcome estimates of treatment regimens obtained as a weighted average of pathogen susceptibilities. This study developed a WISCA model to inform empirical antibiotic regimen selection for febrile neutropenia (FN) episodes in onco-haematological paediatric patients treated at two Italian paediatric tertiary centres.
METHODS METHODS
We included blood cultures from patients with a bloodstream infection and neutropenia admitted to the Paediatric Haematology-Oncology wards in Padua and Genoa Hospitals from 2016 to 2021. WISCAs were developed by estimating the coverage of 20 antibiotics as monotherapy and of 21 combined regimens with a Bayesian probability distribution.
RESULTS RESULTS
We collected 350 blood cultures, including 196 g-negative and 154 g-positive bacteria. Considering the most used antibiotic combinations, such as piperacillin-tazobactam plus amikacin, the median coverage for the pool of bacteria collected in the study was 78%. When adding a glycopeptide, the median coverage increased to 89%, while the replacement of piperacillin-tazobactam with meropenem did not provide benefits. The developed WISCAs showed that no monotherapy offered an adequate coverage rate for the identified pathogens.
CONCLUSIONS CONCLUSIONS
The application of WISCA offers the possibility of maximizing the clinical utility of microbiological surveillance data derived from large hospitals to inform the choice of the best empiric treatment while contributing to spare broad-spectrum antibiotics.

Identifiants

DOI: 10.1186/s12941-024-00673-8 PMID: 38360651
pubmed: 38360651
doi: 10.1186/s12941-024-00673-8
pii: 10.1186/s12941-024-00673-8
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

16

Informations de copyright

© 2024. The Author(s).

Références

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Auteurs

Cecilia Liberati (C)

Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy.

Daniele Donà (D)

Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy. daniele.dona@unipd.it.

Linda Maestri (L)

Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy.

Maria Grazia Petris (MG)

Division of Paediatric Haematology, Oncology and Stem Cell Transplant, Department for Women's and Children's Health, University of Padua, Padua, Italy.

Elisa Barbieri (E)

Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy.

Elisa Gallo (E)

Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.

Jacopo Gallocchio (J)

Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.

Marta Pierobon (M)

Division of Paediatric Haematology, Oncology and Stem Cell Transplant, Department for Women's and Children's Health, University of Padua, Padua, Italy.

Elisabetta Calore (E)

Division of Paediatric Haematology, Oncology and Stem Cell Transplant, Department for Women's and Children's Health, University of Padua, Padua, Italy.

Annachiara Zin (A)

Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy.

Giulia Brigadoi (G)

Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy.

Marcello Mariani (M)

Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy.

Alessio Mesini (A)

Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy.

Carolina Saffioti (C)

Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy.

Elisabetta Ugolotti (E)

Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy.

Dario Gregori (D)

Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.

Carlo Giaquinto (C)

Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy.

Elio Castagnola (E)

Infectious Diseases Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147, Genoa, Italy.

Alessandra Biffi (A)

Division of Paediatric Haematology, Oncology and Stem Cell Transplant, Department for Women's and Children's Health, University of Padua, Padua, Italy.

Classifications MeSH