EVIDENCE BASED EMPIRIC ANTIBIOTIC CHOICES FOR PAEDIATRIC BACTERAEMIA: NATIONAL SUSCEPTIBILITY PROFILES OF GRAM-POSITIVE AND GRAM-NEGATIVE BACTERAEMIA IN ENGLAND AND WALES
ESPID Education. Henderson K. Jun 7, 2011; 7696
Ms. Katherine Henderson
Ms. Katherine Henderson

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Abstract
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Aims: To compare the activity of combinations of antibiotics recommended for empirical treatment of paediatric sepsis by the British National Formulary guidelines for Children (BNF-C) (gentamicin+amoxicillin, or cefotaxime/ceftriaxone alone or aminoglycoside+anti-pseudomonal beta-lactam if pseudomonas suspected, or flucloxacillin or vancomycin if Gram-positive infection suspected).

Methods: The Health Protection Agency’s national surveillance database was interrogated to determine the 10 commonest pathogens causing bacteraemia in children (1 month - 18yrs) and their antimicrobial susceptibility. Data were aggregated to capture resistance rates for the time period July 2008-June 2010 in England and Wales.

Results: The 15 commonest pathogen groups (accounting for ~87% of reported paediatric bacteraemias) included coagulase-negative staphylococci (CoNS) (25%), Staphylococcus aureus (10%), non-pyogenic streptococci (10%), Escherichia coli (8%), Streptococcus pneumoniae (7%), Enterococcus spp. (5%), Neisseria meningitidis (4%), Klebsiella spp. (4%), down to Pseudomonas aeruginosa (2%). For Gram-positives, resistance to gentamicin+amoxicillin was highest for CoNS (26%) and Non-pyogenic Streptococci (27%), but low resistance for S. aureus and other Streptococci. Resistance to cefotaxime/ceftriaxone varied with species (0-8%) but was not commonly reported for staphylococci. Staphylococci remained fully-susceptible to gentamicin+vancomycin. Pseudomonas spp. remained susceptible (>96%) to anti-pseudomonal combinations.

Conclusions: The susceptibility results show that for each organism, at least one of the recommended antibiotic therapies was appropriate. However, this study does highlight the need for regular and timely surveillance of antimicrobial susceptibility of bacteria causing invasive disease in children to allow objective assessment of the continued appropriateness of national treatment guidelines.
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