Assessment of antibiotic appropriateness is receiving increa

Assessment of antibiotic appropriateness is receiving increased attention in the face of growing concerns about the emergence of MDROs, as well as the rise in adverse outcomes associated with antibiotic use such as C. difficile infection. In this study, 15% of cultured Gram-negative organisms met the definition for MDROs (resistant to at least three classes of antibiotics), which is lower than the 21–22% of multi-drug-resistant Gram-negative organisms described in adult LTC facility studies [14], [15]. Only four MRSA isolates were identified, although this may underestimate the true prevalence since cultures for skin/soft tissue infections were not typically obtained. While C. difficile was the most commonly diagnosed gastrointestinal infection, it accounted for less than 2% of HAIs. Similar rates of C. difficile infection have been described in adult LTC populations [12], [16]. However, treatment of recurrent C. difficile infection with an oral vancomycin taper accounted for the longest antibiotic duration (60 days) in these paediatric LTC facilities. This study had limitations. One limitation was the assessment of appropriate antibiotic use, which was based solely on identification of drug–organism mismatches and did not account for redundant therapy or assess the appropriateness of spectrum (broad vs narrow), duration or dose of therapy. In addition, this study did not consider the 1% of HAIs treated with two or more Apatinib in the same class to be inappropriate. These limitations may account, in part, for the higher level of appropriateness found in this study (85%) compared with studies in adult LTC facilities (49–79%) that used different definitions of appropriateness [13], [17], [18], [19]. In addition, 30% of antibiotic-treated HAIs for which diagnostic testing was available had only viral pathogens identified. In these cases, due to poor documentation, it was difficult to ascertain whether a concurrent or superimposed bacterial infection was suspected, and thus antimicrobials prescribed. Overall, diagnoses of HAIs were not always documented clearly. Instead, symptomatology (e.g. increased secretions) was sometimes recorded as an indication for antibiotics. The lack of HAI definitions for paediatric LTC facilities likely contributes to the lack of documentation of definitive HAI diagnoses. Although definitions have been developed for adult LTC facilities, they have not been shown to be useful in paediatric populations [3]. All clinician-diagnosed and documented HAIs were included in the present analysis, which may over- or under-represent the true number of HAIs at the study facilities.
Conflict of interest statement
Funding sources This work was supported by the Agency for Healthcare Research and Quality (R01 HS021470) and by the training grant ‘Training in Pediatric Infectious Diseases’ (National Institute of Allergy and Infectious Diseases, T32AI007531).
Introduction The global emergence of multi-drug resistant pathogens has placed a severe strain on health care systems world-wide. Since the first alarming reports by the Infectious Disease Society of America (IDSA, “Bad bugs, no drugs, no ESKAPE”), there has been an impressive shift in public and government awareness for the potential threat imposed by a global antibiotic crisis.2, 3 Several initiatives have been launched with the aim to improve: sanitation and prevention of the global spread of infections, implementation of a global surveillance system for monitoring drug resistance, avoid unnecessary over-use of antimicrobials,4, 5 and foster drug discovery and development of novel antibiotics by increasing both public and private funding opportunities. In a most recent WHO report a global priority pathogens list (PPL) of antibiotic resistant bacteria has been established to guide the prioritization of funding and incentives for discovery and development of new and effective antibiotic treatments. It is clear that there is an urgent need for novel classes of antibiotics with preferentially novel mechanisms of action to complement our arsenal of current drugs, particularly against Gram-negative ESKAPE pathogens such as carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacter spp.