Evaluation of the antimicrobial management of intracranial suppurative infections in a single pediatric institution
Abstract Objective: To describe the antimicrobial management of and examine the etiology of intracranial suppurative infections (ISIs) at a single pediatric institution. Design: Retrospective review. Patients: We included children hospitalized at a 367-bed freestanding pediatric institution fo...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2025-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X25101058/type/journal_article |
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| author | Cameron E. Bizal Alaina N. Burns Rana E. El Feghaly Brian R. Lee Ann L. Wirtz |
| author_facet | Cameron E. Bizal Alaina N. Burns Rana E. El Feghaly Brian R. Lee Ann L. Wirtz |
| author_sort | Cameron E. Bizal |
| collection | DOAJ |
| description |
Abstract
Objective:
To describe the antimicrobial management of and examine the etiology of intracranial suppurative infections (ISIs) at a single pediatric institution.
Design:
Retrospective review.
Patients:
We included children hospitalized at a 367-bed freestanding pediatric institution for treatment of an ISI (epidural or subdural empyema, brain abscess) between January 1, 2015, and September 30, 2023. ISIs were identified using international classification of diseases 9/10 discharge diagnosis codes.
Methods:
We collected data regarding patient characteristics, infection etiology and complications, antimicrobial choice and route (empiric, definitive, and outpatient), microbiology results, treatment duration, and treatment-related outcomes from the electronic health record.
Results:
A total of 72 patients met inclusion criteria. Most patients received a third- or fourth-generation cephalosporin, metronidazole, and vancomycin empirically (69.4%), while a third- or fourth-generation cephalosporin in combination with metronidazole was the most common definitive regimen (63.9%). Almost half of patients (44%) were transitioned to an entirely oral antibiotic regimen, after a median of 27 days of intravenous therapy. The median duration of antimicrobial therapy was 45 days (interquartile range = 33,56). Organisms in the Streptococcus anginosus group were the most common pathogens identified (62.5%). Treatment-related complications occurred in 12 (16.7%) patients.
Conclusions:
Empiric therapy targeting resistant gram-positive organisms was not required to treat ISIs at our institution. Further data are needed on timing and requirements for oral antibiotic transition and treatment duration. In the future, there is opportunity for multi-institutional collaboration and data-sharing to determine the most appropriate management of pediatric ISIs.
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| format | Article |
| id | doaj-art-a82cc6f205c84797b5c8bcca72439bca |
| institution | Kabale University |
| issn | 2732-494X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj-art-a82cc6f205c84797b5c8bcca72439bca2025-08-20T04:01:02ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2025-01-01510.1017/ash.2025.10105Evaluation of the antimicrobial management of intracranial suppurative infections in a single pediatric institutionCameron E. Bizal0Alaina N. Burns1https://orcid.org/0000-0003-4261-6076Rana E. El Feghaly2https://orcid.org/0000-0001-7533-1144Brian R. Lee3https://orcid.org/0000-0002-1337-1105Ann L. Wirtz4https://orcid.org/0000-0002-7011-4826Department of Pharmacy, Children’s Hospital Colorado, Aurora, CO, USAChildren’s Mercy Kansas City, Kansas City, MO, USADepartment of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, USA University of Missouri-Kansas School of Medicine, Kansas City, MO, USADepartment of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, USA University of Missouri-Kansas School of Medicine, Kansas City, MO, USAChildren’s Mercy Kansas City, Kansas City, MO, USA Abstract Objective: To describe the antimicrobial management of and examine the etiology of intracranial suppurative infections (ISIs) at a single pediatric institution. Design: Retrospective review. Patients: We included children hospitalized at a 367-bed freestanding pediatric institution for treatment of an ISI (epidural or subdural empyema, brain abscess) between January 1, 2015, and September 30, 2023. ISIs were identified using international classification of diseases 9/10 discharge diagnosis codes. Methods: We collected data regarding patient characteristics, infection etiology and complications, antimicrobial choice and route (empiric, definitive, and outpatient), microbiology results, treatment duration, and treatment-related outcomes from the electronic health record. Results: A total of 72 patients met inclusion criteria. Most patients received a third- or fourth-generation cephalosporin, metronidazole, and vancomycin empirically (69.4%), while a third- or fourth-generation cephalosporin in combination with metronidazole was the most common definitive regimen (63.9%). Almost half of patients (44%) were transitioned to an entirely oral antibiotic regimen, after a median of 27 days of intravenous therapy. The median duration of antimicrobial therapy was 45 days (interquartile range = 33,56). Organisms in the Streptococcus anginosus group were the most common pathogens identified (62.5%). Treatment-related complications occurred in 12 (16.7%) patients. Conclusions: Empiric therapy targeting resistant gram-positive organisms was not required to treat ISIs at our institution. Further data are needed on timing and requirements for oral antibiotic transition and treatment duration. In the future, there is opportunity for multi-institutional collaboration and data-sharing to determine the most appropriate management of pediatric ISIs. https://www.cambridge.org/core/product/identifier/S2732494X25101058/type/journal_article |
| spellingShingle | Cameron E. Bizal Alaina N. Burns Rana E. El Feghaly Brian R. Lee Ann L. Wirtz Evaluation of the antimicrobial management of intracranial suppurative infections in a single pediatric institution Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Evaluation of the antimicrobial management of intracranial suppurative infections in a single pediatric institution |
| title_full | Evaluation of the antimicrobial management of intracranial suppurative infections in a single pediatric institution |
| title_fullStr | Evaluation of the antimicrobial management of intracranial suppurative infections in a single pediatric institution |
| title_full_unstemmed | Evaluation of the antimicrobial management of intracranial suppurative infections in a single pediatric institution |
| title_short | Evaluation of the antimicrobial management of intracranial suppurative infections in a single pediatric institution |
| title_sort | evaluation of the antimicrobial management of intracranial suppurative infections in a single pediatric institution |
| url | https://www.cambridge.org/core/product/identifier/S2732494X25101058/type/journal_article |
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