Cecilia Liberati, Daniele Donà, Linda Maestri, Maria Grazia Petris, Elisa Barbieri, Elisa Gallo, Jacopo Gallocchio, Marta Pierobon, Elisabetta Calore, Annachiara Zin, Giulia Brigadoi, Marcello Mariani, Alessio Mesini, Carolina Saffioti, Elisabetta Ugolotti, Dario Gregori, Carlo Giaquinto, Elio Castagnola, Alessandra Biffi
{"title":"应用加权发病率综合抗生素图（WISCA）指导儿科肿瘤患者发热性中性粒细胞减少症的经验性抗生素治疗：意大利北部两家儿科医院的经验。","authors":"Cecilia Liberati, Daniele Donà, Linda Maestri, Maria Grazia Petris, Elisa Barbieri, Elisa Gallo, Jacopo Gallocchio, Marta Pierobon, Elisabetta Calore, Annachiara Zin, Giulia Brigadoi, Marcello Mariani, Alessio Mesini, Carolina Saffioti, Elisabetta Ugolotti, Dario Gregori, Carlo Giaquinto, Elio Castagnola, Alessandra Biffi","doi":"10.1186/s12941-024-00673-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":8052,"journal":{"name":"Annals of Clinical Microbiology and Antimicrobials","volume":"23 1","pages":"16"},"PeriodicalIF":4.6000,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10870518/pdf/","citationCount":"0","resultStr":"{\"title\":\"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.\",\"authors\":\"Cecilia Liberati, Daniele Donà, Linda Maestri, Maria Grazia Petris, Elisa Barbieri, Elisa Gallo, Jacopo Gallocchio, Marta Pierobon, Elisabetta Calore, Annachiara Zin, Giulia Brigadoi, Marcello Mariani, Alessio Mesini, Carolina Saffioti, Elisabetta Ugolotti, Dario Gregori, Carlo Giaquinto, Elio Castagnola, Alessandra Biffi\",\"doi\":\"10.1186/s12941-024-00673-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Guidelines about febrile neutropenia in paediatric patients are not homogeneous; the best empiric treatment of this condition should be driven by local epidemiology. 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WISCAs were developed by estimating the coverage of 20 antibiotics as monotherapy and of 21 combined regimens with a Bayesian probability distribution.</p><p><strong>Results: </strong>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. 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引用次数: 0
摘要
背景：有关儿科发热性中性粒细胞减少症的指南并不统一；这种病症的最佳经验性治疗方法应根据当地流行病学而定。加权发病率综合抗生素图（WISCA）满足了对特定疾病当地药敏性证据的需求，可根据病原体药敏性加权平均值得出的治疗方案结果估计值指导经验性抗生素处方。本研究开发了一个 WISCA 模型，为在意大利两家儿科三级中心接受治疗的传染性血液病儿科患者发热性中性粒细胞减少症（FN）发作的经验性抗生素治疗方案选择提供依据：我们纳入了2016年至2021年帕多瓦和热那亚医院儿科血液肿瘤病房收治的血液感染和中性粒细胞减少症患者的血液培养结果。通过贝叶斯概率分布估算了20种抗生素单药治疗和21种联合治疗的覆盖率，从而制定了WISCA：我们收集了 350 份血液培养物，其中包括 196 种 g 阴性细菌和 154 种 g 阳性细菌。考虑到最常用的抗生素组合（如哌拉西林-他唑巴坦加阿米卡星），研究中收集的细菌池的中位覆盖率为 78%。加入糖肽后，中位覆盖率提高到 89%，而用美罗培南取代哌拉西林-他唑巴坦并没有带来好处。所开发的 WISCAs 表明，没有一种单一疗法能对已确定的病原体提供足够的覆盖率：结论：WISCA 的应用可最大限度地发挥大型医院微生物监测数据的临床效用，为选择最佳经验疗法提供依据，同时有助于备用广谱抗生素。
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.
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: 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: 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: 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.
期刊介绍：
Annals of Clinical Microbiology and Antimicrobials considers good quality, novel and international research of more than regional relevance. Research must include epidemiological and/or clinical information about isolates, and the journal covers the clinical microbiology of bacteria, viruses and fungi, as well as antimicrobial treatment of infectious diseases.
Annals of Clinical Microbiology and Antimicrobials is an open access, peer-reviewed journal focusing on information concerning clinical microbiology, infectious diseases and antimicrobials. The management of infectious disease is dependent on correct diagnosis and appropriate antimicrobial treatment, and with this in mind, the journal aims to improve the communication between laboratory and clinical science in the field of clinical microbiology and antimicrobial treatment. Furthermore, the journal has no restrictions on space or access; this ensures that the journal can reach the widest possible audience.
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