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Antibiotic Stewardship in the Pediatric Dialysis Unit

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Abstract

Antibiotic stewardship has become a key intervention in combating the increasing rates of antibiotic-resistant bacterial infections. By 2050, it is estimated that ten million people worldwide will die annually from an antimicrobial resistant infection if nothing is done to improve the use of antimicrobials. In this chapter, data is presented demonstrating the increasing rates of antibiotic-resistant bacteria identified in children, though data is limited among pediatric dialysis patients. Additionally, the use of antibiotics in dialysis patients is described to be extensive though data is, again, limited among pediatric patients. Finally, antimicrobial stewardship strategies are discussed highlighting the many different potential interventions to improve the use of antimicrobials in children undergoing dialysis. Importantly, more data are needed on which antimicrobial stewardship strategies are effective in improving overall antimicrobial use in this population.

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References

  1. Albrich WC, Monnet DL, Harbarth S. Antibiotic selection pressure and resistance in Streptococcus pneumoniae and Streptococcus pyogenes. Emerg Infect Dis. 2004;10(3):514–7.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Megged O. Extended-spectrum beta-lactamase-producing bacteria causing community-acquired urinary tract infections in children. Pediatr Nephrol. 2014;29(9):1583–7.

    Article  PubMed  Google Scholar 

  3. Donskey CJ. Antibiotic regimens and intestinal colonization with antibiotic-resistant gram-negative bacilli. Clin Infect Dis. 2006;43 Suppl 2:S62–9.

    Article  PubMed  Google Scholar 

  4. Burnham JP, Olsen MA, Kollef MH. Re-estimating annual deaths due to multidrug-resistant organism infections. Infect Control Hosp Epidemiol. 2019;40(1):112–3.

    Article  PubMed  Google Scholar 

  5. CDC. Antibiotic resistance threats in the United States, 2013, Center for Disease Control and Prevention, Editor. 2013, U.S. Department of Health and Human Services: Atlanta, GA.

    Google Scholar 

  6. O'Neill J. Antimicrobial resistance: tackling a crisis for the health and wealth of nations. Review on Antimicrobial Resistance. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations 2014 [cited 2018 April 15]; Available from: https://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf. .

  7. Herold BC, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA. 1998;279(8):593–8.

    Article  CAS  PubMed  Google Scholar 

  8. Herigon JC, et al. Antibiotic management of Staphylococcus aureus infections in US children's hospitals, 1999–2008. Pediatrics. 2010;125(6):e1294–300.

    Article  PubMed  Google Scholar 

  9. Creech CB 2nd, et al. Increasing rates of nasal carriage of methicillin-resistant Staphylococcus aureus in healthy children. Pediatr Infect Dis J. 2005;24(7):617–21.

    Article  PubMed  Google Scholar 

  10. Fritz SA, et al. Prevalence of and risk factors for community-acquired methicillin-resistant and methicillin-sensitive staphylococcus aureus colonization in children seen in a practice-based research network. Pediatrics. 2008;121(6):1090–8.

    Article  PubMed  Google Scholar 

  11. Price A, et al. Methicillin-resistant Staphylococcus aureus and methicillin-susceptible Staphylococcus aureus screening in a cohort of haemodialysis patients: carriage, demographics and outcomes. J Hosp Infect. 2015;90(1):22–7.

    Article  CAS  PubMed  Google Scholar 

  12. Blowey DL, Warady BA, McFarland KS. The treatment of Staphylococcus aureus nasal carriage in pediatric peritoneal dialysis patients. Adv Perit Dial. 1994;10:297–9.

    CAS  PubMed  Google Scholar 

  13. Szeto CC, et al. ISPD catheter-related infection recommendations: 2017 update. Perit Dial Int. 2017;37(2):141–54.

    Article  PubMed  Google Scholar 

  14. Logan LK, et al. Extended-spectrum beta-lactamase-producing and third-generation cephalosporin-resistant enterobacteriaceae in children: trends in the United States, 1999–2011. J Pediatric Infect Dis Soc. 2014;3(4):320–8.

    Article  PubMed  Google Scholar 

  15. Logan LK, et al. Carbapenem-resistant enterobacteriaceae in children, United States, 1999–2012. Emerg Infect Dis. 2015;21(11):2014–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Logan LK, et al. Multidrug- and carbapenem-resistant Pseudomonas aeruginosa in children, United States, 1999–2012. J Pediatric Infect Dis Soc. 2017;6(4):352–9.

    PubMed  Google Scholar 

  17. Logan LK, et al. Acinetobacter baumannii resistance trends in children in the United States, 1999–2012. J Pediatric Infect Dis Soc. 2019;8(2):136–42.

    Article  PubMed  Google Scholar 

  18. Sethna CB, et al. Risk factors for and outcomes of catheter-associated peritonitis in children: the SCOPE collaborative. Clin J Am Soc Nephrol. 2016;11(9):1590–6.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Onder AM, et al. Predictors and outcome of catheter-related bacteremia in children on chronic hemodialysis. Pediatr Nephrol. 2006;21(10):1452–8.

    Article  PubMed  Google Scholar 

  20. Lovegrove MC, et al. US emergency department visits for adverse drug events from antibiotics in children, 2011–2015. J Pediatric Infect Dis Soc. 2019;8(5):384–91.

    Article  CAS  PubMed  Google Scholar 

  21. Goldman JL, et al. Trends in adverse reactions to trimethoprim-sulfamethoxazole. Pediatrics. 2013;131(1):e103–8.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kim J, et al. Epidemiological features of Clostridium difficile-associated disease among inpatients at children's hospitals in the United States, 2001–2006. Pediatrics. 2008;122(6):1266–70.

    Article  PubMed  Google Scholar 

  23. Sammons JS, et al. Clostridium difficile infection is associated with increased risk of death and prolonged hospitalization in children. Clin Infect Dis. 2013;57(1):1–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Pant C, et al. Clostridium difficile infection is associated with poor outcomes in end-stage renal disease. J Investig Med. 2012;60(2):529–32.

    Article  PubMed  Google Scholar 

  25. Redpath Mahon AC, et al. Factors associated with high-cost hospitalization for peritonitis in children receiving chronic peritoneal dialysis in the United States. Pediatr Nephrol. 2019;34(6):1049–55.

    Article  PubMed  Google Scholar 

  26. Raaijmakers R, et al. Fungal peritonitis in children on peritoneal dialysis. Pediatr Nephrol. 2007;22(2):288–93.

    Article  PubMed  Google Scholar 

  27. Warady BA, Bashir M, Donaldson LA. Fungal peritonitis in children receiving peritoneal dialysis: a report of the NAPRTCS. Kidney Int. 2000;58(1):384–9.

    Article  CAS  PubMed  Google Scholar 

  28. Warady BA, et al. Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int. 2012;32 Suppl 2:S32–86.

    Article  PubMed  CAS  Google Scholar 

  29. Gerber JS, et al. Variability in antibiotic use at children's hospitals. Pediatrics. 2010;126(6):1067–73.

    Article  PubMed  Google Scholar 

  30. Lee BR, et al. The burden of inappropriate antibiotic surgical prophylaxis in pediatric patients: a national point prevalence study. in Pediatric Academic Society; 2018. Toronto, Canada.

    Google Scholar 

  31. Hersh AL, et al. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics. 2011;128(6):1053–61.

    Article  PubMed  Google Scholar 

  32. Kronman MP, Zhou C, Mangione-Smith R. Bacterial prevalence and antimicrobial prescribing trends for acute respiratory tract infections. Pediatrics. 2014;134(4):e956–65.

    Article  PubMed  Google Scholar 

  33. Snyder GM, et al. Antimicrobial use in outpatient hemodialysis units. Infect Control Hosp Epidemiol. 2013;34(4):349–57.

    Article  PubMed  Google Scholar 

  34. Neu AM, et al. Implementation of standardized follow-up care significantly reduces peritonitis in children on chronic peritoneal dialysis. Kidney Int. 2016;89(6):1346–54.

    Article  PubMed  Google Scholar 

  35. Sharma A, et al. Survival and complications of cuffed catheters in children on chronic hemodialysis. Pediatr Nephrol. 1999;13(3):245–8.

    Article  CAS  PubMed  Google Scholar 

  36. Stefanidis CJ. Prevention of catheter-related bacteremia in children on hemodialysis: time for action. Pediatr Nephrol. 2009;24(11):2087–95.

    Article  PubMed  Google Scholar 

  37. Sucupira C, et al. Surveillance system of hemodialysis-associated infections in a pediatric unit. Infect Control Hosp Epidemiol. 2012;33(5):521–3.

    Article  PubMed  Google Scholar 

  38. Wang K, et al. Cuffed-tunneled hemodialysis catheter survival and complications in pediatric patients: a single-center data analysis in China. Int J Clin Exp Med. 2015;8(6):9765–71.

    PubMed  PubMed Central  Google Scholar 

  39. Gerding DN. The search for good antimicrobial stewardship. Jt Comm J Qual Improv. 2001;27(8):403–4.

    CAS  PubMed  Google Scholar 

  40. CDC. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, GA: US Department of Health and Human Services; 2014.

    Google Scholar 

  41. CDC. National Healthcare Safety Network (NHSN) Patient Safety Component Manual; 2018. Atlanta, GA.

    Google Scholar 

  42. Barlam TF, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62(10):e51–77.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Hecker MT, et al. Impact of syndrome-specific antimicrobial stewardship interventions on use of and resistance to fluoroquinolones: an interrupted time series analysis. Am J Infect Control. 2019;

    Google Scholar 

  44. Sammons JS, Toltzis P, Zaoutis TE. Clostridium difficile infection in children. JAMA Pediatr. 2013;167(6):567–73.

    Article  PubMed  Google Scholar 

  45. Tamma PD, et al. Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med. 2017;177(9):1308–15.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Parker SK, et al. Anti-infective acquisition costs for a stewardship program: getting to the bottom line. Clin Infect Dis. 2017;65(10):1632–7.

    Article  PubMed  Google Scholar 

  47. Gerber JS, et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial. JAMA. 2013;309(22):2345–52.

    Article  CAS  PubMed  Google Scholar 

  48. Hurst AL, et al. Handshake stewardship: a highly effective rounding-based antimicrobial optimization service. Pediatr Infect Dis J. 2016;35(10):1104–10.

    Article  PubMed  Google Scholar 

  49. Metjian TA, et al. Evaluation of an antimicrobial stewardship program at a pediatric teaching hospital. Pediatr Infect Dis J. 2008;27(2):106–11.

    Article  PubMed  Google Scholar 

  50. Newland JG, et al. Impact of a prospective-audit-with-feedback antimicrobial stewardship program at a children's hospital. J Pediatric Infect Dis Soc. 2012;1(3):179–86.

    Article  PubMed  Google Scholar 

  51. D'Agata EMC, et al. The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities. Infect Control Hosp Epidemiol. 2018;39(12):1400–5.

    Article  PubMed  Google Scholar 

  52. D'Agata EMC, et al. Clinical and economic benefits of antimicrobial stewardship programs in hemodialysis facilities: a decision analytic model. Clin J Am Soc Nephrol. 2018;13(9):1389–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. McPherson C, et al. Characteristics of pediatric antimicrobial stewardship programs: current status of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative. Antibiotics (Basel). 2018:7(1).

    Google Scholar 

  54. Neuman MI, et al. Influence of hospital guidelines on management of children hospitalized with pneumonia. Pediatrics. 2012;130(5):e823–30.

    Article  PubMed  Google Scholar 

  55. Newman RE, et al. Impact of a guideline on management of children hospitalized with community-acquired pneumonia. Pediatrics. 2012;129(3):e597–604.

    Article  PubMed  Google Scholar 

  56. Hamdy RF, et al. Pediatric ASP toolkit; 2019.

    Google Scholar 

  57. Partners NQ. National quality partners playbook: antibiotic stewardship in acute care; 2016.

    Google Scholar 

  58. Gerber JS, et al. Durability of benefits of an outpatient antimicrobial stewardship intervention after discontinuation of audit and feedback. JAMA. 2014;312(23):2569–70.

    Article  PubMed  Google Scholar 

  59. Meeker D, et al. Nudging guideline-concordant antibiotic prescribing: a randomized clinical trial. JAMA Intern Med. 2014;174(3):425–31.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Meeker D, et al. Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: a randomized clinical trial. JAMA. 2016;315(6):562–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Tokars JI, et al. A prospective study of vascular access infections at seven outpatient hemodialysis centers. Am J Kidney Dis. 2001;37(6):1232–40.

    Article  CAS  PubMed  Google Scholar 

  62. Miller JM, et al. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2018 update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis. 2018;67(6):813–6.

    Article  PubMed  Google Scholar 

  63. Connell TG, et al. How reliable is a negative blood culture result? Volume of blood submitted for culture in routine practice in a children's hospital. Pediatrics. 2007;119(5):891–6.

    Article  PubMed  Google Scholar 

  64. Kallen AJ. Identifying and classifying bloodstream infections among hemodialysis patients. Semin Dial. 2013;26(4):407–15.

    Article  PubMed  Google Scholar 

  65. Mermel LA, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1–45.

    Article  CAS  PubMed  Google Scholar 

  66. Yi SH, et al. Sustained infection reduction in outpatient hemodialysis centers participating in a collaborative bloodstream infection prevention effort. Infect Control Hosp Epidemiol. 2016;37(7):863–6.

    Article  PubMed  Google Scholar 

  67. O'Grady NP, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162–93.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Neu AM, et al. Design of the standardizing care to improve outcomes in pediatric end stage renal disease collaborative. Pediatr Nephrol. 2014;29(9):1477–84.

    Article  PubMed  Google Scholar 

  69. Esposito S, et al. Vaccine administration in children with chronic kidney disease. Vaccine. 2014;32(49):6601–6.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Washington University in St. Louis, St. Louis Children’s Hospital, St. Louis, MO, USA

    Jason G. Newland

  2. Division of Pediatric Nephrology, Department of Pediatrics, Pediatric Dialysis and Kidney Transplantation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Alicia M. Neu

Authors
  1. Jason G. Newland
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  2. Alicia M. Neu
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Corresponding author

Correspondence to Alicia M. Neu .

Editor information

Editors and Affiliations

  1. Department of Pediatrics, University of Missouri-Kansas City, School of Medicine, Division of Pediatric Nephrology, Children’s Mercy Kansas City, Kansas City, MO, USA

    Bradley A. Warady

  2. Stanford University School of Medicine, Division of Pediatric Nephrology, Department of Pediatrics, Palo Alto, CA, USA

    Steven R. Alexander

  3. Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany

    Franz Schaefer

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Newland, J.G., Neu, A.M. (2021). Antibiotic Stewardship in the Pediatric Dialysis Unit. In: Warady, B.A., Alexander, S.R., Schaefer, F. (eds) Pediatric Dialysis. Springer, Cham. https://doi.org/10.1007/978-3-030-66861-7_8

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  • DOI: https://doi.org/10.1007/978-3-030-66861-7_8

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  • Online ISBN: 978-3-030-66861-7

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