Editor’s Note: From April 27th to 30th, 2024, the 34th European Congress of Clinical Microbiology and Infectious Diseases (ESCMID Global 2024) took place in Barcelona, Spain, known as the “Pearl of the Iberian Peninsula.” ESCMID Global, formerly known as ECCMID, stands as one of the most influential international conferences in the field of infectious diseases. Often, clinical trials of antibiotics exclude special populations such as obese or underweight individuals, resulting in limited evidence for their treatment strategies. At this conference, several studies and advancements regarding antibiotic management and prescription, including interventions, monitoring, influences, decision support/predictive tools, and behavioral aspects, were reported. Below is a summary of the insights shared by Professor Wenxiang Huang from the Department of Geriatrics at The First Affiliated Hospital of Chongqing Medical University.

01 Assessment and Implementation of Optimized Antibiotic Dosages in Obese and Underweight Patients

Accurate dosing is crucial in antibiotic management. While specific dosing recommendations exist for many special populations, guidance for obese and underweight patients is lacking. V. Caubergs et al. reported a study aimed at developing and implementing antibiotic dosing recommendations for obese and underweight patients in a teaching hospital and investigating the impact of these recommendations on antibiotic prescribing for these two patient groups.

Researchers conducted a six-step prospective assessment and optimization project. They determined the prevalence of obesity and underweight patients and the frequency of antibiotic prescribing in a point prevalence study. Evidence on dosing was retrieved from literature reviews supplemented by an international electronic survey. Expert consensus was reached, and final recommended dosages were established. These recommendations were implemented through a pharmacy-based verification service, which involved developing six clinical rules to continuously screen for potential inappropriate prescriptions (PIP) in patient records. Acceptance rates were evaluated by recording the number of recommendations provided to physicians and their acceptance. Finally, an interrupted time series study compared the period before implementation (standard care) and after implementation (clinical rules) to assess the impact of the clinical rules on the proportion of remaining PIP per day.

During 20 study days, a total of 15,896 hospitalized patients were included, with 41% receiving antibiotic therapy. Among these patients, obesity and underweight accounted for 12% and 9%, respectively. Antibiotic prescriptions almost entirely adhered to standard dosing regimens. Based on literature retrieval, electronic surveys, and consensus groups, six dosing recommendations were implemented. During the 18-week implementation period, a total of 219 recommendations were made, with 86% being accepted. At baseline, a median proportion of 75% remaining PIP per day was observed. Following the intervention, this number decreased to 0% per day. The use of clinical rules resulted in an immediate relative reduction of 84% in remaining PIP (β2=0.16; 95%CI: 0.06~0.45). No significant time trends were observed in both periods.

Summary:

Obese and underweight patients often receive standard doses of antibiotic treatment during hospitalization. This study successfully developed recommended dosages for obese and underweight patients based on literature review, online surveys, and expert consensus, which were validated in clinical practice.

This segment presents insights from Professor Wenxiang Huang ‘s presentation at the ESCMID Global 2024 conference regarding optimizing antibiotic dosages for obese and underweight patients. It showcases the importance of tailored antibiotic dosing in these patient populations and highlights successful strategies for implementation.

Antibiotic Management Program for High-Risk Pediatric Populations: Experience of a Two-Step Intervention in Pediatric Oncology

There remains limited reporting on Antibiotic Stewardship Programs (ASPs) in pediatric high-risk settings. This study, conducted by C. Liberati et al., is part of the ENSURE project (Enhancing Antimicrobial Stewardship and Antibiotic Use Surveillance to Drive Management) and aims to describe the implementation of a multi-step ASP at the Pediatric Oncology Unit (HOU) of a tertiary children’s hospital in Padua, Italy.

Using a retrospective study design, two interrupted time series analyses were conducted between January 1, 2019, and December 31, 2022. Interventions included: 1) February 2020: Promotion of a customized febrile neutropenia clinical pathway (CP) based on local susceptibility data, jointly developed by Infectious Diseases (ID), Pediatric Oncology (HOU), and Clinical Microbiology multidisciplinary experts. 2) April 2021: Promotion of CP via a customized application (Firstline.org) and implementation of bi-weekly prospective audits and feedback by the ID team and hospital pharmacists. The primary outcome was antibiotic consumption measured as Days of Therapy (DOTs)/1000 patient-days for all antibiotics and most frequently used drugs.

The first intervention led to an overall decrease in antibiotic consumption between February 2020 and March 2021 compared to January 2019 to January 2020. Guided by the CP, the use of third-generation cephalosporins sharply decreased, while the use of piperacillin-tazobactam increased. However, there was no change in the use of meropenem and glycopeptides.

The second intervention further reduced the total antibiotic consumption between April 2021 and December 2022. The use of meropenem, amikacin, and glycopeptides significantly decreased. Seasonal factors significantly influenced overall drug trends (an increase in overall DOTs/1000 patient-days during summer months), while the SARS-CoV-2 pandemic did not affect antibiotic use.

Summary:

A multi-step Antibiotic Stewardship Program (ASP), based on the dissemination of clinical pathways (CP) through electronic tools and collaboration with multidisciplinary teams, proved highly effective in optimizing guideline adherence and reducing overprescription in vulnerable patients. DOTs/1000 patient-days emerged as a reliable metric for identifying key issues/targets and monitoring ASP improvements.

First Affiliated Hospital of Chongqing Medical University

Second-level Professor, Chief Physician, Doctoral Supervisor

Recipient of the “Advanced Worker in the National Health System” title, First “Learning from Qian Xuesen Spirit Good Doctor Award,” Chongqing “Golden Reputation Doctor Award.”

Expert in the Chongqing Municipal Government Emergency Management Expert Group, Senior Title Reviewer of the Chongqing Health Commission, Academic and Technical Leader of Chongqing Municipality, Academic Leader in Infectious Diseases at Chongqing Medical University.

Executive Committee Member of the Chinese Medical Association Branch of Bacterial Infection and Drug Resistance Prevention, Member of the Chinese Medical Association Infectious Disease Branch, Executive Committee Member of the China Hospital Association Committee for Rational Use of Antimicrobial Agents, Member of the Chinese Physician Association Geriatrics Branch, Member of the Chinese Association of Traditional Chinese and Western Medicine Infectious Disease Branch, Standing Committee Member of the Chinese Society of Geriatrics Sports and Health Branch.

Vice Leader of the Chongqing New Coronavirus Pneumonia Medical Treatment Expert Advisory Group, Chairman of the Chongqing Medical Association Branch of Bacterial Infection and Drug Resistance Prevention, Chairman of the Chongqing Hospital Association Committee for Geriatric Medicine Management, Chairman of the Chongqing Chinese and Western Medicine Association Infectious Disease Branch.