Antibiotic spectrum index as an antimicrobial stewardship tool in paediatric intensive care settings.

OBJECTIVES: Antibiotic spectrum index (ASI) is a recently developed antimicrobial stewardship (AMS) tool that aims to classify antibiotics based on activity against clinically relevant bacterial pathogens. METHODS: We utilised ASI in a 2-year retrospective study between April 2019 and April 2021 in four paediatric intensive care units of a specialist UK children's hospital to quantify antibiotic use based on age, presence of immunosuppression and AMS input. We then compared ASI to days of therapy (DOT) to determine the utility of this AMS metric. We have made changes to Gerber's original ASI list and score of antibiotics to align with prescribing and resistance patterns in the UK. RESULTS: Median ASI/antibiotic days increased with age: for infants under 1 year of age 4.1 (IQR 4.0-4.3), for children 1-5 years 4.4 (IQR 4.0-4.6) and for children over 5 years 4.5 (IQR 4.1-4.6). Immunocompromised patients received much broader-spectrum antibiotics than immunocompetent patients throughout the whole study period. Patients who had AMS input had a higher ASI compared with those who did not throughout the whole period, likely due to more complex patients being discussed on such rounds. CONCLUSIONS: Our results show a complex picture of changing antibiotic consumption and prescribing in a large specialist paediatric hospital in the UK with a long-standing AMS programme before and throughout the COVID-19 pandemic. ASI shows less variability than DOT and can potentially be used to identify patient groups and time periods where broader-spectrum antibiotics are used to help guide further AMS efforts.

An exploration of 11 years of seasonality in diagnoses at GOSH

BackgroundWith the extensive impact of the COVID-19 pandemic and subsequent government interventions on the development, diagnosis and treatment of illnesses, building an understanding of ‘typical’ diagnosis trends at GOSH is critical for predicting future demands and potential clinical challenges. Seasonality analysis is an effective method with which one can explore, model and predict the occurrence of events over time when – as with many common diagnoses at GOSH – they generally exhibit a periodic trend over the year.MethodsTo investigate diagnosis seasonality at GOSH, we have extracted all diagnoses recorded in the Legacy and Epic systems, since the year 2010. We have developed an analytics pipeline that uses these data to compute historical rates for any given diagnosis, or group of diagnoses. Based on these diagnosis rates, our pipeline applies a widely used regressive, multiplicative, seasonal decomposition model with integrated model evaluation.ResultsFor the analysis, a total of 3,480,887 diagnosis events were considered across 29,529 patients between receiving a diagnosis between 1stJanuary 2010 and 30th September 2021. This exploration presents data on many of the common diagnoses at GOSH that exhibit a clear seasonal trend in combination with a statistically significant deviation from that trend since March 2020, likely due to the pandemic. In addition, we illustrate how the available data and model allow us to predict the diagnostic shortfall during the same period.

SARS-CoV-2 and Anti-Cardiolipin Antibodies.

The current COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to distinct diagnostic and management challenges for front-line healthcare workers. The risk of excessive coagulation activation leading to a cascade of thrombotic events in critically ill patients with SARS-CoV-2 is now well reported. We discuss a recent case of COVID-19 with concurrent acute pulmonary embolism and a positive cardiolipin antibody (IgM). The presence of antiphospholipid antibodies is key to diagnosing antiphospholipid syndrome (APS). However, their presence can be transient or persistent after viral infections. Serial inflammatory markers in conjunction with anti-phospholipid antibody testing is critical for the diagnosis of APS in this emerging patient population. Our case report reviews details suggestive of APS in the setting of SARS-CoV-2 and aims to provide clinical diagnostic clues that could help warrant further workup and assist with management strategies.