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. 2021 May 1;10(1):74.
doi: 10.1186/s13756-021-00939-2.

Development of a Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to guide the choice of the empiric antibiotic treatment for urinary tract infection in paediatric patients: a Bayesian approach

Elisa Barbieri  1 , Daniele Bottigliengo  2 , Matteo Tellini  3 , Chiara Minotti  3 , Mara Marchiori  4 , Paola Cavicchioli  4 , Dario Gregori  2 , Carlo Giaquinto  5 , Liviana Da Dalt  3 , Daniele Donà  5
Affiliations

Development of a Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to guide the choice of the empiric antibiotic treatment for urinary tract infection in paediatric patients: a Bayesian approach

Elisa Barbieri et al. Antimicrob Resist Infect Control. .

Abstract

Background: To evaluate the ability of Weighted-Incidence Syndromic Combination Antibiograms (WISCA) to inform the selection of empirical antibiotic regimens for suspected paediatric community-acquired urinary tract infections.

Methods: Data were collected from outpatients (< 15 years) accessing the emergency rooms of Padua University-Hospital and Mestre Dell' Angelo-Hospital (Venice) between January 1st, 2016, and December 31st, 2018. WISCAs were developed by estimating the coverage of eight regimens using a Bayesian hierarchical model adjusted for age, sex, and previous antibiotic treatment or renal/urological comorbidities.

Results: 385 of 620 urine culture requests were included in the model analysis. The most frequently observed bacterium was E. coli (85% and 87%, Centre A and B). No centre effect on coverage estimates was found, and data were successfully pooled together. Coverage ranged from 77.8% (Co-trimoxazole) to 97.6% (Carbapenems). Complex cases and males had significantly lower odds of being covered by a regimen than non-complex cases and females (odds ratio (OR) 0.49 [95% HDI, 0.38-0.65], and OR: 0.73 [95% HDIs, 0.56-0.96] respectively). Children aged 3-5 years had lower odds of being covered by a regimen than other age groups, except for neonates.

Conclusions: The developed WISCAs provide highly informative estimates on coverage patterns overcoming the limitation of combination antibiograms and expanding the framework of previous Bayesian WISCA algorithm.

Keywords: Antibiotic-resistance; Antimicrobial stewardship; Bayesian model; Children; Combination antibiogram; Urinary tract infection.

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Conflict of interest statement

The authors declare no conflict of interest, no financial and non-financial competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of case selection according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines
Fig. 2
Fig. 2
WISCA estimated coverage for all the evaluated antibiotic regimes. Dots represent the median of the posterior distribution and line the associated 95% Highest Density Intervals
Fig. 3
Fig. 3
WISCA estimated coverage for all the evaluated antibiotic regimes stratified by age group and non-complex versus complex cases. Dots represent the median of the posterior distribution and the line the associated 95% Highest Density Intervals
See this image and copyright information in PMC

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