Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Infectious Diseases and Antimicrobials

Infectious Diseases and Antimicrobials

Pdf Summary

Dr. Jennifer A. Muszynski from Nationwide Children’s Hospital and The Ohio State University College of Medicine discusses infectious diseases and antimicrobial agents in pediatric intensive care units (PICUs). The presentation explores the etiology, clinical manifestations, and treatment of life-threatening infections in critically ill children, focusing on the appropriate selection and use of antimicrobials.<br /><br />Key points include:<br />1. <strong>Prevalence and Inappropriateness of Antibiotics</strong>: Up to 80% of PICU patients receive antimicrobials, and 60% of these may be inappropriate due to incorrect dosage or spectrum.<br />2. <strong>Factors Influencing Antimicrobial Selection</strong>: Consideration must be given to the suspected organisms, infection site, antibiotic penetration, and organism susceptibility.<br />3. <strong>Etiologies of Sepsis</strong>: Common sources include the bloodstream, meningitis/encephalitis, and pneumonia. The organisms vary, with substantial instances of culture-negative results and gram-positive bacteria like Staphylococcus aureus, including MRSA.<br />4. <strong>Patient-Specific Factors</strong>: Factors such as age, immunization status, geographical location, chronic conditions, and immune status are crucial for identifying likely infectious organisms.<br />5. <strong>Age-Related Differences in Meningitis Pathogens</strong>: Different pathogens are predominant based on the child’s age and immunization status.<br />6. <strong>Multidrug Resistant Organisms and Antimicrobial Resistance</strong>: Resistance patterns vary geographically, emphasizing the importance of knowing local antibiograms.<br />7. <strong>Immune Compromise Considerations</strong>: Various immune deficiencies heighten risks for different types of infections.<br />8. <strong>Classes of Antibiotics and Mechanism of Action</strong>: A detailed breakdown of antibiotic classes, including cell wall inhibitors, macrolides, aminoglycosides, and more.<br />9. <strong>Pharmacodynamics and Pharmacokinetics</strong>: Important to optimize dosing strategies for effective infection control.<br />10. <strong>Antimicrobial Stewardship Programs (ASPs)</strong>: Effective ASPs reduce misuse, improve patient safety, and curb resistance, requiring hospital administration support and outcome tracking.<br /><br />The presentation also includes case studies to discuss practical application in diagnosing and empirically treating infections such as meningitis, toxic shock syndrome, and bacterial co-infection with influenza. Rapid, appropriate empirical antibiotic therapy, considering patient-specific and regional factors, is emphasized to manage severe infections in PICU settings effectively.

Keywords

pediatric intensive care units

infectious diseases

antimicrobial agents

antibiotic resistance

sepsis etiology

meningitis pathogens

multidrug resistant organisms

immune compromise

antimicrobial stewardship

pharmacodynamics

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