RAISING AWARE-NESS OF ANTIMICROBIAL STEWARDSHIP CHALLENGES IN PAEDIATRIC EMERGENCY CARE: RESULTS FROM THE PERFORM STUDY ASSESSING CONSISTENCY AND APPROPRIATENESS OF ANTIBIOTIC PRESCRIBING ACROSS EUROPE

Backgrounds: Optimisation of antimicrobial stewardship is key to tackling antimicrobial resistance (AMR). We described patterns of empiric antibiotic use in European paediatric Emergency Departments (EDs) and characterised appropriateness and consistency of prescribing. Methods: Febrile children attending ED with suspected infection and venepuncture for diagnostics tests were recruited to the BIVA study in PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management), and cases were phenotyped using the validated PERFORM probability algorithm. Empiric systemic antibiotic use was determined in view of assigned final ‘bacterial’ or ‘viral’ phenotype. Antibiotics were classified according to WHO AWaRe (Access, Watch, Reserve). Results: Of 2130 participating children, 1549 (72.7%) were assigned a ‘bacterial’ and 581 (27.3%) a ‘viral’ phenotype. A total of 1318 (85.1%) patients with a ‘bacterial’ and 269 (46.3%) with a ‘viral’ phenotype were prescribed empiric antibiotics during the first two days of admission. Of all patients treated with antibiotics, the majority (87.8% in ‘bacterial’ and 87.0% in ‘viral’ group) received parenteral antibiotics. The top three antibiotics prescribed were third-generation cephalosporins, penicillins and penicillin/beta-lactamase inhibitor combinations. 61.0% in the ‘bacterial’ and 80.3% patients in the ‘viral’ group receiving antibiotics had ≥ one WHO Watch antibiotic prescribed. The proportion of Watch antibiotic use was similar in initial and final syndrome classifications. Conclusions/Learning Points: Differentiating bacterial from viral aetiology in febrile illness on initial ED presentation remains challenging, resulting in over-prescription of antibiotics. Of note, a significant proportion of patients with a final ‘viral’ phenotype received systemic antibiotics during admission, predominantly classified as WHO Watch. Rapid and accurate point-of-care tests in the ED differentiating between bacterial and viral aetiology, could significantly improve antimicrobial stewardship, and help stem the rising tide of AMR. Funding: EU H2020 programme, GA No 66830