Identifying 12 Targets for Pediatric Infection Research

Susan E. Coffin, MD, MPH

Experts identified 6 health care-associated infection topics and 6 antimicrobial stewardship topics that should be a high-priority target for pediatric research, according to a paper published in Infection Control & Hospital Epidemiology.

Investigators from across the U.S. included 26 pediatric and adult infectious disease clinicians in a study that collected expert recommendations and research priorities over a period of 7 months. The researchers also included a literature review, interactive teleconferences, web surveys, and 2 in-person meetings in their efforts to collect these viewpoints.

The study authors wrote that their aim was to “develop a pediatric research agenda focused on pediatric healthcare-associated infections and antimicrobial stewardship topics that will yield the highest impact on child health.”

The specialists that were included had expertise in health care-associated infection prevention and/or antimicrobial stewardship. Also included were members of the Division of Healthcare Quality and Promotion at the Centers for Disease Control and Prevention, the study authors said.

The researchers focused on 2 domains: topic identification and ranking of priorities. After the discussions concluded, the study authors had a list of 12 high-priority research topics within the 2 domains, they said.

The investigators wrote that health care-associated high-priority topics included: judicious testing for Clostridioides difficile (C diff) infection, chlorhexidine (CHG) bathing, measuring and preventing hospital-onset bloodstream infection rates, surgical site infection prevention, surveillance and prevention of multidrug resistant gram-negative rod infections.

Additionally, antimicrobial stewardship priorities included β-lactam allergy de-labeling, judicious use of perioperative antibiotics, intravenous to oral conversion of antimicrobial therapy, developing a patient-level “harm index” for antibiotic exposure, and benchmarking and or peer comparison of antibiotic use for common inpatient conditions, the study authors wrote.

As previously reported by HCPLive, researchers hope to standardize C diff infection treatment. After targeting primary care providers, emergency department workers and ward teams, a team of investigators determined that educational sessions promoted a standardized treatment for both severe and fulminant C diff infection.

The team held educational sessions earlier this year that helped providers determine care management methods. Notably, there was only a non-significant increase in the appropriate and timeliness of antibiotics usage in the group that received the intervention (92% vs. 97%, respectively). Also, in the intervention group, the study authors noted a lower mortality rate and length of hospital stay.

Their educational sessions were interrupted and moved to virtual sessions due to the ongoing novel coronavirus (COVID-19) pandemic, but as HCPLive has also described, C diff infections have decreased during the ongoing crisis.

Pediatric patients who also have sickle cell disease may be at risk for hospital-acquired C diff infection, too, which was also previously reported by HCPLive. This can be due to a variety of factors, those study authors wrote, but can be summed up as these patients’ multiple hospitalizations, antibiotic exposure, and transfusions.

The prevalence for C diff, according to these study authors, was estimated to be about 40 in 30,000 for the sickle cell disease group and about 5,000 in 11.8 million for the non-sickle cell disease group.