20.500.12556/DiRROS-24141 Raising AWaRe-ness of antimicrobial stewardship challenges in pediatric emergency care results from the PERFORM study assessing consistency and appropriateness of antibiotic prescribing across Europe Background: Optimization of antimicrobial stewardship is key to tackling antimicrobial resistance, which is exacerbated by overprescription of antibiotics in pediatric emergency departments (EDs). We described patterns of empiric antibiotic use in European EDs and characterized appropriateness and consistency of prescribing. Methods: Between August 2016 and December 2019, febrile children attending EDs in 9 European countries with suspected infection were recruited into the PERFORM (Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management) study. Empiric systemic antibiotic use was determined in view of assigned final “bacterial” or “viral” phenotype. Antibiotics were classified according to the World Health Organization (WHO) AWaRe classification. Results: Of 2130 febrile episodes (excluding children with nonbacterial/nonviral phenotypes), 1549 (72.7%) were assigned a bacterial and 581 (27.3%) a viral phenotype. A total of 1318 of 1549 episodes (85.1%) with a bacterial and 269 of 581 (46.3%) with a viral phenotype received empiric systemic antibiotics (in the first 2 days of admission). Of those, the majority (87.8% in the bacterial and 87.0% in the viral group) received parenteral antibiotics. The top 3 antibiotics prescribed were thirdgeneration cephalosporins, penicillins, and penicillin/β-lactamase inhibitor combinations. Of those treated with empiric systemic antibiotics in the viral group, 216 of 269 (80.3%) received ≥1 antibiotic in the “Watch” category. Conclusions: Differentiating bacterial from viral etiology in febrile illness on initial ED presentation remains challenging, resulting in a substantial overprescription of antibiotics. A significant proportion of patients with a viral phenotype received systemic antibiotics, predominantly classified as WHO Watch. Rapid and accurate point-of-care tests in the ED differentiating between bacterial and viral etiology could significantly improve antimicrobial stewardship. antimicrobial stewardship pediatric emergency care antibiotic prescription AWaRe infectious diseases true false true Angleški jezik Ni določen Neznano 2025-11-17 15:25:43 2025-11-17 15:25:43 2025-11-18 03:43:33 0000-00-00 00:00:00 2024 0 0 Nasl. z nasl. zaslona; Opis vira z dne 23. 7. 2025; str. 526–534 issue 3 Vol. 78 Mar. 2024 0000-00-00 Zaloznikova Objavljeno apc 0000-00-00 0000-00-00 0000-00-00 616-053.2 1537-6591 10.1093/cid/ciad615 243477251 RAZ_Kolberg_Laura_2024.pdf RAZ_Kolberg_Laura_2024.pdf 1 1CAB612900BD462E8BB90AC76C780276 2b5e9c61ab9c7a37977f4582f6a09d4b919bc6aeaa674e4a4d187f63d8901937 719d9cbd-c3c1-11f0-94a7-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=35932 https://academic.oup.com/cid/article/78/3/526/7307577 0 80ce4abb-c3c1-11f0-94a7-001a4af901a5 https://dirros.openscience.si/Dokument.php?lang=slv&id=35933 Univerzitetni klinični center Ljubljana 0 0 0