Bon usage des carbapénèmes en pédiatrie : évaluation des pratiques professionnelles
Bibliographic record
Abstract
The increase of carbapenem resistance is a major health problem and improving the use of carbapenem is now crucial. Although the pediatric population is very specific, there still be a lack of data in children. The aim of this study was to assess the compliance of carbapenem prescriptions with guidelines in pediatrics.We carried out a retrospective study over a one-year period (2019) in our university hospital. All children admitted who received at least one dose of carbapenem were included. The use of carbapenem was considered as appropriate when concurrently approved by an infectious disease specialist (ID) or retrospectivly guidelines-concordant or retrospectively approved by two independent ID specialists, one trained in France, the other one trained in Canada. . As a secondary outcome, we analysed the review of carbapenem at 72 hours after initiation.We collected a total of 96 carbapenem prescriptions (80 (83%), 10 (10%) and 6 (6%) for meropenem, imipenem and ertapenem, respectively) in 75 patients (median age 46 months [IQR 4-115], 34 males). In 61 cases, a bacteria was isolated including 19 (29%) extended spectrum β-lactamases (ESBL)-producing Enterobacteriaceae, mostly Escherichia coli (n = 12, 63%) and Klebsiella pneumoniae (n = 6, 32%). Overall, most of carbapenem prescriptions were considered as appropriate at initiation (n = 89, 93%) whether there were empirical (n = 54, 70%) or culture-based (n = 18, 95%). The main reasons for carbapenem prescription according to the physician in charge were the unfavorable evolution while treated by another antibiotic (n=33, 34%), the presence of ESBLs-producing bacteria risk factors (n = 21, 21%), the degree of criticalness (n = 22, 23%) or the presence of neutropenia (n = 19, 20%). The treatments were stepped down at 72h in 31% of prescriptions.There was no alternative to carbapenem given the bacteriological documentation for 39% of prescriptions.We found that most of carpapenem prescriptions were considered as appropriate at initiation in a retrospective pediatric cohort. At 72h after initiation of carbapenem, around two thirds of prescriptions should have been improved with a step down strategy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".