Stefan Weichert

Background: Because infections are a major driver of morbidity and mortality in children with hematologic or oncologic diseases, antimicrobials are frequently prescribed in pediatric oncology practice. However, excess or inappropriate use of antimicrobials is directly linked to the emergence of antimicrobial resistance. Although point-prevalence studies have examined the extent of antimicrobial use, a comprehensive qualitative evaluation of individual antimicrobial prescriptions remains lacking. Objective: The aim of this study is to identify appropriate versus inappropriate antimicrobial use among pediatric cancer patients in a point-prevalence study, followed by an expert panel adjudication process and a subsequent report of these findings to participating centers. This study also aims to improve the quality of patient care by informing centers about discrepancies between internal standards of care and national guidelines. Methods: Our point-prevalence study is performed at pediatric cancer centers in Germany and Austria. All patients under 18 years old who are hospitalized at the time of the study are included. As a supplement to the point-prevalence study, an expert panel is qualitatively assessing each of the antimicrobial prescriptions at the participating centers to review local guidelines and compare them with national guidelines. Results: As of December 2021, the point-prevalence survey has been conducted at 30 sites and expert panel adjudication for qualitative assessment of each antimicrobial use is ongoing. Results of the study are expected in 2022. Conclusions: This is the first point-prevalence study conducted among pediatric cancer centers with an integrated, multistep, qualitative approach that assesses each antimicrobial prescription. The results of this study will inform possible interventions for internal guidelines and antimicrobial stewardship programs implemented at pediatric cancer centers. In addition, local guidelines will be compared with national guidelines. Furthermore, this study will contribute to the overall integration of antimicrobial stewardship principles and initiatives in pediatric oncology and hematology, thereby improving safety and quality of care for children and adolescents with cancer and blood disorders. International Registered Report Identifier (IRRID): DERR1-10.2196/35774

BACKGROUND Because infections are a major driver of morbidity and mortality in children with hematologic or oncologic diseases, antimicrobials are frequently prescribed in pediatric oncology practice. However, excess or inappropriate use of antimicrobials is directly linked to the emergence of antimicrobial resistance. Although point-prevalence studies have examined the extent of antimicrobial use, a comprehensive qualitative evaluation of individual antimicrobial prescriptions remains lacking. OBJECTIVE The aim of this study is to identify appropriate versus inappropriate antimicrobial use among pediatric cancer patients in a point-prevalence study, followed by an expert panel adjudication process and a subsequent report of these findings to participating centers. This study also aims to improve the quality of patient care by informing centers about discrepancies between internal standards of care and national guidelines. METHODS Our point-prevalence study is performed at pediatric cancer centers in Germany and Austria. All patients under 18 years old who are hospitalized at the time of the study are included. As a supplement to the point-prevalence study, an expert panel is qualitatively assessing each of the antimicrobial prescriptions at the participating centers to review local guidelines and compare them with national guidelines. RESULTS As of December 2021, the point-prevalence survey has been conducted at 30 sites and expert panel adjudication for qualitative assessment of each antimicrobial use is ongoing. Results of the study are expected in 2022. CONCLUSIONS This is the first point-prevalence study conducted among pediatric cancer centers with an integrated, multistep, qualitative approach that assesses each antimicrobial prescription. The results of this study will inform possible interventions for internal guidelines and antimicrobial stewardship programs implemented at pediatric cancer centers. In addition, local guidelines will be compared with national guidelines. Furthermore, this study will contribute to the overall integration of antimicrobial stewardship principles and initiatives in pediatric oncology and hematology, thereby improving safety and quality of care for children and adolescents with cancer and blood disorders. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/35774

Mother-to-child transmission of HIV1 is the main cause for pediatric HIV1-infection. Since 1995 in developed countries the rate of vertical HIV1 transmission was reduced from 40% to 1-2% by the combination of antiretroviral therapy of pregnant women, antiretroviral prophylaxis in the newborn and refraining from breast-feeding. Nowadays the main causes for HIV1-infection in children are 1) not offered (voluntary) HIV1-testing in early pregnancy (in spite of recommendation for prenatal care) and 2) missing knowledge about prophylactic interventions in HIV1-positive pregnant women and their HIV1-exposed newborn. Diagnosis and/or exclusion of HIV1-infection in HIV1-exposed and HIV1-positive infants is difficult, because maternal HIV1-antibodies pass the placenta and can persist in the child up to two years after birth. Since in 1996 the era of "highly active antiretroviral therapy (HAART)", the use of an antiretroviral three-drug-regimen, began, HIV1-infection in children changed from a fatal illness to a chronic disease with decreased mortality and improved qualitiy of life. The lack of drug approvement, absence of adequate drug formulation and of pharmacokinetic data for children make the treatment of HIV1-infection in children much more difficult than in adults. Treatment of children depends on clinical category, CD4 cell count, viral load and age of diagnosis. With the current state of knowledge (failure of treatment interruption studies in adults and pending ones in children) once HAART is started it must be carried on life-long. This implies great challenges in adherence to avoid development of resistance and in confrontation with long-term adverse effects of HIV1-therapy.