16-17 May 2024

Contents

Day 1

Keep Antimicrobials Working

• Joint collaboration between BSAC and BPS
• https://bsac-kaw.co.uk/

UK AWaRe goals 2024 - 2029

• Access: 70%
• Reduce overall usage by 5%

HAP talk

• Epidemiology (UK):

  • Incidence: 75k/yr
  • Deaths following HAP: 15k
  • Each HAP assc. with ~9 extra bed-days

• Diagnostics:

  • Currently a mess; some use definition below, some use ‘LRTI after inpatient for >48h OR resident in nursing facility’,
  • 3 Criteria:
    • Clinical syndrome of LRTI
    • Inflammatory response (Fever, raised WCC/CRP)
    • Imaging changes c/w HAP (e.g. CXR, CT)
  • Current being trialled in HAPFAST in UK
    • Note sample acquisition is quite poor; average SpCx in 14%

• Treatment:

  • NICE guidance: Based on 9 RCTs, but only 1 was in the UK (N=10)

  • Low-risk AMR: Co-amox (or Cotrim, Cefalexin, Doxy, Levo)

  • High risk AMR, Severe, Allergic: Lots of options, some quite confusing:

    | Reserve | Meropenem Ceftazidime-avibactam | | --- | --- | | Watch (Pseudo cover) | Piperacillin-tazobactam Ceftazidime Levofloxacin | | Watch (No Pseudo cover) | Ceftriaxone Cefuroxime |

    With no guidance as to which to choose and why.

• Interesting fact: with PsA, Mero + Amikacin given together has less risk of resistance evolving compared to meropenem monotherapy

CNS Infections in children

• CNS Ab Penetrance:

  

• Need to X BBB, then Blood-CSF barrier to penetrate to CSF (?+ parenchyma?)

  

• Intraventricular ABx in children:

  • No apparent advantage normally
  • Neurosurgical: definite advantage