Inflammatory markers to inform antibiotic treatment: the next frontier of diagnostic stewardship?

Chair(s)

• AS

  Anna Sick-Samuels, MD, MPH (she/her/hers)

  Assistant Professor of Pediatrics
  Johns Hopkins Children's Center
  Baltimore, Maryland, United States
• 

  Charlotte Woods-Hill, MD MSHP

  Assistant Professor
  Perelman School of Medicine at the University of Pennsylvania
  Phi, Pennsylvania, United States

Diagnostic Stewardship, the judicious use of microbiology diagnostic testing, is a rapidly growing field to combat antimicrobial overuse and deliver high-value care. Evidence supports the role of inflammatory markers (e.g., C-reactive protein and procalcitonin) in select indications to improve management and outcomes. However, they are widely used to evaluate patients with potential infections and may represent a target for diagnostic stewardship to optimize applications. This session will explore current evidence, challenges, and knowledge gaps in the application of inflammatory markers for the evaluation of suspected infection to inform antibiotic treatment considering perspectives across the hospital care continuum.

Dr. Anna Sick-Samuels (Johns Hopkins) will provide an overview of inflammatory markers mechanism of actions and principles and present a hypothetical case (e.g., febrile patient with respiratory symptoms) and ask expert panelists from 3 pediatric settings to evaluate the current evidence for application, limitations, and opportunities to optimize applications while considering setting-specific challenges. Dr. Daniel Shapiro (UCSF) will consider the role of inflammatory markers in the emergency department. Dr. John Morrison (Johns Hopkins All Children’s Hospital) will consider applications in hospitalized acute care patients. Dr. Charley Woods-Hill (CHOP) will discuss utility in the pediatric intensive care unit and challenges that are similar to or different from the other care settings. Panelists will consider how clinicians can collaborate across disciplines to best use inflammatory markers in different pediatric care settings, discuss how applying principles of diagnostic stewardship could help to standardize care, reduce antibiotic overuse, and establish priorities for future research.

Presentations:

• 1:00pm – 1:21pm HST

  Inflammatory Marker Alphabet Soup- what Do the Letters Stand For? Mechanism and Principles Behind Inflammatory Marker Testing
  

  Speaker: Anna Sick-Samuels, MD, MPH (she/her/hers) – Johns Hopkins Children's Center
• 1:21pm – 1:44pm HST

  Is the Patient Sick or Not? Applying Inflammatory Markers in the Pediatric Emergency Room
  

  Speaker: Daniel Shapiro, MD, MPH – UCSF Benioff Children's Hospital Oakland
• 1:44pm – 2:07pm HST

  To Continue Antibiotics, or Not? Use of Inflammatory Markers to Diagnose and Manage Common Infections in the Hospital Setting
  

  Speaker: John M. Morrison, MD PhD (he/him/his) – Johns Hopkins All Children's Hospital
• 2:07pm – 2:30pm HST

  A Sea of Data Points in an Ocean of Uncertainty: CRP and Procalcitonin in Pediatric Intensive Care Unit
  

  Speaker: Charlotte Woods-Hill, MD MSHP – Perelman School of Medicine at the University of Pennsylvania