ArticleJAC-antimicrobial resistance2026
Antibiotic use in children with suspected CNS infection in the molecular diagnostic era: a cohort study of 1198 children.
Article in JAC-antimicrobial resistance, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
10 authors.
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Abstract
Objectives: Central nervous system (CNS) infections in children require rapid diagnostic evaluation and prompt empiric antimicrobial therapy. However, clinical presentation is often non-specific, leading to frequent use of broad-spectrum antibiotics while awaiting cerebrospinal fluid (CSF) results. We evaluated antibiotic treatment modifications during the diagnostic work-up and quantified changes in antibiotic spectrum coverage (ASC) before and after lumbar puncture (LP). Patients and methods: We conducted a retrospective single-centre study including children <18 years who underwent LP for suspected CNS infection between January 2016 and December 2024. CSF was analysed using the BioFire Results: Among 1198 children undergoing LP, 730 (60.9%) received antibiotic therapy. Antibiotic use was highest in neonates (227/246; 92.3%) and infants aged 29 days to <6 months (118/140; 84.3%) and lowest in adolescents (106/329; 32.2%). Treatment was modified after LP-related diagnostic information became available in 412/1198 children (34.4%). Among treated children, 313 (42.9%) underwent de-escalation, 99 (13.6%) escalation and 318 (43.6%) had no change. Overall, mean ASC decreased from 8.5 before LP to 6.6 afterwards (ΔASC -1.9; Conclusions: LP-related diagnostic information was associated with frequent antibiotic treatment modification and reduced antibiotic spectrum coverage. These findings support integrated CSF diagnostics, including multiplex polymerase chain reaction, as a component of antimicrobial stewardship in children with suspected CNS infection.
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