Local experience in adapting «SCAT 2025» scale for risk stratification of resistant pathogens and selection of initial empirical antimicrobial therapy in a multispecialty children’s hospital

Thu, 20 Aug 2026 15:34:37 +0000

Objective.

To develop and perform pilot prospective validation of a locally adapted pediatric version of the SCAT scale for risk stratification of resistant pathogens and justification of initial empirical antimicrobial therapy in hospitalized children in a multispecialty children’s hospital.

Materials and Methods.

Over the period from 15 December 2025 to 15 February 2026, a single-center prospective observational study was conducted at the Morozovskaya Children’s City Clinical Hospital. The study included two sequential phases: local adaptation of the SCAT scale for risk stratification of resistant pathogens to pediatric practice and pilot clinical validation of the adapted version. The adaptation was carried out considering the patient flow structure, prior antibacterial therapy, local microbiological data, and expert assessment. The validation phase sequentially enrolled 100 patients hospitalized in intensive care units of the Morozovskaya Children’s City Clinical Hospital who required initial empiric antimicrobial therapy. For each patient, the risk category was determined according to the reference version of the “SCAT 2025” scale and the version adapted for this children’s hospital, the “SCAT pediatric Morozovskaya” scale, and the recommended initial therapy according to the adapted scale was assessed. The primary endpoint was the proportion of cases with adequate choice of initial empirical antimicrobial therapy. Therapy was considered adequate if, based on the assigned risk category, in vitro activity corresponded to the clinically significant isolated pathogen upon subsequent microbiological verification. Secondary endpoints included the frequency of therapy escalation and de-escalation, and the consistency between the original and adapted versions of stratification.

Results.

This study included 100 patients. Local adaptation of the scale resulted in changes to 4 parameters and the addition of 9 risk-determining parameters, primarily related to comorbidity in children hospitalized in the following profiles: pediatric surgery, pediatric oncology, onco-hematology, and children at risk of invasive mycosis. Compared to the original pediatric version of SCAT, the adapted version changed the risk category for 30 (30%) patients. An adequate choice of initial empirical antimicrobial therapy was achieved in 97 (97%) cases. Therapy escalation due to insufficient initial coverage was required in 3 (3%) patients. The greatest clinical applicability of the adapted tool was noted in subgroups of children with congenital malformations, oncological and onco-hematological diseases, the presence of invasive devices, and the risk of invasive mycosis.

Conclusions.

The experience of the Morozovskaya Children’s City Clinical Hospital is presented based on the analysis of local data on the structure of patients in the medical care profiles, which allowed doctors to adapt the updated antibiotic stewardship «SCAT 2025» tool to the existing needs of «SCAT Children Morozovskaya», taking into account the specifics of informed decision-making process. The proposed «SCAT Children Morozovskaya» tool increases the accuracy of therapeutic strategies when prescribing antimicrobial drugs, which in turn contributes to improving treatment outcomes.

Komarov A.G. on КМАХ

Local experience in adapting «SCAT 2025» scale for risk stratification of resistant pathogens and selection of initial empirical antimicrobial therapy in a multispecialty children’s hospital

Objective.

Materials and Methods.

Results.

Conclusions.