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Patil PS, Suryawanshi SJ, Patil SS, Pawar AP. HME-assisted formulation of taste-masked dispersible tablets of cefpodoxime proxetil and roxithromycin. J Taibah Univ Med Sci 2024; 19:252-262. [PMID: 38616800 PMCID: PMC11010712 DOI: 10.1016/j.jtumed.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 11/10/2023] [Accepted: 12/13/2023] [Indexed: 04/16/2024] Open
Abstract
Objectives Antibiotics are the most commonly administered medications among pediatric patients. However most of the time, accurate dose administration to children becomes a problem due to the extremely bitter taste. Cefpodoxime proxetil (CP) and roxithromycin (ROX) are antibiotics often prescribed to the pediatric population and have a bitter taste. Marketed formulations of these drugs are dry suspension and/or tablets. The lyophilization method involves various steps and thus is time consuming and expensive. The objective of this study was to mask the bitter taste of CP and ROX without compromising the solubility and drug release profile compared to marketed formulations, as well as to overcome the disadvantages associated with the currently used lyophilization technique. Methods Hot melt extrusion (HME) technology was used to process CP and ROX individually with Eudragit E PO polymer. The extrudates obtained were characterized by Fourier transform infrared spectroscopy, powder X-ray diffraction, and differential scanning calorimetry. The powdered extrudates were formulated as dispersible tablets and evaluated for in vitro and in vivo taste-masking efficiency. Results The tablets prepared in this study showed comparable dissolution profiles but the taste-masking efficiency was significantly enhanced compared to the marketed tablets of CP and ROX. The results of in vivo human taste-masking evaluation were also in agreement with the in vitro taste-masking studies. Conclusion The current work presents solvent-free, scalable, and continuous HME technology for addressing the bitter taste issues of CP and ROX. The disadvantages associated with the currently used lyophilization technique were overcome by developing the formulations using HME technology.
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Affiliation(s)
- Prathamesh S. Patil
- Department of Pharmaceutics, Bharati Vidyapeeth (Deemed to be University), Poona College of Pharmacy, Pune, Maharashtra, India
- STEERLife India Pvt. Ltd, Bengaluru, Karnataka, India
| | | | - Sharvil S. Patil
- Department of Pharmaceutics, Bharati Vidyapeeth (Deemed to be University), Poona College of Pharmacy, Pune, Maharashtra, India
| | - Atmaram P. Pawar
- Department of Pharmaceutics, Bharati Vidyapeeth (Deemed to be University), Poona College of Pharmacy, Pune, Maharashtra, India
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Menting SGP, Redican E, Murphy J, Bucholc M. Primary Care Antibiotic Prescribing and Infection-Related Hospitalisation. Antibiotics (Basel) 2023; 12:1685. [PMID: 38136719 PMCID: PMC10740527 DOI: 10.3390/antibiotics12121685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023] Open
Abstract
Inappropriate prescribing of antibiotics has been widely recognised as a leading cause of antimicrobial resistance, which in turn has become one of the most significant threats to global health. Given that most antibiotic prescriptions are issued in primary care settings, investigating the associations between primary care prescribing of antibiotics and subsequent infection-related hospitalisations affords a valuable opportunity to understand the long-term health implications of primary care antibiotic intervention. A narrative review of the scientific literature studying associations between primary care antibiotic prescribing and subsequent infection-related hospitalisation was conducted. The Web of Science database was used to retrieve 252 potentially relevant studies, with 23 of these studies included in this review (stratified by patient age and infection type). The majority of studies (n = 18) were published in the United Kingdom, while the remainder were conducted in Germany, Spain, Denmark, New Zealand, and the United States. While some of the reviewed studies demonstrated that appropriate and timely antibiotic prescribing in primary care could help reduce the need for hospitalisation, excessive antibiotic prescribing can lead to antimicrobial resistance, subsequently increasing the risk of infection-related hospitalisation. Few studies reported no association between primary care antibiotic prescriptions and subsequent infection-related hospitalisation. Overall, the disparate results in the extant literature attest to the conflicting factors influencing the decision-making regarding antibiotic prescribing and highlight the necessity of adopting a more patient-focussed perspective in stewardship programmes and the need for increased use of rapid diagnostic testing in primary care.
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Affiliation(s)
| | - Enya Redican
- School of Psychology, Ulster University, Coleraine BT52 1SA, UK
| | - Jamie Murphy
- School of Psychology, Ulster University, Coleraine BT52 1SA, UK
| | - Magda Bucholc
- School of Computing, Engineering and Intelligent Systems, Ulster University, Derry-Londonderry BT48 7JL, UK
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Arbanas I, Monescu V, Dragomir N, Sauciuc LD, Cojocaru E, Csutak K, Popovici BE, Andreea P, Elena-Daniela S, Lixandru RI, Bleotu L, Falup-Pecurariu O. A 7-Year Survey (2015-2021) in One Pediatric Hospital (Brasov, Romania) on Rotavirus Gastroenteritis Specified as Community- or Hospital-Acquired Infection in Young Children. Trop Med Infect Dis 2023; 8:509. [PMID: 38133441 PMCID: PMC10747557 DOI: 10.3390/tropicalmed8120509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
This project is an observational, descriptive study evaluating frequencies of rotavirus disease in hospitalized children aged less than 5 years old between 2015 and 2021 in the Pediatric Hospital of Brasov, Central Romania. The study compares socio-demographic (age, sex, place of living and ethnicity), clinical, and treatment aspects between community-acquired rotavirus gastroenteritis (CARG) and hospital-acquired rotavirus gastroenteritis (HARG). During that period, 1913 hospitalized children had a rapid positive immunichromatographic rotavirus test from stool specimens. Among them, 1620 (84.6%) were CARG and 293 (15.4%) were HARG. CARG conditions represented 28.5% of all acute hospitalized gastroenteritis (n = 5673) whereas HARG represented 5.2%. Around the same percentage of urban children were seen in CARG as in HARG (58.5% (n = 948) for CARG and 56.3% (n = 164) for HARG). About 64.9% (n = 1052) of CARG cases were from Roma population, and 66.5% (n = 195) in HARG. The age group with the highest frequency of the disease was 12 to 24 months old for both CARG and HARG. The average hospital duration was 5.09 days for CARG and 7.62 days for HARG. Diarrhea was the principal symptom in both CARG and HARG (92.6% (n = 1500) for CARG and 93.9% (n = 275) for HARG). Most CARG patients (61% (n = 989)) were treated for symptomatic management with iv fluids. Most HARG (60.4% (n = 177)) were treated for symptomatic management with iv fluids and antibiotics. A significant seasonal shift to a later period in the year was observed during the last registration year of 2021, possibly due to the COVID-19 epidemic. The seasonal disease burden of rotavirus infection in children remains high in hospital care in Romania, which may justify the systematic introduction of rotavirus vaccination across the whole country.
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Affiliation(s)
- Ioana Arbanas
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
- Faculty of Medicine Brasov, Transilvania University, 500019 Brasov, Romania
| | - Vlad Monescu
- Faculty of Mathematics, Transilvania University, 500091 Brasov, Romania
| | - Niculina Dragomir
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
| | - Larisa Diana Sauciuc
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
| | - Emanuela Cojocaru
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
| | - Katalin Csutak
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
| | - Bianca Elena Popovici
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
- Faculty of Medicine Brasov, Transilvania University, 500019 Brasov, Romania
| | - Pandaru Andreea
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
| | - Spirea Elena-Daniela
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
| | - Raluca-Ileana Lixandru
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
- Faculty of Medicine Brasov, Transilvania University, 500019 Brasov, Romania
| | - Laura Bleotu
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
| | - Oana Falup-Pecurariu
- Children’s Clinical Hospital Brasov, 500063 Brasov, Romania; (I.A.); (N.D.); (L.D.S.); (E.C.); (K.C.); (B.E.P.); (P.A.); (S.E.-D.); (R.-I.L.); (L.B.); (O.F.-P.)
- Faculty of Medicine Brasov, Transilvania University, 500019 Brasov, Romania
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Lin R, Xing Z, Liu X, Chai Q, Xin Z, Huang M, Zhu C, Luan C, Gao H, Du Y, Deng X, Zhang H, Ma D. Performance of targeted next-generation sequencing in the detection of respiratory pathogens and antimicrobial resistance genes for children. J Med Microbiol 2023; 72. [PMID: 37910007 DOI: 10.1099/jmm.0.001771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Introduction. Respiratory tract infection, which is associated with high morbidity and mortality, occurs frequently in children. At present, the main diagnostic method is culture. However, the low pathogen detection rate of the culture approach prevents timely and accurate diagnosis. Fortunately, next-generation sequencing (NGS) can compensate for the deficiency of culture, and its application in clinical diagnostics has become increasingly available.Gap Statement. Targeted NGS (tNGS) is a platform that can select and enrich specific regions before data enter the NGS pipeline. However, the performance of tNGS in the detection of respiratory pathogens and antimicrobial resistance genes (ARGs) in infections in children is unclear.Aim and methodology. In this study, we estimated the performance of tNGS in the detection of respiratory pathogens and ARGs in 47 bronchoalveolar lavage fluid (BALF) specimens from children using conventional culture and antimicrobial susceptibility testing (AST) as the gold standard.Results. RPIP (Respiratory Pathogen ID/AMR enrichment) sequencing generated almost 500 000 reads for each specimen. In the detection of pathogens, RPIP sequencing showed targeted superiority in detecting difficult-to-culture bacteria, including Mycoplasma pneumoniae. Compared with the results of culture, the sensitivity and specificity of RPIP were 84.4 % (confidence interval 70.5-93.5 %) and 97.7 % (95.9 -98.8%), respectively. Moreover, RPIP results showed that a single infection was detected in 10 of the 47 BALF specimens, and multiple infections were detected in 34, with the largest number of bacterial/viral coinfections. Nevertheless, there were also three specimens where no pathogen was detected. Furthermore, we analysed the drug resistance genes of specimens containing Streptococcus pneumoniae, which was detected in 25 out of 47 specimens in the study. A total of 58 ARGs associated with tetracycline, macrolide-lincosamide-streptogramin, beta-lactams, sulfonamide and aminoglycosides were identified by RPIP in 19 of 25 patients. Using the results of AST as a standard, the coincidence rates of erythromycin, tetracycline, penicillin and sulfonamides were 89.5, 79.0, 36.8 and 42.1 %, respectively.Conclusion. These results demonstrated the superiority of RPIP in pathogen detection, particularly for multiple and difficult-to-culture pathogens, as well as in predicting resistance to erythromycin and tetracycline, which has significance for the accurate diagnosis of pathogenic infection and in the guidance of clinical treatment.
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Affiliation(s)
- Ruihong Lin
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Zhihao Xing
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Xiaorong Liu
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Qiang Chai
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Zefeng Xin
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Meng Huang
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Chunqing Zhu
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Ce Luan
- Department of Anatomy, College of Basic Medicine, Chongqing Medical University, Chongqing 400042, PR China
| | - Hongdan Gao
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Yao Du
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Xuwen Deng
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Hetong Zhang
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
| | - Dongli Ma
- Shenzhen Pediatrics Institute of Shantou University Medical College, Shenzhen 518026, Guangdong, PR China
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Logan LK, Coy LR, Pitstick CE, Marshall SH, Medernach RL, Domitrovic TN, Konda S, Qureshi NK, Hujer AM, Zheng X, Rudin SD, Weinstein RA, Bonomo RA. The role of the plasmid-mediated fluoroquinolone resistance genes as resistance mechanisms in pediatric infections due to Enterobacterales. Front Cell Infect Microbiol 2023; 13:1249505. [PMID: 37900312 PMCID: PMC10613066 DOI: 10.3389/fcimb.2023.1249505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/30/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Fluoroquinolones (FQs) are not commonly prescribed in children, yet the increasing incidence of multidrug-resistant (MDR) Enterobacterales (Ent) infections in this population often reveals FQ resistance. We sought to define the role of FQ resistance in the epidemiology of MDR Ent in children, with an overall goal to devise treatment and prevention strategies. Methods A case-control study of children (0-18 years) at three Chicago hospitals was performed. Cases had infections by FQ-susceptible, β-lactamase-producing (bla) Ent harboring a non- or low-level expression of PMFQR genes (PMFQS Ent). Controls had FQR infections due to bla Ent with expressed PMFQR genes (PMFQR Ent). We sought bla genes by PCR or DNA (BD Max Check-Points assay®) and PMFQR genes by PCR. We performed rep-PCR, MLST, and E. coli phylogenetic grouping. Whole genome sequencing was additionally performed on PMFQS Ent positive isolates. Demographics, comorbidities, and device, antibiotic, and healthcare exposures were evaluated. Predictors of infection were assessed. Results Of 170 β-lactamase-producing Ent isolates, 85 (50%) were FQS; 23 (27%) had PMFQR genes (PMFQS cases). Eighty-five (50%) were FQR; 53 (62%) had PMFQR genes (PMFQR controls). The median age for children with PMFQS Ent and PMFQR Ent was 4.3 and 6.2 years, respectively (p = NS). Of 23 PMFQS Ent, 56% were Klebsiella spp., and of 53 PMFQR Ent, 76% were E. coli. The most common bla and PMFQR genes detected in PMFQS Ent were bla SHV ESBL (44%) and oqxAB (57%), and the corresponding genes detected in PMFQR Ent were bla CTX-M-1-group ESBL (79%) and aac(6')-Ib-cr (83%). Whole genome sequencing of PMFQS Ent revealed the additional presence of mcr-9, a transferable polymyxin resistance gene, in 47% of isolates, along with multiple plasmids and mobile genetic elements propagating drug resistance. Multivariable regression analysis showed that children with PMFQS Ent infections were more likely to have hospital onset infection (OR 5.7, 95% CI 1.6-22) and isolates containing multiple bla genes (OR 3.8, 95% CI 1.1-14.5). The presence of invasive devices mediated the effects of healthcare setting in the final model. Differences in demographics, comorbidities, or antibiotic use were not found. Conclusions Paradoxically, PMFQS Ent infections were often hospital onset and PMFQR Ent infections were community onset. PMFQS Ent commonly co-harbored multiple bla and PMFQR genes, and additional silent, yet transferrable antibiotic resistance genes such as mcr-9, affecting therapeutic options and suggesting the need to address infection prevention strategies to control spread. Control of PMFQS Ent infections will require validating community and healthcare-based sources and risk factors associated with acquisition.
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Affiliation(s)
- Latania K. Logan
- Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, United States
- Pediatrics, Rush University Medical Center, Chicago, IL, United States
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Laura Rojas Coy
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States
- Molecular Biology, and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | | | - Steven H. Marshall
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Rachel L. Medernach
- Pediatrics, Rush University Medical Center, Chicago, IL, United States
- Medicine, Rush University Medical Center, Chicago, IL, United States
| | - T. Nicholas Domitrovic
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Sreenivas Konda
- Biostatistics, University of Illinois at Chicago, Chicago, IL, United States
| | - Nadia K. Qureshi
- Pediatrics, Loyola University Medical Center, Maywood, IL, United States
| | - Andrea M. Hujer
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States
- Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Xiaotian Zheng
- Microbiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Pathology, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Susan D. Rudin
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Robert A. Weinstein
- Medicine, Rush University Medical Center, Chicago, IL, United States
- Department of Medicine, Cook County Health, Chicago, IL, United States
| | - Robert A. Bonomo
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, United States
- Molecular Biology, and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- Biochemistry, Pharmacology, Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, OH, United States
- Case Western Reserve University (CWRU)-Cleveland VA Medical Center (VAMC) Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, United States
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Olsen NJ, Larsen SC, Køster-Rasmussen R, Rohde JF, Østergaard JN, Heitmann BL, Specht IO. Does attendance in outdoor kindergartens reduce the use of antibiotics in children? Acta Paediatr 2023; 112:1944-1953. [PMID: 37307024 DOI: 10.1111/apa.16869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/13/2023]
Abstract
AIM The aim of this study was to determine whether children enrolled in rural outdoor kindergartens had a lower risk of redeeming at least one prescription for antibiotics compared with children enrolled in urban conventional kindergartens, and if type of antibiotics prescribed differed according to kindergarten type. METHODS Two Danish municipalities provided data including civil registration numbers from children enrolled in a rural outdoor kindergarten in 2011-2019, and a subsample of all children enrolled in urban conventional kindergartens in the same period. Civil registration numbers were linked to individual-level information on redeemed prescriptions for antibiotics from the Danish National Prescription Registry. Regression models were performed on 2132 children enrolled in outdoor kindergartens, and 2208 children enrolled in conventional kindergartens. RESULTS There was no difference between groups in risk of redeeming at least one prescription for all types of antibiotics (adjusted risk ratio: 0.97 [95% confidence intervals 0.93, 1.02, p = 0.26]). Similarly, there were no differences between kindergarten type and risk of redeeming at least one prescription for systemic, narrow-spectrum systemic antibacterial, broad-spectrum systemic antibacterial or topical antibiotics. CONCLUSION Compared with children who were enrolled in conventional kindergartens, children who were enrolled in outdoor kindergartens did not have a lower risk of redeeming prescriptions for any type of antibiotics.
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Affiliation(s)
- Nanna Julie Olsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Sofus Christian Larsen
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Køster-Rasmussen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jeanett Friis Rohde
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | | | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Boden Group, The Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ina Olmer Specht
- Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Burnside JS, Buchthal OV, Patil U. A Systematic Review of Antimicrobial Resistance During the COVID-19 Pandemic. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:188-193. [PMID: 37559691 PMCID: PMC10407777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Antimicrobial-resistant pathogens, or "superbugs," cause more than 35 000 deaths and more than 2.8 million antibiotic-resistant infections in the US each year. Worldwide, antimicrobial resistance (AMR) has claimed at least 700 000 lives per year, including 230 000 from multi-drug resistant (MDR) tuberculosis. AMR-related deaths are projected to increase to 10 million by the year 2050. The use of biocides, improper prescribing of antibiotics for viral infections, prolonged hospital stays, and other issues contribute to AMR. The purpose of this study was to determine whether the COVID-19 pandemic has had an impact on the rates of AMR globally. While it is still early for the results of research studies, 4 articles indicated an increase, 2 found a decrease, and 2 had mixed results. It is possible that this pandemic may be contributing to an increase of medication-resistant infections.
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Affiliation(s)
| | | | - Uday Patil
- Office of Public Health Studies, University of Hawai‘i at Maānoa, Honolulu, HI
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Guliy OI, Zaitsev BD, Borodina IA. Electroacoustic Biosensor Systems for Evaluating Antibiotic Action on Microbial Cells. SENSORS (BASEL, SWITZERLAND) 2023; 23:6292. [PMID: 37514587 PMCID: PMC10383298 DOI: 10.3390/s23146292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023]
Abstract
Antibiotics are widely used to treat infectious diseases. This leads to the presence of antibiotics and their metabolic products in the ecosystem, especially in aquatic environments. In many countries, the growth of pathogen resistance to antibiotics is considered a threat to national security. Therefore, methods for determining the sensitivity/resistance of bacteria to antimicrobial drugs are important. This review discusses the mechanisms of the formation of antibacterial resistance and the various methods and sensor systems available for analyzing antibiotic effects on bacteria. Particular attention is paid to acoustic biosensors with active immobilized layers and to sensors that analyze antibiotics directly in liquids. It is shown that sensors of the second type allow analysis to be done within a short period, which is important for timely treatment.
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Affiliation(s)
- Olga I Guliy
- Institute of Biochemistry and Physiology of Plants and Microorganisms-Subdivision of the Federal State Budgetary Research Institution Saratov Federal Scientific Centre of the Russian Academy of Sciences (IBPPM RAS), Saratov 410049, Russia
| | - Boris D Zaitsev
- Kotelnikov Institute of Radio Engineering and Electronics, Russian Academy of Sciences, Saratov Branch, Saratov 410019, Russia
| | - Irina A Borodina
- Kotelnikov Institute of Radio Engineering and Electronics, Russian Academy of Sciences, Saratov Branch, Saratov 410019, Russia
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Parzen-Johnson S, Sun S, Scardina T, Patel SJ. Fluoroquinolone Use Among Hospitalized Children: Diagnosis-Based Stratification to Identify Stewardship Targets. Open Forum Infect Dis 2023; 10:ofad297. [PMID: 37323425 PMCID: PMC10264067 DOI: 10.1093/ofid/ofad297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
Background As FQ (fluoroquinolone) use has shifted in pediatric populations, better metrics are needed to guide targeted antibiotic stewardship interventions and limit development of adverse events and resistance, particularly in medically complex children. In this study, we identify high-utilization groups based on underlying medical conditions and describe their relative FQ use over time. Methods This study is a retrospective analysis of data from the Pediatric Health Information System database from 2016 to 2020. We identify high-utilization groups based on underlying medical conditions using International Classification of Diseases, Ninth or Tenth Revision codes. We delineate overall trends in the use of FQs in the inpatient setting, including rate and proportional use by each patient group. Results Patients with an oncology diagnosis represent a large (25%-44%) and rising proportion (+4.8%/year, P = .001) of national FQ use over the study period. Patients with intra-abdominal infections, including appendicitis, have had a significant increase in both their relative proportional use of FQs (+0.6%/year, P = .037) and proportion of FQ use per admission encounter over the study period (+0.6%/year, P = .008). Patients with cystic fibrosis represent a decreasing proportion of overall use (-2.1%/year, P = .011) and have decreasing FQ use per inpatient encounter (-0.8%/year, P = .001). Conclusions Patients with an oncology diagnosis and patients with an intra-abdominal infection appear to be targets for FQ stewardship. Patients with cystic fibrosis have decreasing inpatient FQ use. Key Points: This study describes fluoroquinolone use among hospitalized children from 2016 to 2020, stratified by underlying diagnoses. These trends are used to identify high-yield antibiotic stewardship targets.
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Affiliation(s)
- Simon Parzen-Johnson
- Correspondence: Simon Parzen-Johnson, MD, Division of Infectious Diseases, Ann and Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611 ()
| | - Shan Sun
- Division of Infectious Diseases, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Tonya Scardina
- Department of Pharmacy, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Vairo C, Villar Vidal M, Maria Hernandez R, Igartua M, Villullas S. Colistin- and amikacin-loaded lipid-based drug delivery systems for resistant gram-negative lung and wound bacterial infections. Int J Pharm 2023; 635:122739. [PMID: 36801363 DOI: 10.1016/j.ijpharm.2023.122739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
Antimicrobial resistance (AMR) is a global health issue, which needs to be tackled without further delay. The World Health Organization(WHO) has classified three gram-negative bacteria, Pseudomonas aeruginosa, Klebsiella pneumonia and Acinetobacter baumannii, as the principal responsible for AMR, mainly causing difficult to treat nosocomial lung and wound infections. In this regard, the need for colistin and amikacin, the re-emerged antibiotics of choice for resistant gram-negative infections, will be examined as well as their associated toxicity. Thus, current but ineffective clinical strategies designed to prevent toxicity related to colistin and amikacin will be reported, highlighting the importance of lipid-based drug delivery systems (LBDDSs), such as liposomes, solid lipid nanoparticles (SLNs) and nanostructured lipid carriers (NLCs), as efficient delivery strategies for reducing antibiotic toxicity. This review reveals that colistin- and amikacin-NLCs are promising carriers with greater potential than liposomes and SLNs to safely tackle AMR, especially for lung and wound infections.
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Affiliation(s)
- Claudia Vairo
- BioKeralty Research Institute AIE, Albert Einstein, 25-E3, 01510 Miñano, Spain; NanoBioCel Group, Laboratory of Pharmaceutics, University of the Basque Country (UPV/EHU), School of Pharmacy, Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain
| | | | - Rosa Maria Hernandez
- NanoBioCel Group, Laboratory of Pharmaceutics, University of the Basque Country (UPV/EHU), School of Pharmacy, Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | - Manoli Igartua
- NanoBioCel Group, Laboratory of Pharmaceutics, University of the Basque Country (UPV/EHU), School of Pharmacy, Paseo de la Universidad 7, 01006 Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | - Silvia Villullas
- BioKeralty Research Institute AIE, Albert Einstein, 25-E3, 01510 Miñano, Spain.
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11
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Hawkins S, Ericson JE, Gavigan P. Opportunities for Antibiotic Reduction in Pediatric Patients With Urinary Tract Infection After Discharge From the Emergency Department. Pediatr Emerg Care 2023; 39:184-187. [PMID: 36728201 DOI: 10.1097/pec.0000000000002868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate how often antibiotics are adjusted by providers, specifically discontinued or de-escalated to a more narrow-spectrum agent, based on final culture and susceptibility results, when treating patients diagnosed with a urinary tract infection (UTI) in the pediatric emergency department (ED). METHODS This was a retrospective study of pediatric patients younger than 18 years who were discharged home from the ED with a diagnosis of UTI between January 1, 2018, and December 31, 2019. Patients were included if a urine culture was sent as part of their UTI workup and were excluded if they had been pretreated with antibiotics before the diagnosis. Discontinuation was considered possible if the urine culture had no or insignificant bacterial growth. De-escalation was defined as changing to a more narrow-spectrum antibiotic based on susceptibility testing. RESULTS Empiric antibiotics were prescribed in 131 of 136 UTI episodes. Cefdinir (39%) and cephalexin (36%) were most commonly prescribed, but agents and durations were inconsistent. Discontinuation occurred in only 4 of 52 possible episodes (8%), resulting in a median of 6 extra days of unnecessary antibiotics per episode. For 62 of the 78 cases (79%) with culture confirmation, the prescribed empiric antibiotic was active against the isolated pathogen. A narrower agent could have been used in 29 of 62 (47%) of these cases. However, de-escalation was never attempted. Lack of de-escalation in these episodes resulted in a median of 7 extra days of unnecessary broad-spectrum antibiotic exposure. CONCLUSIONS Inconsistent empiric antibiotics and inaccurate diagnosis result in excess antibiotic exposures for pediatric patients diagnosed with UTI. Postdischarge antimicrobial stewardship interventions are needed to reduce unnecessary antibiotic exposure in children.
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Affiliation(s)
| | - Jessica E Ericson
- Division of Pediatric Infectious Disease, Penn State Children's Hospital, Hershey, PA
| | - Patrick Gavigan
- Division of Pediatric Infectious Disease, Penn State Children's Hospital, Hershey, PA
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Badiger KB, Kamanna K, Hanumanthappa R, Devaraju KS, Giddaerappa G, Sannegowda LK. Synthesis, Antioxidant, and Electrochemical Behavior Studies of 2-Amino-4 H-Chromene Derivatives Catalyzed by WEOFPA: Green Protocol. Polycycl Aromat Compd 2023. [DOI: 10.1080/10406638.2023.2173620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- Krishnappa B. Badiger
- Peptide and Medicinal Chemistry Research Laboratory, Department of Chemistry, Rani Channamma University, Belagavi, India
| | - Kantharaju Kamanna
- Peptide and Medicinal Chemistry Research Laboratory, Department of Chemistry, Rani Channamma University, Belagavi, India
| | | | - K. S. Devaraju
- Department of Biochemistry, Karnatak University, Dharwad, India
| | - G. Giddaerappa
- Department of Studies in Chemistry, Vijayanagara Sri Krishnadevaraya University, Ballari, India
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13
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Chorafa E, Komatsiouli V, Iosifidis E, Kourti M, Sdougka M, Roilides E. Antimicrobial Stewardship Programs in PICU Settings: A Systematic Review. Pediatr Crit Care Med 2023; 24:e20-e27. [PMID: 36000864 DOI: 10.1097/pcc.0000000000003069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Development of antimicrobial stewardship programs (ASPs) is strategy for prevention and management of emergence of antimicrobial-resistant organisms. In this study, we systematically reviewed the literature on antimicrobial stewardship interventions in PICUs and analyzed approaches, structure, implementation, and outcomes of the ASPs. DATA SOURCES PubMed and Scopus databases were systematically searched for studies published from January 1, 2007, to December 31, 2020, reporting interventions on judicious use of antimicrobials in PICUs (last search performed February 28, 2021). DATA SELECTION Studies that evaluated an intervention in a PICU setting or both in PICU and other settings and reported separate results for PICU were eligible for full-text review. Studies that had implemented stewardship in the entire hospital, including the PICU, but without presenting dedicated PICU data were excluded from the analysis. DATA EXTRACTION The strategy of intervention, structure of ASP team, implementation, and outcomes were assessed with a checklist tool for all studies included in the analysis. Risk of bias was assessed with the Cochrane Risk-of-Bias in Nonrandomized studies of Interventions tool. DATA SYNTHESIS Thirteen articles were found: 11 that applied ASP in PICUs, and two at hospital level. All PICU-dedicated ASPs applied a multimodal intervention combining strategies simultaneously; audit with feedback (6/11) and facility-specific clinical practice guidelines (7/11) were the most common strategies. A multidisciplinary team was formulated in all ASPs except for three biomarker-based interventions. Six of 11 studies included techniques to enhance behavior change and one implemented a behavior-based intervention. Antibiotic consumption was evaluated in all ASPs, cost in three of 11, antibiotic resistance in one of 11, length of hospitalization in six of 11, and mortality in eight of 11. All hospital-wide ASPs used audit with feedback in addition to facility-specific clinical practice guidelines and assessed antimicrobial consumption, expenditures, length of stay, and mortality. CONCLUSIONS The prevalence of ASPs in PICUs is limited, and few programs follow all of the currently available recommendations.
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Affiliation(s)
- Elisavet Chorafa
- Infectious Diseases Unit, Third Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
| | - Vasiliki Komatsiouli
- Infectious Diseases Unit, Third Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
| | - Elias Iosifidis
- Infectious Diseases Unit, Third Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
| | - Maria Kourti
- Infectious Diseases Unit, Third Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
| | - Maria Sdougka
- Pediatric Intensive Care Unit, Hippokration General Hospital, Thessaloniki, Greece
| | - Emmanuel Roilides
- Infectious Diseases Unit, Third Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University and Hippokration General Hospital, Thessaloniki, Greece
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Differences in diagnosis, management, and outcomes of acute febrile illness by health facility level in southern Ethiopia. Sci Rep 2022; 12:19166. [PMID: 36357441 PMCID: PMC9649757 DOI: 10.1038/s41598-022-23641-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
We assessed the diagnosis, management and outcomes of acute febrile illness in a cohort of febrile children aged under 5 years presenting at one urban and two rural health centres and one tertiary hospital between 11 August 2019 and 01 November 2019. Pneumonia was diagnosed in 104 (30.8%) of 338 children at health centres and 128 (65.0%) of 197 at the hospital (p < 0.001). Malaria was detected in 33 (24.3%) of 136 children at the urban health centre, and in 55 (55.6%) of 99 and 7 (7.4%) of 95 children at the rural health centres compared to 11 (11.6%) of 95 at the hospital. Antibacterials were prescribed to 20 (11.5%) of 174 children without guidelines-specified indications (overprescribing) at health centres and in 7 (33.3%) of 21 children at the hospital (p = 0.013). Antimalarials were overprescribed to 13 (7.0%) of 185 children with negative malaria microscopy at the hospital. The fever resolved by day 7 in 326 (99.7%) of 327 children at health centres compared to 177 (93.2%) of 190 at the hospital (p < 0.001). These results suggest that additional guidance to health workers is needed to optimise the use of antimicrobials across all levels of health facilities.
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Krutyakov YA, Khina AG. Bacterial Resistance to Nanosilver: Molecular Mechanisms and Possible Ways to Overcome them. APPL BIOCHEM MICRO+ 2022. [DOI: 10.1134/s0003683822050106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Wilairatana P, Mala W, Masangkay FR, Kotepui KU, Kotepui M. The Prevalence of Malaria and Bacteremia Co-Infections among Febrile Patients: A Systematic Review and Meta-Analysis. Trop Med Infect Dis 2022; 7:tropicalmed7090243. [PMID: 36136654 PMCID: PMC9503679 DOI: 10.3390/tropicalmed7090243] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/03/2022] [Accepted: 09/09/2022] [Indexed: 12/02/2022] Open
Abstract
Comprehensive data on the relative contribution of bacteremia to malaria outcomes in a large number of participants are lacking. Therefore, we collated data on the co-existence of malaria and bacteremia in the literature to provide evidence-based information for future studies investigating the clinical significance of this co-infection. The study protocol was registered at PROSPERO (ID: CRD42021287971). Relevant studies were identified from PubMed, Web of Science, and Scopus. The pooled prevalence of (1) co-existent malaria and bacteremia among febrile patients, (2) the pooled prevalence of bacteremia among patients with malaria, (3) the probability of co-infection, and (4) the pooled prevalence of deaths were estimated by the random-effects model. Fifty-one studies involving 1583 cases of co-infection were included in the analyses. Typhoidal Salmonella spp. and Staphylococcus aureus were the most common Gram-negative and Gram-positive bacteria, respectively. The prevalence of co-existent malaria and bacteremia among febrile patients was 1.9% (95% confidence interval (CI) = 1.5–2.2%, I2 = 96.64%, 31 studies). The prevalence of bacteremia among patients with malaria was 7.6% (95% CI = 6.7–8.7%, and I2 = 96.68%, 43 studies). Co-infection by malaria and bacteremia did not occur by chance (p = 0.024, odds ratio = 0.64, 95% CI = 0.43–0.94, and I2 = 95.7%, 29 studies). The pooled prevalence of deaths among patients with co-infection was 15.0% (95% CI = 8.0–23.0%, I2 = 75.23%, 8 studies). On the basis of this study, we conclude that although the prevalence of co-infection was low, patients with malaria appear at greater risk of bacteremia and death.
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Affiliation(s)
- Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Wanida Mala
- Medical Technology, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
- Center of Excellence Research for Melioidosis and Microorganisms, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Frederick Ramirez Masangkay
- Department of Medical Technology, Institute of Arts and Sciences, Far Eastern University–Manila, Manila 1008, Philippines
| | - Kwuntida Uthaisar Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Manas Kotepui
- Medical Technology, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
- Correspondence: ; Tel.: +66-954392469
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Blanco MV, Hamdy RF, Liu CM, Jones H, Montalbano A, Nedved A. Antibiotic Prescribing Patterns for Pediatric Urgent Care Clinicians. Pediatr Emerg Care 2022; 38:e1538-e1540. [PMID: 35947062 DOI: 10.1097/pec.0000000000002809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous studies have reported high rates of inappropriate antibiotic prescriptions in urgent care (UC). Specific prescribing patterns for the most common diagnoses are not known. The aim of the study is to determine the diagnoses for which antibiotics are prescribed in pediatric UC settings. METHODS We recruited pediatric UC providers via email to participate in a national multisite quality improvement study. Participants completed a survey on 10 consecutive encounters in which an antibiotic was given between March and May 2018. Encounters in which only topical antibiotics were prescribed were excluded. We categorized the encounters into 3 previously established tiers to determine appropriateness of antibiotic use. The tiers represent a descending order for antibiotic need based on diagnoses, with the first tier representing diagnoses almost always requiring antibiotics and the third tier representing diagnoses when an antibiotic is almost never required. We reported the diagnoses and frequency of antibiotic prescription within each tier. RESULTS The 157 providers from 20 institutions submitted a total of 2809 encounters. We excluded 339 encounters in which only topical antibiotics were prescribed. Most diagnoses fell into the tier 2 category (85.81%), with only 9.12% in tier 1 and 5.06% in tier 3. The most common diagnoses reported were acute otitis media (48.96%), pharyngitis (25.09%), and skin and soft tissue infections (7.29%). CONCLUSIONS In this sample of pediatric UC encounters, only 5% of diagnoses receiving antibiotic prescriptions were made up of tier 3 diagnoses, determined to almost never require antibiotics. While viral respiratory infections have been reported to frequently be treated with antibiotics in general UC centers, our study of pediatric UC centers showed that this was infrequent. However, otitis media with effusion and otalgia should be further investigated. With most antibiotic prescriptions being tier 2 diagnoses, pediatric UC providers can use evidence-based prescribing practices, shared decision making, and contingency plans to reduce unnecessary antibiotic exposure.
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Affiliation(s)
| | | | - Cindy M Liu
- Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Heather Jones
- From the Department of Pediatrics, Children's Mercy Kansas City
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Bumbangi FN, Llarena AK, Skjerve E, Hang’ombe BM, Mpundu P, Mudenda S, Mutombo PB, Muma JB. Evidence of Community-Wide Spread of Multi-Drug Resistant Escherichia coli in Young Children in Lusaka and Ndola Districts, Zambia. Microorganisms 2022; 10:microorganisms10081684. [PMID: 36014101 PMCID: PMC9416312 DOI: 10.3390/microorganisms10081684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/02/2022] [Accepted: 08/17/2022] [Indexed: 12/23/2022] Open
Abstract
Increased antimicrobial resistance (AMR) has been reported for pathogenic and commensal Escherichia coli (E. coli), hampering the treatment, and increasing the burden of infectious diarrhoeal diseases in children in developing countries. This study focused on exploring the occurrence, patterns, and possible drivers of AMR E. coli isolated from children under-five years in Zambia. A hospital-based cross-sectional study was conducted in the Lusaka and Ndola districts. Rectal swabs were collected from 565 and 455 diarrhoeic and healthy children, respectively, from which 1020 E. coli were cultured and subjected to antibiotic susceptibility testing. Nearly all E. coli (96.9%) were resistant to at least one antimicrobial agent tested. Further, 700 isolates were Multi-Drug Resistant, 136 were possibly Extensively-Drug Resistant and nine were Pan-Drug-Resistant. Forty percent of the isolates were imipenem-resistant, mostly from healthy children. A questionnaire survey documented a complex pattern of associations between and within the subgroups of the levels of MDR and socio-demographic characteristics, antibiotic stewardship, and guardians’ knowledge of AMR. This study has revealed the severity of AMR in children and the need for a community-specific-risk-based approach to implementing measures to curb the problem.
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Affiliation(s)
- Flavien Nsoni Bumbangi
- School of Medicine, Eden University, Lusaka P.O. Box 37727, Zambia
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
- Correspondence: ; Tel.: +260-975911623
| | - Ann-Katrin Llarena
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, 1432 Ås, Norway
| | - Eystein Skjerve
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, 1432 Ås, Norway
| | - Bernard Mudenda Hang’ombe
- Department of Paraclinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
| | - Prudence Mpundu
- Department of Environmental and Occupational Health, Levy Mwanawasa Medical University, Lusaka P.O. Box 33991, Zambia
| | - Steward Mudenda
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Paulin Beya Mutombo
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa 834, Congo
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
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Diagnostic Stewardship—The Impact of Rapid Diagnostic Testing for Paediatric Respiratory Presentations in the Emergency Setting: A Systematic Review. CHILDREN 2022; 9:children9081226. [PMID: 36010116 PMCID: PMC9406643 DOI: 10.3390/children9081226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
Antimicrobial resistance is a growing public health crisis, propelled by inappropriate antibiotic prescription, in particular the over-prescription of antibiotics, prolonged duration of antibiotic therapy and the overuse of broad-spectrum antibiotics. The paediatric population, in particular, those presenting to emergency settings with respiratory symptoms, have been associated with a high rate of antibiotic prescription rates. Further research has now shown that many of these antibiotic prescriptions may have been avoided, with more targeted diagnostic methods to identify underlying aetiologies. The purpose of this systematic review was to assess the impact of rapid diagnostic testing, for paediatric respiratory presentations in the emergency setting, on antibiotic prescription rates. To review the relevant history, a comprehensive search of Medline, EMBASE and Cochrane Database of Systematic Reviews was performed. Eighteen studies were included in the review, and these studies assessed a variety of rapid diagnostic testing tools and outcome measures. Overall, rapid diagnostic testing was found to be an effective method of diagnostic antibiotic stewardship with great promise in improving antibiotic prescribing behaviours. Further studies are required to evaluate the use of rapid diagnostic testing with other methods of antibiotics stewardship, including clinical decisions aids and to increase the specificity of interventions following diagnosis to further reduce rates of antibiotic prescription.
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Mangal S, Arcia A, Carter E. Environmental Scan of Parent-Facing Health Information About Antibiotics in US Children's Hospital Websites. J Pediatric Infect Dis Soc 2022; 11:291-294. [PMID: 35230447 PMCID: PMC9214779 DOI: 10.1093/jpids/piac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 01/14/2022] [Indexed: 11/14/2022]
Abstract
Nearly half of free-standing children's hospital websites contain parent-facing resources about antibiotics. Most resources have information on safe antibiotic use, antibiotic resistance, and questions to ask clinicians. Accessibility can be improved by increasing readability, available languages, and multimedia. Future research should evaluate information accuracy, actionability, and comprehension with target audiences.
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Affiliation(s)
- Sabrina Mangal
- Columbia University School of Nursing, New York, New York, USA
| | - Adriana Arcia
- Columbia University School of Nursing, New York, New York, USA
| | - Eileen Carter
- Columbia University School of Nursing, New York, New York, USA
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Nguyen HQ, Nguyen THY, Thao HP, Nguyen LDT, Nguyen NTQ, Hsia Y. Effectiveness of an enhanced antibiotic stewardship programme amongst paediatric patients in a tertiary hospital in Vietnam. J Hosp Infect 2022; 127:121-128. [PMID: 35714830 DOI: 10.1016/j.jhin.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND In 2016, the Vietnamese Ministry of Health promoted development of antimicrobial stewardship for hospitals. AIM To evaluate the effectiveness and safety of the enhanced antibiotic stewardship programme (ASP) compared to the original ASP amongst paediatric patients at a tertiary hospital for infectious diseases in Vietnam. METHODS We conducted an interrupted time series analysis to examine antibiotic use in paediatric patients aged 0 to 17 years admitted to the Hospital for Tropical Diseases in Ho Chi Minh City from April 2016 to March 2020. Outcomes measured were defined daily doses (DDDs) per 1000 patient-days; antibiotic days of therapy (DOT) per 1000 patient-days; percentage of antibiotic use by the WHO Access, Watch, and Reserve (AWaRe) system; Access-to-Watch ratio; and worse clinical outcomes at discharge. FINDINGS Of 60,172 admissions during the study period, 28,019 received at least one antibiotic (46.6%) during hospital stay. The Watch antibiotics were the most commonly prescribed (78.1% of total antibiotic courses). The enhanced ASP did not improve antibiotic prescribing by DDDs per 1000 patient-days (RR: 1.05, 95%CI: 0.94-1.17) and DOT per 1000 patient-days (RR: 1.11, 95%CI: 0.99-1.25) compared to the original ASP. However, the percentage of Access antibiotics prescribed, and the Access-to-Watch ratio increased after the enhanced ASP (RR: 1.73, 95%CI: 1.38-2.17). There was no significant difference in worse clinical outcomes at discharge between the original and enhanced ASP (RR: 1.25, 95%CI: 0.78-2.00). CONCLUSION The enhanced ASP had modest impact on antibiotic consumption in paediatric population despite the improvement of Access antibiotic use and the Access-to-Watch ratio.
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Affiliation(s)
- Hoa Quoc Nguyen
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; School of Pharmacy, Queen's University Belfast, Belfast, United Kingdom.
| | - Thi Hai Yen Nguyen
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Huynh Phuong Thao
- Department of Pharmacy, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Le Dang Tu Nguyen
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nga Thi-Quynh Nguyen
- Faculty of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Yingfen Hsia
- School of Pharmacy, Queen's University Belfast, Belfast, United Kingdom; Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's University, London, United Kingdom
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La Vecchia A, Ippolito G, Taccani V, Gatti E, Bono P, Bettocchi S, Pinzani R, Tagliabue C, Bosis S, Marchisio P, Agostoni C. Epidemiology and antimicrobial susceptibility of Staphylococcus aureus in children in a tertiary care pediatric hospital in Milan, Italy, 2017-2021. Ital J Pediatr 2022; 48:67. [PMID: 35526042 PMCID: PMC9077633 DOI: 10.1186/s13052-022-01262-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent worldwide and can cause severe diseases. MRSA is associated with other antibiotic resistance. COVID-19 pandemic increased antimicrobial resistance in adult patients. Only a few data report the antimicrobial susceptibility of S. aureus in the Italian pediatric population, before and during the COVID-19 pandemic. Methods We included all the S. aureus positive samples with an available antibiogram isolated from pediatric patients (< 18 years old) in a tertiary care hospital in Milan, Italy, from January 2017 to December 2021. We collected data on demographics, antimicrobial susceptibility, and clinical history. We compared methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA strains. We calculated the frequency of isolation by year. The incidence of isolates during 2020 was compared with the average year isolation frequency using the univariate Poisson test. We compared the proportion of MRSA isolates during 2020 to the average proportion of other years with the Chi-squared test. Results Our dataset included a total of 255 S. aureus isolated from 226 patients, 120 (53%) males, and 106 (47%) females, with a median age of 3.4 years (IQR 0.8 – 10.5). The mean isolation frequency per year was 51. We observed a significant decrease of isolations during 2020 (p = 0.02), but after adjusting for the total number of hospitalization per year there was no evidence that the incidence changed. Seventy-six (30%) S. aureus were MRSA. Twenty (26%) MRSA vs 23 (13%) MSSA (p = 0.02) were hospital-acquired. MRSA strains showed higher resistance to cotrimoxazole, clindamycin, macrolides, levofloxacin, gentamicin, and tetracyclin than MSSA strains. None of MRSA were resistant to linezolid and vancomycin, one was resistant to daptomycin. The proportion of MRSA did not change during the COVID-19 pandemic. The overall clindamycin resistance was high (17%). Recent antibiotic therapy was related to MRSA infection. Conclusion The proportion of MRSA did not change during the COVID-19 pandemic and remained high. Clindamycin should not be used as an empirical MRSA treatment due to its high resistance.
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Affiliation(s)
| | | | | | | | - Patrizia Bono
- Laboratory of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Bettocchi
- Pediatric Emergency Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,De Marchi Foundation, Pediatric Area, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaella Pinzani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milan, Italy
| | - Claudia Tagliabue
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milan, Italy
| | - Samantha Bosis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milan, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Intermediate Care Unit, via Francesco Sforza 9, 20122, Milan, Italy. .,Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy.
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23
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Infection prevention requirements for the medical care of immunosuppressed patients: recommendations of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc07. [PMID: 35707229 PMCID: PMC9174886 DOI: 10.3205/dgkh000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In Germany, guidelines for hygiene in hospitals are given in form of recommendations by the Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, "KRINKO"). The KRINKO and its voluntary work are legitimized by the mandate according to § 23 of the Infection Protection Act (Infektionsschutzgesetz, "IfSG"). The original German version of this document was published in February 2021 and has now been made available to the international professional public in English. The guideline provides recommendations on infection prevention and control for immunocompromised individuals in health care facilities. This recommendation addresses not only measures related to direct medical care of immunocompromised patients, but also management aspects such as surveillance, screening, antibiotic stewardship, and technical/structural aspects such as patient rooms, air quality, and special measures during renovations.
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24
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Keij FM, Tramper-Stranders GA, Koch BCP, Reiss IKM, Muller AE, Kornelisse RF, Allegaert K. Pharmacokinetics of Clavulanic Acid in the Pediatric Population: A Systematic Literature Review. Clin Pharmacokinet 2022; 61:637-653. [PMID: 35355215 PMCID: PMC9095526 DOI: 10.1007/s40262-022-01116-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/24/2022]
Abstract
Background and Objective Clavulanic acid is a commonly used β-lactam inhibitor in pediatrics for a variety of infections. Clear insight into its mode of action is lacking, however, and a target has not been identified. The dosing of clavulanic acid is currently based on that of the partner drug (amoxicillin or ticarcillin). Still, proper dosing of the compound is needed because clavulanic acid has been associated with adverse effects. In this systematic review, we aim to describe the current literature on the pharmacokinetics of clavulanic acid in the pediatric population Methods We performed a systematic search in MEDLINE, Embase.com, Cochrane Central, Google Scholar, and Web of Science. We included all published studies reporting pharmacokinetic data on clavulanic acid in neonates and children 0–18 years of age. Results The search resulted in 18 original studies that met the inclusion criteria. In general, the variation in drug exposure was large, which can be partly explained by differences in disease state, route of administration, or age. Unfortunately, the studies’ limited background information hampered in-depth assessment of the observed variability. Conclusion The pharmacokinetics of clavulanic acid in pediatric patients is highly variable, similar to reports in adults, but more pronounced. Significant knowledge gaps remain with regard to the population-specific explanation for this variability. Model-based pharmacokinetic studies that address both maturational and disease-specific changes in the pediatric population are therefore needed. Furthermore, additional pharmacodynamic studies are needed to define a clear target. The combined outcomes will eventually lead to pharmacokinetic-pharmacodynamic modeling of clavulanic acid and targeted exposure. Clinical Trial Registration PROSPERO CRD42020137253. Supplementary Information The online version contains supplementary material available at 10.1007/s40262-022-01116-3.
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Affiliation(s)
- Fleur M Keij
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Doctor Molenwaterplein 40, 3015 CN, Rotterdam, The Netherlands. .,Department of Pediatrics, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands.
| | - Gerdien A Tramper-Stranders
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Doctor Molenwaterplein 40, 3015 CN, Rotterdam, The Netherlands.,Department of Pediatrics, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Doctor Molenwaterplein 40, 3015 CN, Rotterdam, The Netherlands
| | - Anouk E Muller
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Medical Microbiology, Haaglanden Medical Center, The Hague, The Netherlands
| | - René F Kornelisse
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Doctor Molenwaterplein 40, 3015 CN, Rotterdam, The Netherlands
| | - Karel Allegaert
- Department of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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25
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Levine G, Bielicki J, Fink G. Cumulative Antibiotic Exposure in the First Five Years of Life: Estimates for 45 Low- and Middle-income Countries from Demographic and Health Survey Data. Clin Infect Dis 2022; 75:1537-1547. [PMID: 35325088 DOI: 10.1093/cid/ciac225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Estimates of the total cumulative exposure to antibiotics of children in low-resource settings, and the source of these treatments, are limited. METHODS We estimated the average number of antibiotic treatments children received in the first five years of life in 45 low- and middle-income countries (LMICs) using Demographic and Health Survey (DHS) data. The two-week point prevalence of fever, diarrhea or cough and antibiotic treatment for these illnesses were estimated for ages 0-59 months and aggregated to estimate cumulative illness and antibiotic treatment for each country. We estimated treatment rates and contribution to total antibiotic use attributable to medical care, informal care, and self-medication. RESULTS Forty-five countries contributed 438,140 child-observations. The proportion of illness episodes treated with antibiotics ranged from 10% (95% CI: 9-12) (Niger) to 72% (95% CI: 69-75) (Jordan). A mean of 42·7% (95% CI: 42.1-43.3) of febrile and 32.9% of non-febrile illness (95% CI: 32.4-33.5) episodes received antibiotics. In their first five years, we estimate children received 18.5 antibiotics treatments on average (IQR: 11.6-24.6) in LMICs. Cumulative antibiotic exposure ranged from 3.7 treatments in Niger (95% CI: 2.8-4.6) to 38·6 treatments in DR Congo (95% CI: 34.7-42.4). A median of 9.0% of antibiotic treatment was attributable to informal care (IQR: 5.9-21.2), and 16.9% to self-medication (IQR: 9.5-26.2). CONCLUSIONS Childhood antibiotic exposure is high in some LMICs, with considerable variability. While access to antibiotics for children is still not universal, important opportunities for reducing excess use also exist, particularly with respect to the informal care sector and self-medication.
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Affiliation(s)
- Gillian Levine
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse, Allschwil, Switzerland.,University of Basel, Petersplatz, Basel, Switzerland
| | - Julia Bielicki
- Pediatric Infectious Disease Research Group, St George's University of London, Cranmer Terrace, Tooting, London, United Kingdom.,Infection Prevention and Control, University Children's Hospital, Basel, Spitalstrasse, Basel, Switzerland
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse, Allschwil, Switzerland.,University of Basel, Petersplatz, Basel, Switzerland
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26
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Mutagonda RF, Marealle AI, Nkinda L, Kibwana U, Maganda BA, Njiro BJ, Ndumwa HP, Kilonzi M, Mikomangwa WP, Mlyuka HJ, Felix FF, Myemba DT, Mwakawanga DL, Sambayi G, Kunambi PP, Ndayishimiye P, Sirili N, Mfaume R, Nshau A, Nyankesha E, Scherpbier R, Bwire GM. Determinants of misuse of antibiotics among parents of children attending clinics in regional referral hospitals in Tanzania. Sci Rep 2022; 12:4836. [PMID: 35318386 PMCID: PMC8941073 DOI: 10.1038/s41598-022-08895-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/14/2022] [Indexed: 01/10/2023] Open
Abstract
Parents are the important implementers on appropriate/inappropriate use of antibiotics, especially in the pediatric population. Limited studies have associated poor knowledge, attitude, and practice (KAP) among parents with antibiotics misuse. Therefore, this study was conducted to determine the parents' KAP and factors associated with inappropriate use of antibiotics among Tanzanian children. A hospital-based cross-sectional study was conducted in 14 regional referral hospitals (RRHs) in Tanzania between June and September 2020. KAP was estimated using a Likert scale, whereas KAP factors were determined using logistic regression models. A total of 2802 parents were enrolled in the study. The median age (interquartile range) of parents was 30.0 (25-36) years where 82.4% (n = 2305) were female parents. The majority of the parents had primary education, 56.1% (n = 1567). Of 2802 parents, only 10.9% (n = 298) had good knowledge about antibiotics, 16.4% (n = 455) had positive attitude whereas 82.0% (n = 2275) had poor practice on the appropriate use of antibiotics. Parents' education level, i.e., having a university degree (aOR: 3.27 95% CI 1.62-6.63, p = 0.001), good knowledge (aOR: 1.70, 95% CI 1.19-2.23, p = 0.003) and positive attitudes (aOR: 5.56, 95% CI 4.09-7.56, p < 0.001) were significantly associated with the appropriate use of antibiotics in children. Most parents had poor knowledge, negative attitude, and poor practice towards antibiotics use in children. Parents' education level, employment status, knowledge on antibiotic use, and good attitude contributed to the appropriate use of antibiotics in children attending clinics at RRHs.
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Affiliation(s)
- Ritah F Mutagonda
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Alphonce I Marealle
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Lilian Nkinda
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Upendo Kibwana
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Betty A Maganda
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Belinda J Njiro
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Harrieth P Ndumwa
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Wigilya P Mikomangwa
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Hamu J Mlyuka
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Fatuma F Felix
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - David T Myemba
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Dorkasi L Mwakawanga
- School of Nursing, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Godfrey Sambayi
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Peter P Kunambi
- School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | | | - Nathanael Sirili
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Rashid Mfaume
- Regional Administrative Secretary, Dar Es Salaam Region, P.O. Box 5429, Dar es Salaam, Tanzania
| | - Arapha Nshau
- Pharmacy Council, Ministry of Health, Community Development, Gender, Elderly and Children, P.O. Box 31818, Dar es Salaam, Tanzania
| | - Elevanie Nyankesha
- United Nations Children's Fund, New York Head Quarter, 3 United Nations Plaza, New York, NY, 10017, USA
| | - Robert Scherpbier
- United Nations Children's Fund, Bâtiment BIT, Route des Morillons 4, 1211, Geneva 22, Switzerland
| | - George M Bwire
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
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27
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Daniels J, Dixon EF, Gill A, Bishop J, D'Amico M, Ahmed K, Dodds J, Tryposkiadis K, Wilks M, Millar M, Husain S, Gray J, Whiley A, Moore PV, Munetsi RL, Hemming K, Roberts T, Plumb J, Deeks J, Khan KS, Thangaratinam S. A rapid intrapartum test for group B Streptococcus to reduce antibiotic usage in mothers with risk factors: the GBS2 cluster RCT. Health Technol Assess 2022; 26:1-82. [PMID: 35195519 DOI: 10.3310/bicf1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mother-to-baby transmission of group B Streptococcus (Streptococcus agalactiae) is the main cause of early-onset infection. OBJECTIVES We investigated if intrapartum antibiotic prophylaxis directed by a rapid intrapartum test reduces maternal and neonatal antibiotic use, compared with usual care (i.e. risk factor-directed antibiotics), among women with risk factors for vertical group B Streptococcus transmission, and examined the accuracy and cost-effectiveness of the rapid test. DESIGN An unblinded cluster randomised controlled trial with a nested test accuracy study, an economic evaluation and a microbiology substudy. SETTING UK maternity units were randomised to either a strategy of rapid test or usual care. PARTICIPANTS Vaginal and rectal swabs were taken from women with risk factors for vertical group B Streptococcus transmission in established term labour. The accuracy of the GeneXpert® Dx IV GBS rapid testing system (Cepheid, Maurens-Scopont, France) was compared with the standard of selective enrichment culture in diagnosing maternal group B Streptococcus colonisation. MAIN OUTCOME MEASURES Primary outcomes were rates of intrapartum antibiotic prophylaxis administered to prevent early-onset group B Streptococcus infection and accuracy estimates of the rapid test. Secondary outcomes were maternal antibiotics for any indication, neonatal antibiotic exposure, maternal antibiotic duration, neonatal group B Streptococcus colonisation, maternal and neonatal antibiotic resistance, neonatal morbidity and mortality, and cost-effectiveness of the strategies. RESULTS Twenty-two maternity units were randomised and 20 were recruited. A total of 722 mothers (749 babies) participated in rapid test units and 906 mothers (951 babies) participated in usual-care units. There were no differences in the rates of intrapartum antibiotic prophylaxis for preventing early-onset group B Streptococcus infection in the rapid test units (41%, 297/716) compared with the usual-care units (36%, 328/906) (risk ratio 1.16, 95% confidence interval 0.83 to 1.64). There were no differences between the groups in intrapartum antibiotic administration for any indication (risk ratio 0.99, 95% confidence interval 0.81 to 1.21). Babies born in the rapid test units were 29% less likely to receive antibiotics (risk ratio 0.71, 95% confidence interval 0.54 to 0.95) than those born in usual-care units. The sensitivity and specificity of the rapid test were 86% (95% confidence interval 81% to 91%) and 89% (95% confidence interval 85% to 92%), respectively. In 14% of women (99/710), the rapid test was invalid or the machine failed to provide a result. In the economic analysis, the rapid test was shown to be both less effective and more costly and, therefore, dominated by usual care. Sensitivity analysis indicated potential lower costs for the rapid test strategy when neonatal costs were included. No serious adverse events were reported. CONCLUSIONS The Group B Streptococcus 2 (GBS2) trial found no evidence that the rapid test reduces the rates of intrapartum antibiotic prophylaxis administered to prevent early-onset group B Streptococcus infection. The rapid test has the potential to reduce neonatal exposure to antibiotics, but economically is dominated by usual care. The accuracy of the test is within acceptable limits. FUTURE WORK The role of routine testing for prevention of neonatal infection requires evaluation in a randomised controlled trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN74746075. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jane Daniels
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emily F Dixon
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alicia Gill
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jon Bishop
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Maria D'Amico
- Centre for Women's Health, Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Khaled Ahmed
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Julie Dodds
- Centre for Women's Health, Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kostas Tryposkiadis
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Mark Wilks
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Michael Millar
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Shahid Husain
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jim Gray
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angela Whiley
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Patrick V Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ruvimbo L Munetsi
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tracy Roberts
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jane Plumb
- Group B Strep Support, Haywards Heath, UK
| | - Jonathan Deeks
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Khalid S Khan
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Shakila Thangaratinam
- Institute of Metabolism and System Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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28
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Izmalkova TY, Sazonova OI, Dymova EA, Sokolov SL, Gafarov AB. Playgrounds in City of Pushchino with Different Types of Coating as Reservoir of Antibiotic-Resistant Strains of Pseudomonas spp. Curr Microbiol 2022; 79:80. [PMID: 35103849 DOI: 10.1007/s00284-022-02768-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/11/2022] [Indexed: 12/19/2022]
Abstract
In this study, we investigated antibiotic-resistant microorganisms isolated by the direct plating method from 6 playgrounds in the city of Pushchino, Moscow Region, with different types of coating: sand, soil with sand, grass and a modern playground coating made of pressed rubber crumb. According to the results of the study, sand is the cleanest type of coating, both in terms of the total count of cultivated microorganisms (8 × 105/g of substrate) and in terms of the content of resistant strains. The most contaminated both in terms of the total count of cultivated microorganisms (1.2-1.9 × 109/g of substrate) and in terms of the content of antibiotic-resistant strains was the coating of pressed rubber crumb. We isolated 65 antibiotic-resistant strains of fluorescent pseudomonads. Nine Pseudomonas strains were found to contain antibiotic resistance plasmids (one belongs to P-1 incompatibility group, seven to IncP-7 and one to unidentified incompatibility group). For the first time, we discovered a conjugative plasmid pD4A-46 conferring tetracycline resistance and belonging to the P-7 incompatibility group. Taking into account the results obtained under this study, it can be recommended to periodically treat the crumb rubber coating with non-toxic antiseptics, i.e. hydrogen peroxide or chlorhexidine.
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Affiliation(s)
- Tatiana Yu Izmalkova
- G.K. Skryabin Institute of Biochemistry and Physiology of Microorganisms, Federal Research Center "Pushchino Center for Biological Research of the Russian Academy of Sciences", pr. Nauki, 5, Pushchino, Moscow Region, Russian Federation, 142290.
| | - Olesya I Sazonova
- G.K. Skryabin Institute of Biochemistry and Physiology of Microorganisms, Federal Research Center "Pushchino Center for Biological Research of the Russian Academy of Sciences", pr. Nauki, 5, Pushchino, Moscow Region, Russian Federation, 142290
| | - Ekaterina A Dymova
- G.K. Skryabin Institute of Biochemistry and Physiology of Microorganisms, Federal Research Center "Pushchino Center for Biological Research of the Russian Academy of Sciences", pr. Nauki, 5, Pushchino, Moscow Region, Russian Federation, 142290
| | - Sergei L Sokolov
- G.K. Skryabin Institute of Biochemistry and Physiology of Microorganisms, Federal Research Center "Pushchino Center for Biological Research of the Russian Academy of Sciences", pr. Nauki, 5, Pushchino, Moscow Region, Russian Federation, 142290
| | - Arslan B Gafarov
- G.K. Skryabin Institute of Biochemistry and Physiology of Microorganisms, Federal Research Center "Pushchino Center for Biological Research of the Russian Academy of Sciences", pr. Nauki, 5, Pushchino, Moscow Region, Russian Federation, 142290
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29
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Extending the Reach of Antimicrobial Stewardship to Pediatric Patients. Infect Dis Ther 2022; 11:101-110. [PMID: 35072918 PMCID: PMC8847632 DOI: 10.1007/s40121-022-00590-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/10/2022] [Indexed: 11/05/2022] Open
Abstract
Guidance for developing and implementing antimicrobial stewardship programs for children is lacking. This review article describes unique considerations for planning antimicrobial management of children that may impact stewardship strategies. A variety of methods and training tools are described along with metrics specific to measuring antibiotic use and outcomes in children. Handshake stewardship is specifically explained and is considered a best practice. Information on stewardship in unique settings, including the neonatal intensive care unit and outpatient settings, are included.
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30
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Chan YQ, Chen K, Chua GT, Wu P, Tung KTS, Tsang HW, Lung D, Ip P, Chui CSL. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac036. [PMID: 35449720 PMCID: PMC9018396 DOI: 10.1093/jacamr/dlac036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/13/2022] [Indexed: 11/12/2022] Open
Abstract
Background Objectives Methods Results Conclusions
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Affiliation(s)
- Yi Qi Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kailin Chen
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong, China
| | - Gilbert T. Chua
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Peng Wu
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Keith T. S. Tung
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hing Wai Tsang
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - David Lung
- Department of Pathology, Hong Kong Children’s Hospital, Hong Kong, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Celine S. L. Chui
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Corresponding author. E-mail:
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Mwansa TN, Kamvuma K, Mulemena JA, Phiri CN, Chanda W. Antibiotic susceptibility patterns of pathogens isolated from laboratory specimens at Livingstone Central Hospital in Zambia. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000623. [PMID: 36962542 PMCID: PMC10022373 DOI: 10.1371/journal.pgph.0000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multidrug resistance (MDR) is a global problem that require multifaceted effort to curb it. This study aimed to evaluate the antibiotic susceptibility patterns of routinely isolated bacteria at Livingstone Central Hospital (LCH). METHODS A retrospective study was performed on all isolated organisms from patient specimens that were processed from January 2019 to December 2021. Specimens were cultured on standard media and Kirby-Bauer disc diffusion method was employed for susceptibility testing following the Clinical and Laboratory Standard Institute's recommendations. RESULTS A total of 765 specimens were processed and only 500 (65.4%) met the inclusion criteria. Of the 500, 291(58.2%) specimens were received from female and from the age-group 17-39 years (253, 50.6%) and 40-80 years (145, 29%) in form of blood (331, 66.2%), urine (165, 33%) and sputum (4, 0.8%). Amongst the bacterial isolates, Staphylococcus aureus (142, 28.4%) was the commonest followed by Escherichia coli (91, 18.2%), and Enterobacter agglomerans (76, 15.2%), and Klebsiella pneumoniae (43, 8.6%). The resistance pattern revealed ampicillin (93%) as the least effective drug followed by oxacillin (88%), penicillin (85.6%), co-trimoxazole (81.5%), erythromycin (71.9%), nalidixic acid (68%), and ceftazidime (60%) whereas the most effective antibiotics were imipenem (14.5%), and piperacillin/tazobactam (16.7%). The screening of methicillin resistant Staphylococcus aureus (MRSA) with cefoxitin showed 23.7% (9/38) resistance. CONCLUSION Increased levels of MDR strains and rising numbers of MRSA strains were detected. Therefore, re-establishing of the empiric therapy is needed for proper patient management, studies to determine the levels of extended spectrum beta lactamase- and carbapenemase-producing bacteria are warranted.
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Affiliation(s)
- Thresa N Mwansa
- Department of Pathology and Microbiology, Mulungushi University School of Medicine and Health Sciences, Livingstone, Zambia
| | - Kingsley Kamvuma
- Department of Pathology and Microbiology, Mulungushi University School of Medicine and Health Sciences, Livingstone, Zambia
| | - John Amos Mulemena
- Department of Pathology and Microbiology, Mulungushi University School of Medicine and Health Sciences, Livingstone, Zambia
| | - Christopher Newton Phiri
- Department of Pathology and Microbiology, Mulungushi University School of Medicine and Health Sciences, Livingstone, Zambia
| | - Warren Chanda
- Department of Pathology and Microbiology, Mulungushi University School of Medicine and Health Sciences, Livingstone, Zambia
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Buonsenso D, Pata D, Fiori B, Sanguinetti M, Acampora A, Ferrari V, Albano R, Spanu T, Valentini P. Escherichia coli resistance patterns, empiric and targeted antibiotic prescriptions in children: a single center experience. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022214. [PMID: 36300243 PMCID: PMC9686184 DOI: 10.23750/abm.v93i5.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/23/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIM Antibiotic resistance represents one of the major public health issues, due to the potential future ineffectiveness of available antibiotics. However, epidemiological studies on E. coli antibiotic resistance patterns in the pediatric population are limited. METHODS We conducted a retrospective analysis on children younger than 18 years of age admitted to the Department of Pediatrics from April 2016 to April 2018 with E. coli isolation on biological materials. RESULTS 205 subjects were included in the study (mean age 1.6 years). We found an overall low rate of resistance of E. coli isolates to Amoxicil-lin/Clavulanate (20%), Cephalosporins (6.3%) and Aminoglycosides (6.3%), while no isolates were resistant to Carbapenems. Presence of invasive devices and intensive care admissions were as-sociated with resistance to Cephalosporines (P < 0.001; OR 9.21, 95% CI 2.7 - 31.39) and Amino-glycosides (P < 0.004; OR 5.42, 95% CI 1.71 - 17.15), while no factors associated with resistance to the other antibiotics were found. CONCLUSIONS Aminoglycosides and Cephalosporins were frequently used as empiric therapy, whereas targeted therapies aimed at sparing these classes of antibiotics once antibiograms were available have not always been established. These data may inform local antimicrobial stewardship and guide the development of programs aiming at a better use of antibiotics.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy , Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy, Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Davide Pata
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Barbara Fiori
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anna Acampora
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Vittoria Ferrari
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rossana Albano
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Teresa Spanu
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy, Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Egle L, Sauter K, Ockfen S, Haber M, Becker S, Wagenpfeil G, Zemlin M, Meyer S, Simon A. Retrospective audit of antibiotic use in a university general pediatrics department using hospital pharmacy dispensing data. GMS INFECTIOUS DISEASES 2021; 9:Doc06. [PMID: 34956817 PMCID: PMC8662896 DOI: 10.3205/id000075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Antibiotics are among the most frequently prescribed drugs in children's hospitals, which is why regular monitoring of antibiotic use in hospitals is of great importance. This retrospective audit (60 months, January 2014 - December 2018) analyzes the antibiotic consumption at a university inpatient department of general pediatrics including neonatal and pediatric intensive care based on pharmacy dispensing data in units of grams per 100 patient days and in Defined Daily Doses per 100 patient days. The results provide potential targets for Antibiotic Stewardship interventions. Conversely, this audit elicits methodological limitations of the method of antibiotic surveillance in pediatrics recommended by the Robert Koch Institute, Berlin.
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Affiliation(s)
- Leonie Egle
- Pediatric Hematology and Oncology, Children’s Hospital Medical Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Katharina Sauter
- Pediatric Hematology and Oncology, Children’s Hospital Medical Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Svenja Ockfen
- Pediatric Hematology and Oncology, Children’s Hospital Medical Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Manfred Haber
- Pharmacy, Saarland University Hospital, Homburg/Saar, Germany
| | - Sören Becker
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University Hospital, Homburg/Saar, Germany
| | - Gudrun Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, University Medical Center, Saarland University, Campus Homburg, Homburg, Germany
| | - Michael Zemlin
- Department Clinic for General Pediatrics and Neonatology, Children’s Hospital Medical Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Sascha Meyer
- Department Clinic for General Pediatrics and Neonatology, Children’s Hospital Medical Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Arne Simon
- Pediatric Hematology and Oncology, Children’s Hospital Medical Center, Saarland University Hospital, Homburg/Saar, Germany,*To whom correspondence should be addressed: Arne Simon, Pediatric Oncology and Hematology, Children’s Hospital Medical Center, Saarland University Hospital, Kirrberger Str. Building 09, 66424 Homburg/Saar, Germany, Phone: +49 6841 1628409, Fax: +49 6841 1628424, E-mail:
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Wu Y, Chen S, Li J, Cai C, Wang H, Zhou M, Cao J, Wang Q, Wu S, Ding S, Zhao X, Sun L, Hu Q, Zhou H, Qian X, Yang Q, Chen S, Zhang R. Surveillance of Multidrug-Resistant Bacterial Infections in Non-Adult Patients - Zhejiang Province, China, 2014-2019. China CDC Wkly 2021; 3:1005-1013. [PMID: 34888116 PMCID: PMC8633553 DOI: 10.46234/ccdcw2021.244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Antimicrobial resistance has become a major public health threat globally. The prevalence of multidrug-resistant (MDR) bacterial infections increased substantially among inpatients under 18 years of age in recent years. In Zhejiang Province, China, the trends of drug-resistance in non-adult patients from 2014 to 2019 were monitored, aiming to determine the variation patterns and epidemiological features of MDR strains. Methods Patient data were collected from the Annual Review of Hospital Infection Resistance Survey in Zhejiang Province, 2014–2019. Statistical analysis was performed to analyze the pattern of distribution of five key bacterial pathogens in different age groups, ward settings, and bloodstream infections. Results From 2014 to 2019, a total of 30,163 multidrug-resistant strains were identified among 212,252 clinical isolates. The prevalence of extended spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa (CRPA), and methicillin-resistant Staphylococcus aureus (MRSA) were 40.6%, 2.3%, 14.7%, 9.0%, and 27.4%, respectively. The prevalence of these key pathogens was lower than that reported in the national surveillance system (China Antimicrobial Resistance Surveillance System and Infectious Diseases Surveillance of Pediatrics). The prevalence of ESBL-E and CRE decreased since 2015 but that of CRPA and MRSA increased from 2014 to 2018.
Conclusions Despite an overall decrease in the prevalence of drug-resistant bacteria in 2019, the rising prevalence of MRSA and CRPA still warrant much attention. Multidrug-resistant bacteria prevention and control strategies should be adjusted in a timely manner based on the surveillance results.
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Affiliation(s)
- Yuchen Wu
- Department of Clinical Laboratory, the Second Affiliated Hospital of Zhejiang University, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shi Chen
- Clinical Microbiology Laboratory, the Third People's Hospital of Hangzhou, Hangzhou, Zhejiang, China
| | - Jiaping Li
- Department of Clinical Laboratory, the Second Affiliated Hospital of Zhejiang University, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chang Cai
- China Australia Joint Laboratory for Animal Health Big Data Analytics, College of Animal Science and Technology, Zhejiang Agricultural and Forestry University, Hangzhou, Zhejiang, China
| | - Hanyu Wang
- Master of Science, New Jersey Institute of Technology, Newark, New Jersey, the United States of America
| | - Mingming Zhou
- National Clinical Research Center for Child Health, the Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Junmin Cao
- Department of Hospital Infection Control, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Qiang Wang
- Department of Clinical Laboratory, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shenghai Wu
- Department of Laboratory Medicine, the First Affiliated People's Hospital of Hangzhou, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shibiao Ding
- Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Xiaofei Zhao
- Department of Clinical Laboratory, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Long Sun
- Department of Clinical Laboratory, Hangzhou Women's Hospital, Hangzhou Maternity and Child Health Care Hospital, Hangzhou, Zhejiang, China
| | - Qingfeng Hu
- Clinical Diagnostic Laboratory, People's Hospital of Zhejiang, Hangzhou, Zhejiang, China
| | - Hongwei Zhou
- Department of Clinical Laboratory, the Second Affiliated Hospital of Zhejiang University, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiang Qian
- Department of Clinical Laboratory, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Qing Yang
- The First Affiliated Hospital of Zhejiang University, Zhejiang University, Hangzhou, Zhejiang, China
| | - Sheng Chen
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Rong Zhang
- Department of Clinical Laboratory, the Second Affiliated Hospital of Zhejiang University, Zhejiang University, Hangzhou, Zhejiang, China
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Paediatric Antimicrobial Stewardship for Respiratory Infections in the Emergency Setting: A Systematic Review. Antibiotics (Basel) 2021; 10:antibiotics10111366. [PMID: 34827304 PMCID: PMC8615165 DOI: 10.3390/antibiotics10111366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022] Open
Abstract
Antimicrobial resistance occurs due to the propensity of microbial pathogens to develop resistance to antibiotics over time. Antimicrobial stewardship programs (ASPs) have been developed in response to this growing crisis, to limit unnecessary antibiotic prescription through initiatives such as education-based seminars, prescribing guidelines, and rapid respiratory pathogen (RRP) testing. Paediatric patients who present to the emergency setting with respiratory symptoms are a particularly high-risk population susceptible to inappropriate antibiotic prescribing behaviours and are therefore an ideal cohort for focused ASPs. The purpose of this systematic review was to assess the efficacy and safety of ASPs in this clinical context. A systematic search of PubMed, Medline, EMBASE and the Cochrane Database of Systematic Reviews was conducted to review the current evidence. Thirteen studies were included in the review and these studies assessed a range of stewardship interventions and outcome measures. Overall, ASPs reduced the rates of antibiotic prescription, increased the prescription of narrow-spectrum antibiotics, and shortened the duration of antibiotic therapy. Multimodal interventions that were education-based and those that used RRP testing were found to be the most effective. Whilst we found strong evidence that ASPs are effective in reducing antibiotic prescribing, further studies are required to assess whether they translate to equivalent clinical outcomes.
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36
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Willis ZI, de St Maurice A. A Piece of the Puzzle: The Role of Molecular Testing in Antimicrobial Stewardship. J Pediatric Infect Dis Soc 2021; 10:930-935. [PMID: 34129044 DOI: 10.1093/jpids/piab037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/30/2021] [Indexed: 11/14/2022]
Abstract
Molecular testing may have an important role in expediting the diagnosis of infectious diseases. Pediatric infectious diseases specialists need to be cognizant of the strengths and limitations of these existing and emerging technologies in order to ensure that they are used and interpreted appropriately.
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Affiliation(s)
- Zachary I Willis
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Annabelle de St Maurice
- Division of Infectious Diseases, Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA
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37
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Pereira-Dias J, Nguyen Ngoc Minh C, Tran Thi Hong C, Nguyen Thi Nguyen T, Ha Thanh T, Zellmer C, Chung The H, Pike L, Higginson EE, Baker S. The gut microbiome of healthy Vietnamese adults and children is a major reservoir for resistance genes against critical antimicrobials. J Infect Dis 2021; 224:S840-S847. [PMID: 34374428 PMCID: PMC8687120 DOI: 10.1093/infdis/jiab398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Antimicrobials are a key group of therapeutic agents. Given the animal/human population density and high antimicrobial consumption rate in Southeast Asia, the region is a focal area for monitoring antimicrobial resistance (AMR). Hypothesizing that the gastrointestinal tract of healthy individuals in Vietnam is a major source of AMR genes that may be transferred to pathogens, we performed shotgun metagenomic sequencing on fecal samples from 42 healthy Vietnamese people (21 children and 21 adults). We compared their microbiome profiles by age group and determined the composition of AMR genes. An analysis of the taxonomic profiles in the gut microbiome showed a clear differentiation by age, with young children (age <2 years) exhibiting a unique structure in comparison to adults and older children. We identified a total of 132 unique AMR genes, with macrolide, lincosamide, and streptogramin class resistance genes (ermB and lnuC) and tetracycline resistance genes being almost ubiquitous across the study population. Notably, samples from younger children were significantly associated with a greater number of AMR genes than other age groups, including key signature genes associated with AMR pathogens (eg, blaCTX-M, mphA). Our data suggest that the gut microbiome of those living in Vietnam, particularly young children, is a substantial reservoir of AMR genes, which can be transferred to circulating enteric pathogens. Our data support the generation of longitudinal cohort studies of those living in urban and rural areas of developing countries to understand the behavior of these AMR reservoirs and their role in generating multidrug-resistant and extensively drug-resistant pathogens.
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Affiliation(s)
- Joana Pereira-Dias
- University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom.,Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | | | | | | | - Tuyen Ha Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Caroline Zellmer
- University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom.,Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Hao Chung The
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Lindsay Pike
- The Wellcome Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - Ellen E Higginson
- University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Stephen Baker
- University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom.,Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
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38
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Spaulding AB, Watson D, Dreyfus J, Heaton P, Koutsari C, Kharbanda AB. Associations of Antimicrobial-Resistant Gram-Negative Bloodstream Infections with Outcomes among Hospitalized Pediatric Patients in the United States. J PEDIAT INF DIS-GER 2021. [DOI: 10.1055/s-0041-1731643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Objective The aim of this study was to assess the impact of pediatric antimicrobial-resistant gram-negative bloodstream infections (GNBSIs).
Methods A retrospective cohort study (2009–2016) was conducted using the Premier Healthcare Database among pediatric admissions with GNBSIs at hospitals reporting microbiology data. Infections for neonates and nonneonates were classified as multidrug resistance (MDR), resistant to one or two antibiotic drug classes (1–2DR), or susceptible.
Results Among 1,276 GNBSIs, 266 (20.8%) infections were 1–2DR and 23 (1.8%) MDR. Compared with susceptible GNBSIs, MDR nonneonates had higher mortality and higher costs, whereas 1–2DR neonates had longer stays and higher costs.
Conclusions Antimicrobial-resistant GNBSIs were associated with worse outcomes among pediatric hospitalized patients.
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Affiliation(s)
| | - David Watson
- Children's Minnesota Research Institute, Minneapolis, Minnesota, United States
| | | | - Phillip Heaton
- Children's Minnesota Research Institute, Minneapolis, Minnesota, United States
| | - Christina Koutsari
- Antimicrobial Stewardship Program, Children's Minnesota, Minneapolis, Minnesota, United States
| | - Anupam B. Kharbanda
- Pediatric Emergency Medicine, Chief of Critical Care Services, Children's Minnesota, Minneapolis, Minnesota, United States
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Ang JY, Arrieta A, Bradley JS, Zhang Z, Yu B, Rizk ML, Johnson MG, Rhee EG. Ceftolozane/Tazobactam in Neonates and Young Infants: The Challenges of Collecting Pharmacokinetics and Safety Data in This Vulnerable Patient Population. Am J Perinatol 2021; 38:804-809. [PMID: 31910460 DOI: 10.1055/s-0039-3402719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE New treatments are needed for multidrug-resistant (MDR) gram-negative infections in neonates. Ceftolozane/tazobactam is a β-lactam/β-lactamase inhibitor combination that has broad-spectrum activity against most common gram-negative bacteria, including MDR strains. We evaluated pharmacokinetics (PK) and safety of ceftolozane/tazobactam in term and premature neonates and young infants. STUDY DESIGN This is a subgroup analysis of a phase 1, noncomparative, open-label, multicenter study that characterized the PK, safety, and tolerability of a single intravenous (IV) dose of ceftolozane/tazobactam in pediatric patients with proven/suspected gram-negative infection or receiving perioperative prophylaxis. RESULTS Seven patients were enrolled in Group A (birth [7 days postnatal] to < 3 months, > 32 weeks gestation) and six patients were enrolled in Group B (birth [7 days postnatal] to < 3 months, ≤ 32 weeks gestation). PK profiles in neonates and young infants were generally comparable to those of older children receiving a single IV dose of ceftolozane/tazobactam. No serious adverse events (AEs), treatment-related AEs, severe AEs, or clinically significant laboratory abnormalities were reported. CONCLUSION Among term and premature neonates and young infants, PK was comparable to older children and ceftolozane/tazobactam was generally well tolerated. An adaptable and flexible study design is necessary for enrollment in neonatal PK trials.
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Affiliation(s)
- Jocelyn Y Ang
- Division of Infectious Diseases, Children's Hospital of Michigan, Detroit, Michigan.,Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Antonio Arrieta
- Division of Pediatric Infectious Disease, Children's Hospital of Orange County, Orange, California
| | - John S Bradley
- Division of Infectious Disease, Rady Children's Hospital, San Diego, California.,Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California
| | | | - Brian Yu
- Merck & Co., Inc., Kenilworth, New Jersey
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40
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Guo S, Sun Q, Zhao X, Shen L, Zhen X. Prevalence and risk factors for antibiotic utilization in Chinese children. BMC Pediatr 2021; 21:255. [PMID: 34074254 PMCID: PMC8168021 DOI: 10.1186/s12887-021-02706-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Antibiotic resistance poses a significant threat to public health globally. Irrational utilization of antibiotics being one of the main reasons of antibiotic resistant. Children as a special group, there's more chance of getting infected. Although most of the infection is viral in etiology, antibiotics still are the most frequently prescribed medications for children. Therefore, high use of antibiotics among children raises concern about the appropriateness of antibiotic prescribing. This systematic review aims to measuring prevalence and risk factors for antibiotic utilization in children in China. METHODS English and Chinese databases were searched to identify relevant studies evaluating the prevalence and risk factors for antibiotic utilization in Chinese children (0-18 years), which were published between 2010 and July 2020. A Meta-analysis of prevalence was performed using random effect model. The Agency for Healthcare Research and Quality (AHRQ) and modified Jadad score was used to assess risk of bias of studies. In addition, we explored the risk factors of antibiotic utilization in Chinese children using qualitative analysis. RESULTS Of 10,075 studies identified, 98 eligible studies were included after excluded duplicated studies. A total of 79 studies reported prevalence and 42 studies reported risk factors for antibiotic utilization in children. The overall prevalence of antibiotic utilization among outpatients and inpatients were 63.8% (35 studies, 95% confidence interval (CI): 55.1-72.4%), and 81.3% (41 studies, 95% CI: 77.3-85.2%), respectively. In addition, the overall prevalence of caregiver's self-medicating of antibiotics for children at home was 37.8% (4 studies, 95% CI: 7.9-67.6%). The high prevalence of antibiotics was associated with multiple factors, while lacking of skills and knowledge in both physicians and caregivers was the most recognized risk factor, caregivers put pressure on physicians to get antibiotics and self-medicating with antibiotics at home for children also were the main factors attributed to this issue. CONCLUSION The prevalence of antibiotic utilization in Chinese children is heavy both in hospitals and home. It is important for government to develop more effective strategies to improve the irrational use of antibiotic, especially in rural setting.
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Affiliation(s)
- Shasha Guo
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Qiang Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Xinyang Zhao
- School of Nursing, China Medical University, Shenyang, 110100, China
| | - Liyan Shen
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Xuemei Zhen
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China.
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41
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Gerber JS, Jackson MA, Tamma PD, Zaoutis TE. Policy Statement: Antibiotic Stewardship in Pediatrics. J Pediatric Infect Dis Soc 2021; 10:641-649. [PMID: 33595086 DOI: 10.1093/jpids/piab002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/04/2021] [Indexed: 11/15/2022]
Abstract
Antibiotic overuse contributes to antibiotic resistance, which is a threat to public health. Antibiotic stewardship is a practice dedicated to prescribing antibiotics only when necessary and, when antibiotics are considered necessary, promoting the use of the appropriate agent(s), dose, duration, and route of therapy to optimize clinical outcomes while minimizing the unintended consequences of antibiotic use. Because there are differences in common infectious conditions, drug-specific considerations, and the evidence surrounding treatment recommendations (eg, first-line therapy and duration of therapy) between children and adults, this statement provides specific guidance for the pediatric population. This policy statement discusses the rationale for inpatient and outpatient antibiotic stewardship programs (ASPs); essential personnel, infrastructure, and activities required; approaches to evaluating their effectiveness; and gaps in knowledge that require further investigation. Key guidance for both inpatient and outpatient ASPs are provided.
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Affiliation(s)
- Jeffrey S Gerber
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mary Anne Jackson
- Department of Pediatrics, Section of Infectious Disease, Children's Mercy Hospital, UMKC School of Medicine, Kansas City, Missouri, USA
| | - Pranita D Tamma
- Department of Pediatrics, Division of Pediatric Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Theoklis E Zaoutis
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Javaid N, Sultana Q, Rasool K, Gandra S, Ahmad F, Chaudhary SU, Mirza S. Trends in antimicrobial resistance amongst pathogens isolated from blood and cerebrospinal fluid cultures in Pakistan (2011-2015): A retrospective cross-sectional study. PLoS One 2021; 16:e0250226. [PMID: 33901205 PMCID: PMC8075205 DOI: 10.1371/journal.pone.0250226] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/02/2021] [Indexed: 12/29/2022] Open
Abstract
While antimicrobial resistance (AMR) continues to be a major public health problem in Pakistan, data regarding trends of resistance among pathogenic bacteria remains scarce, with few studies presenting long-term trends in AMR. This study was therefore designed to analyze long-term AMR trends at a national level in Pakistan. We report here results of a comprehensive analysis of resistance, among pathogens isolated from blood and cerebrospinal fluid (CSF), between 2011 and 2015. Susceptibility data was obtained from a local laboratory with collection points all across Pakistan (Chughtai Laboratory). Resistance proportions to most commonly used antimicrobials were calculated for each pathogen over a period of five years. While Acinetobacter species demonstrated highest resistance rates to all tested antimicrobials, a sharp increase in carbapenem resistance was the most noticeable (50%-95%) between 2011-2015. Our results also highlight the presence of third and fourth generation cephalosporins resistance in Salmonella enterica serovar Typhi in Pakistan. Interestingly, where rise in AMR was being observed in some major invasive pathogens, decreasing resistance trends were observed in Staphylococcus aureus, against commonly used antimicrobials. Overall pathogens isolated from blood and CSF between 2011-2015, showed an increase in resistance towards commonly used antimicrobials.
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Affiliation(s)
- Nida Javaid
- Department of Biology, School of Science and Engineering, Lahore University of Management Science, Lahore, Pakistan
| | - Qamar Sultana
- Department of Microbiology, Chughtai Lab/Chughtai Institute of Pathology, Lahore, Pakistan
| | - Karam Rasool
- Department of Microbiology, Chughtai Lab/Chughtai Institute of Pathology, Lahore, Pakistan
| | - Sumanth Gandra
- Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MI, United States of America
| | - Fayyaz Ahmad
- Department of Statistics, University of Gujrat, Gujrat, Pakistan
| | - Safee Ullah Chaudhary
- Biomedical Informatics Research Laboratory, Department of Biology, Lahore University of Management Sciences, Lahore, Pakistan
| | - Shaper Mirza
- Department of Biology, School of Science and Engineering, Lahore University of Management Science, Lahore, Pakistan
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Horner C, Cunney R, Demirjian A, Doherty C, Green H, Mathai M, McMaster P, Munro A, Paulus S, Roland D, Patel S. Paediatric Common Infections Pathways: improving antimicrobial stewardship and promoting ambulation for children presenting with common infections to hospitals in the UK and Ireland. JAC Antimicrob Resist 2021; 3:dlab029. [PMID: 34223103 PMCID: PMC8210287 DOI: 10.1093/jacamr/dlab029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/15/2021] [Indexed: 12/19/2022] Open
Abstract
Paediatric common infection pathways have been developed in collaboration between the BSAC and national paediatric groups, addressing the management of cellulitis, lymphadenitis/lymph node abscess, pneumonia/pleural empyema, pyelonephritis, tonsillitis/peritonsillar abscess, otitis media/mastoiditis, pre-septal/post-septal (orbital) cellulitis, and meningitis. Guidance for the management of a child presenting with a petechial/purpuric rash and the infant under 3 months of age with fever is also provided. The aim of these pathways is to support the delivery of high-quality infection management in children presenting to a hospital. The pathways focus on diagnostic approaches, including the recognition of red flags suggesting complex or severe infection requiring urgent intervention, approaches to antimicrobial stewardship (AMS) principles and guidance on safe and timely ambulation aligned with good practice of outpatient parenteral antimicrobial therapy (OPAT).
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Affiliation(s)
- Carolyne Horner
- The British Society for Antimicrobial Chemotherapy, Birmingham, UK
| | - Robert Cunney
- Temple Street Children's University Hospital, Dublin, Ireland
| | | | | | - Helen Green
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Alasdair Munro
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stéphane Paulus
- Children’s Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Sanjay Patel
- The British Society for Antimicrobial Chemotherapy, Birmingham, UK
- Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Figueiredo RADO, Kajantie E, Neuvonen PJ, Rounge TB, Weiderpass E, Viljakainen H. Lifetime antimicrobial use is associated with weight status in early adolescence-A register-based cohort study. Pediatr Obes 2021; 16:e12727. [PMID: 32959492 PMCID: PMC7900955 DOI: 10.1111/ijpo.12727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Antimicrobial agents (AMs) are the most prescribed drugs to children. Early and repeated exposure to AMs in infancy is associated with increased risk of childhood overweight and obesity. AIMS We extended the investigation of AMs use, from birth to early adolescence, and evaluated their association with weight status. MATERIALS & METHODS A total of 10093 children from Finnish Health in Teens cohort (Fin-HIT) with register-based data on AMs purchases and measured weight status at the mean age of 11.2 y (SD 0.82) were included in the study. The key exposures were the number AM purchases at a given age or the sum of these during the entire follow-up time to describe lifetime exposure / use. Outcome was weight status in early adolescence defined with International Obesity Task Force cut-offs for the age- and sex-specific body mass index. Odds Ratio (OR) and 95% confidence intervals (CI) were estimated using Multinomial Logistic Regression. RESULTS Of children, 73.7% were normal weight, 11.1% thin and 15.2% overweight/obese. AMs use was highest during the second year of life, when 65% of all children used AMs, but thereafter decreased with age. The highest mean purchases and prevalence at any given age along with the highest lifetime use were consistently seen among overweight children. Each episode of AMs use throughout life increased the risk of being overweight in adolescence [OR = 1.02 (1.02-1.03)]. However, there was an inverse association between AMs use and thinness [OR = 0.98 (0.97-0.99)]. DISCUSSION Despite a high prevalence of AMs use during the early years, lifetime-use was associated with weight status in early adolescence in a dose response manner. CONCLUSION Future studies should address mechanisms underlying the relationship between AM use and weight.
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Affiliation(s)
| | - Eero Kajantie
- National Institute for Health and WelfareHelsinki and OuluFinland
- Children's HospitalHelsinki University Hospital and University of HelsinkiFinland
- PEDEGO Research UnitMRC Oulu, Oulu University Hospital and University of OuluFinland
- Department of Clinical and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
| | - Pertti J. Neuvonen
- Department of Clinical PharmacologyUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Trine B. Rounge
- Folkhälsan Research CenterHelsinkiFinland
- Department of ResearchCancer Registry of NorwayOsloNorway
- Department of InformaticsUniversity of OsloOsloNorway
| | | | - Heli Viljakainen
- Folkhälsan Research CenterHelsinkiFinland
- Department of Food and NutritionUniversity of HelsinkiHelsinkiFinland
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Hansen KØ, Hansen IKØ, Richard CS, Jenssen M, Andersen JH, Hansen EH. Antimicrobial Activity of Securamines From the Bryozoan Securiflustra securifrons. Nat Prod Commun 2021. [DOI: 10.1177/1934578x21996180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Natural products and their derivatives have served as powerful therapeutics against pathogenic microorganisms and are the mainstay of our currently available treatment options to combat infections. As part of our ongoing search for antimicrobial natural products from marine organisms, one fraction prepared from the Arctic marine bryozoan Securiflustra securifrons was found to be active against the human pathogenic bacterium Streptococcus agalactiae (gr. B). Chemical investigation of the fraction revealed that it contained several variants of the highly modified secondary metabolites known as securamines. The securamines are alkaloids sharing a common isoprene-histamine-tryptamine backbone. In this study, we describe the antimicrobial activities of securamine C, E, and H – J (4, 5, and 1-3) and the attempt to deconvolute the mode of action of 1.
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Affiliation(s)
- Kine Ø. Hansen
- Marbio, UiT–The Arctic University of Norway, Breivika, Tromsø, Norway
| | - Ida K. Ø. Hansen
- Norwegian College of Fishery Science, UiT - The Arctic University of Norway, Breivika, Norway
| | - Céline S. Richard
- Norwegian College of Fishery Science, UiT - The Arctic University of Norway, Breivika, Norway
| | - Marte Jenssen
- Marbio, UiT–The Arctic University of Norway, Breivika, Tromsø, Norway
| | | | - Espen H. Hansen
- Marbio, UiT–The Arctic University of Norway, Breivika, Tromsø, Norway
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Yue M, Liu D, Hu X, Ding J, Li X, Wu Y. Genomic characterisation of a multidrug-resistant Escherichia coli strain carrying the mcr-1 gene recovered from a paediatric patient in China. J Glob Antimicrob Resist 2021; 24:370-372. [PMID: 33581344 DOI: 10.1016/j.jgar.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/20/2021] [Accepted: 02/02/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The global spread of carbapenem-resistant Enterobacterales is a leading public-health threat. Lack of effective treatment has resulted in use of colistin as a last-resort therapeutic option for multidrug-resistant (MDR) bacterial infections. Here we report the complete genome sequence of a MDR Escherichia coli strain carrying a plasmid-mediated colistin resistance gene mcr-1 recovered from a Chinese paediatric patient. METHODS Whole-genome sequencing of E. coli strain 1506 was performed using both Oxford Nanopore MinION and Illumina NovaSeq 6000 platforms. De novo hybrid assembly of short Illumina reads and long MinION reads was performed using Unicycler. In silico multilocus sequence typing (MLST), antimicrobial resistance genes (ARGs) and plasmid replicons were identified from the genome sequence. Core genome multilocus sequence typing (cgMLST) analysis between E. coli 1506 and all of the ST48 E. coli strains retrieved from the NCBI GenBank database was performed using BacWGSTdb 2.0 server. RESULTS The complete genome sequence of E. coli 1506 consists of six contigs comprising 4 849 058 bp, including one chromosome and five plasmids, and was assigned to ST48. Fourteen ARGs were identified, including mcr-1 located on a 33 309-bp IncX4 plasmid. The closest relative of E. coli 1506 was another isolate originating from livestock in Australia, which differed by 614 cgMLST alleles. CONCLUSION Our study reports the genome sequence of a MDR E. coli carrying mcr-1 isolated from a Chinese paediatric patient. These data may help to understand the antimicrobial resistance mechanisms and genomic features and highlight the growing threat of antimicrobial resistance in children.
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Affiliation(s)
- Meina Yue
- Department of Clinical Laboratory, Hangzhou Children's Hospital, Hangzhou, China
| | - Di Liu
- Department of Clinical Laboratory, Hangzhou Children's Hospital, Hangzhou, China
| | - Xue Hu
- Department of Clinical Laboratory, Hangzhou Children's Hospital, Hangzhou, China
| | - Juan Ding
- Department of Clinical Laboratory, Hangzhou Children's Hospital, Hangzhou, China
| | - Xiaoyu Li
- Department of Clinical Laboratory, Hangzhou Children's Hospital, Hangzhou, China.
| | - Yidong Wu
- Department of Clinical Laboratory, Hangzhou Children's Hospital, Hangzhou, China.
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Anforderungen an die Infektionsprävention bei der medizinischen Versorgung von immunsupprimierten Patienten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:232-264. [PMID: 33394069 PMCID: PMC7780910 DOI: 10.1007/s00103-020-03265-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
Antibiotic overuse contributes to antibiotic resistance, which is a threat to public health. Antibiotic stewardship is a practice dedicated to prescribing antibiotics only when necessary and, when antibiotics are considered necessary, promoting use of the appropriate agent(s), dose, duration, and route of therapy to optimize clinical outcomes while minimizing the unintended consequences of antibiotic use. Because there are differences in common infectious conditions, drug-specific considerations, and the evidence surrounding treatment recommendations (eg, first-line therapy, duration of therapy) between children and adults, this statement provides specific guidance for the pediatric population. This policy statement discusses the rationale for inpatient and outpatient antibiotic stewardship programs; essential personnel, infrastructure, and activities required; approaches to evaluating their effectiveness; and gaps in knowledge that require further investigation. Key guidance for both inpatient and outpatient antibiotic stewardship programs are provided.
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Affiliation(s)
- Jeffrey S Gerber
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
| | - Mary Anne Jackson
- Section of Infectious Disease, Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Pranita D Tamma
- Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Theoklis E Zaoutis
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Girona‐Alarcón M, Fresán E, Garcia‐Garcia A, Bobillo‐Perez S, Balaguer M, Felipe A, Esteban ME, Jordan I. Device-associated multidrug-resistant bacteria surveillance in critically ill children: 10 years of experience. Acta Paediatr 2021; 110:203-209. [PMID: 32383199 DOI: 10.1111/apa.15342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 04/21/2020] [Accepted: 05/04/2020] [Indexed: 12/21/2022]
Abstract
AIM Multidrug-resistant bacterial infections are a public health problem worldwide. However, most of the information available refers to adults. The main objectives were to determine the incidence, risk factors, and outcomes for device-associated infections, especially those involving multidrug-resistant bacteria. METHODS This is a prospective, observational study. Children aged ≥1 month and <18 years admitted to the paediatric intensive care unit from 2008 to 2017, with a device-associated infection microbiologically confirmed were included. Patients infected with resistant bacteria were compared with those who had a drug-susceptible infection. RESULTS The study included 213 patients. Out of all the device-associated infections, 22% (48 patients) were caused by multidrug-resistant bacteria. The most frequent were extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. Cardiovascular diseases, age under 1year, comorbidity, prolonged use of invasive device, and length of stay until infection were risk factors for resistant bacteria, but not specifically for ESBL-producing bacteria. Length of stay and mortality was increased in patients with multidrug-resistant bacteria. CONCLUSION Being under 1-year-old and having a cardiovascular disease were the two major risk factors for resistant bacterial infection. ESBL-producing bacteria were the most frequent multidrug-resistant agents. However, patients with ESBL-producing bacteria did not have any additional risk factors, so they may have been colonised in the community.
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Affiliation(s)
- Mònica Girona‐Alarcón
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
| | - Elena Fresán
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
| | - Ana Garcia‐Garcia
- Immunology Department Hospital Sant Joan de Déu‐Clínic University of Barcelona Barcelona Spain
| | - Sara Bobillo‐Perez
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
| | - Monica Balaguer
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
| | - Aida Felipe
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
| | - Maria Esther Esteban
- Zoology and Anthropology Section Department of Evolutionary Biology, Ecology and Environmental Sciences Faculty of Biology GREAB‐ Biological Anthropology Research Group Institut de Recerca de la Biodiversitat (IRBio) University of Barcelona Barcelona Spain
| | - Iolanda Jordan
- Paediatric Intensive Care Unit Institut de Recerca Hospital Sant Joan de Déu University of Barcelona Barcelona Spain
- Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group Institut de Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu Barcelona Spain
- Paediatric Intensive Care Unit CIBERESP, Hospital Sant Joan de Déu‐Clínic University of Barcelona Barcelona Spain
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Willems J, Hermans E, Schelstraete P, Depuydt P, De Cock P. Optimizing the Use of Antibiotic Agents in the Pediatric Intensive Care Unit: A Narrative Review. Paediatr Drugs 2021; 23:39-53. [PMID: 33174101 PMCID: PMC7654352 DOI: 10.1007/s40272-020-00426-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 02/08/2023]
Abstract
Antibiotics are one of the most prescribed drug classes in the pediatric intensive care unit, yet the incidence of inappropriate antibiotic prescribing remains high in critically ill children. Optimizing the use of antibiotics in this population is imperative to guarantee adequate treatment, avoid toxicity and the occurrence of antibiotic resistance, both on a patient level and on a population level. Antibiotic stewardship encompasses all initiatives to promote responsible antibiotic usage and the PICU represents a major target environment for antibiotic stewardship programs. This narrative review provides a summary of the available knowledge on the optimal selection, duration, dosage, and route of administration of antibiotic treatment in critically ill children. Overall, more scientific evidence on how to optimize antibiotic treatment is warranted in this population. We also give our personal expert opinion on research priorities.
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Affiliation(s)
- Jef Willems
- Department of Pediatric Intensive Care, Ghent University Hospital, Gent, Belgium
| | - Eline Hermans
- Department of Pediatrics, Ghent University Hospital, Gent, Belgium
- Heymans Institute of Pharmacology, Ghent University, Gent, Belgium
| | - Petra Schelstraete
- Department of Pediatric Pulmonology, Ghent University Hospital, Gent, Belgium
| | - Pieter Depuydt
- Department of Intensive Care Medicine, Ghent University Hospital, Gent, Belgium
| | - Pieter De Cock
- Department of Pediatric Intensive Care, Ghent University Hospital, Gent, Belgium.
- Heymans Institute of Pharmacology, Ghent University, Gent, Belgium.
- Department of Pharmacy, Ghent University Hospital, Gent, Belgium.
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