1
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Nguyen PT, Nguyen TT, Huynh LT, Graham SM, Marais BJ. Clinical algorithm reduces antibiotic use among children presenting with respiratory symptoms to hospital in central Vietnam. Pneumonia (Nathan) 2023; 15:11. [PMID: 37488633 PMCID: PMC10367404 DOI: 10.1186/s41479-023-00113-9] [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: 10/23/2022] [Accepted: 06/29/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE To assess the safety and utility of a pragmatic clinical algorithm to guide rational antibiotic use in children presenting with respiratory infection. METHODS The effect of an algorithm to guide the management of young (< 5 years) children presenting with respiratory symptoms to the Da Nang Hospital for Women and Children, Vietnam, was evaluated in a before-after intervention analysis. The main outcome was reduction in antibiotic use, with monitoring of potential harm resulting from reduced antibiotic use. The intervention comprised a single training session of physicians in the use of an algorithm informed by local evidence; developed during a previous prospective observational study. The evaluation was performed one month after the training. RESULTS Of the 1290 children evaluated before the intervention, 102 (7.9%) were admitted to hospital and 556/1188 (46.8%) were sent home with antibiotics. Due to COVID-19, only 166 children were evaluated after the intervention of whom 14 (8.4%) were admitted to hospital and 54/152 (35.5%) were sent home with antibiotics. Antibiotic use was reduced (from 46.8% to 35.5%; p = 0.009) after clinician training, but adequate comparison was compromised. The reduction was most pronounced in children with wheeze or runny nose and no fever, or a normal chest radiograph, where antibiotic use declined from 46.7% to 28.8% (p < 0.0001). The frequency of repeat presentation to hospital was similar between the two study periods (141/1188; 11.9% before and 10/152; 6.6% after; p = 0.10). No child represented with serious disease after being sent home without antibiotics. CONCLUSIONS We observed a reduction in antibiotic use in young children with a respiratory infection after physician training in the use of a simple evidence-based management algorithm. However, the study was severely impacted by COVID-19 restrictions, requiring further evaluation to confirm the observed effect.
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Affiliation(s)
- Phuong Tk Nguyen
- Respiratory Department, Da Nang Hospital for Women and Children, Da Nang, Vietnam.
- Sydney Vietnam Initiative, The University of Sydney, Sydney, Australia.
| | - Tam Tm Nguyen
- Respiratory Department, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - Lan Tb Huynh
- Respiratory Department, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - Stephen M Graham
- Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Ben J Marais
- Discipline of Paediatrics and Adolescent Medicine, The Children's Hospital at Westmead, Westmead, Australia
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, Australia
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2
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Lim R, Chaummanivong M, Taikeophithoun C, Gray A, Jenney AWJ, Sychareun V, Nguyen C, Russell F. Higher childhood pneumonia admission threshold remains in Lao PDR: an observational study. Arch Dis Child 2022; 107:872-877. [PMID: 35584907 DOI: 10.1136/archdischild-2021-323626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/22/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES WHO Integrated Management of Childhood Illness (IMCI) guidelines changed pneumonia hospitalisation criteria in 2014, which was implemented in Lao People's Democratic Republic (Lao PDR) in 2015. We determined adherence to: current (2014) IMCI guidelines for children presenting to hospitals with pneumonia, current outpatient management guidelines and identified hospitalisation predictors. DESIGN Prospective observational study (January 2017 to December 2018). SETTING Outpatient and emergency departments of four hospitals in Vientiane, Lao PDR. PATIENTS 594 children aged 2-59 months diagnosed with pneumonia. MAIN OUTCOME MEASURES Number of children diagnosed, hospitalised, managed, administered preventive measures and followed-up accordant with current guidelines. RESULTS Non-severe and severe pneumonia were correctly diagnosed in 97% and 43% of children, respectively. Non-severe pneumonia with lower chest wall indrawing (LCI) was diagnosed as severe in 15%. Hospitalisation rates were: 80% for severe pneumonia, 86% and 3% for non-severe pneumonia with and without LCI, respectively. Outpatient oral antibiotic prescribing was high (99%), but only 30% were prescribed both the recommended antibiotic and duration. Appropriate planned follow-up was 89%. Hospitalisation predictors included age 2-5 months (compared with 24-59 months; OR 3.95, 95% CI 1.90 to 8.24), public transport to hospital (compared with private vehicle; OR 2.60, 95% CI 1.09 to 6.24) and households without piped drinking water (OR 4.67, 95% CI 2.75 to 7.95). CONCLUSIONS Hospitalisation practice for childhood pneumonia in Lao PDR remains more closely aligned with the 2005 WHO IMCI guidelines than the currently implemented 2014 iteration. Compliance with current outpatient antibiotic prescribing guidelines was low.
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Affiliation(s)
- Ruth Lim
- Asia-Pacific Health Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Molina Chaummanivong
- Faculty of Public Health, University of Health Sciences, Vientiane, Vientiane Capital, Lao People's Democratic Republic
| | - Chansathit Taikeophithoun
- Faculty of Public Health, University of Health Sciences, Vientiane, Vientiane Capital, Lao People's Democratic Republic
| | - Amy Gray
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Adam W J Jenney
- Department of Infectious Diseases, Monash University, Clayton, Victoria, Australia
| | - Vanphanom Sychareun
- Faculty of Public Health, University of Health Sciences, Vientiane, Vientiane Capital, Lao People's Democratic Republic
| | - Cattram Nguyen
- Asia-Pacific Health Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona Russell
- Asia-Pacific Health Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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3
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Bui-Binh-Bao S, Nguyen-Thi-My T, Nguyen-Duy-Nam A, Kim Hoa NT, Pham-Van D. Is Serum Lactate a Good Predictor of Mortality in Children Aged 2 Months to 5 Years With Pneumonia in Central Vietnam. Glob Pediatr Health 2021; 8:2333794X211060806. [PMID: 34869798 PMCID: PMC8637374 DOI: 10.1177/2333794x211060806] [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: 10/06/2021] [Accepted: 10/29/2021] [Indexed: 12/01/2022] Open
Abstract
Pneumonia is a major cause of morbidity and mortality in children globally. Lactate, a product of anaerobic cellular metabolism, has been used as an indicator of poor tissue oxygenation and cellular hypoxia. Our objective was to determine whether serum lactate concentration at hospital admission predicted mortality in children aged 2 months to 5 years with pneumonia. Two hundred and eighty-one pediatric patients admitted to the Department of Pediatrics of a provincial hospital with WHO-defined pneumonia and severe pneumonia were included; of whom, 8 died during hospital stay. The median serum lactate concentration was 4.8 mmol/l (IQR 2.6-6.9) among children who died and 3.6 mmol/l (IQR 2.8-4.3) among children who survived (P > .05); 4.1 mmol/l (IQR 2.7-4.7) among children with severe pneumonia and 3.5 mmol/l (IQR 2.8-4.3) among children with pneumonia (P > .05). Serum lactate concentration had a low value in predicting pneumonia-related mortality (AUC 0.68, 95% CI 0.62-0.73); and the concentration cut-off of >4.06 mmol/l had the best sensitivity and specificity (75% and 68.9%, respectively) with a 2.4-fold risk of death (LR+ 2.4; 95% CI 1.6-3.7). Although hyperlactatemia was associated with severity and mortality in children 2 months to 5 years of age with pneumonia, its benefit was unclear.
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Affiliation(s)
- Son Bui-Binh-Bao
- Hue University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue Province, Vietnam
| | | | - Anh Nguyen-Duy-Nam
- Hue University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue Province, Vietnam
| | | | - Dung Pham-Van
- Binh Dinh General Hospital, Quy Nhon City, Binh Dinh Province, Vietnam
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4
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Nguyen TKP, Bui BBS, Ngo QC, Fitzgerald DA, Graham SM, Marais BJ. Applying lessons learnt from research of child pneumonia management in Vietnam. Paediatr Respir Rev 2021; 39:65-70. [PMID: 33158773 DOI: 10.1016/j.prrv.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
Pneumonia is the leading cause of paediatric hospitalisation in Vietnam, placing a huge burden on the health care system. Pneumonia is also the main reason for antibiotic use in children. Unfortunately many hospital admissions for child pneumonia in Vietnam are unnecessary and inappropriate use of antibiotics is common, as in the rest of Asia, with little awareness of its adverse effects. We explored the value of an alternative approach that, instead of focusing on the identification of children with severe bacterial pneumonia, focuses on the identification of children with 'unlikely bacterial pneumonia' to improve patient care and rational antibiotic use. Implementing improved models of care require pragmatic management algorithms that are well validated, but it is ultimately dependent on financial structures, management support and evidence-based training of healthcare providers at all relevant levels. Apart from better case management, sustained reductions in the pneumonia disease burden also require increased emphasis on primary prevention.
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Affiliation(s)
- T K P Nguyen
- Respiratory Department, Da Nang Hospital for Women and Children, Viet Nam.
| | - B B S Bui
- Discipline of Paediatrics, Hue University of Medicine and Pharmacy, Viet Nam
| | - Q C Ngo
- Vietnam Respiratory Society, Ha Noi, Viet Nam
| | - D A Fitzgerald
- Respiratory Medicine, The Children's Hospital at Westmead, The University of Sydney, Australia
| | - S M Graham
- Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - B J Marais
- Discipline of Child and Adolescent Health, The Children's Hospital at Westmead, The University of Sydney, Australia
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5
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Lange J, Kozielski J, Bartolik K, Kabicz P, Targowski T. The incidence of pneumonia in the paediatric population in Poland in light of the maps of health needs. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
In Poland, no statistical data are available concerning the analysis of the incidence of pneumonia in inpatient children. The requirement for these data results mainly from the need to prepare systemic and economic solutions.
Aim
This study aimed to use reported data for evaluating pneumonia incidence rates among hospitalised children and other parameters in various age groups.
Subject and methods
A detailed analysis was performed as part of the Operational Programme Knowledge Education Development co-financed by the European Social Fund. Services reported to the National Health Fund in 2014 were considered, including pneumonia incidence among hospitalised children and mortality in specific age groups.
Results
In 2014, a total of 68,543 children were hospitalised for pneumonia (68% of all hospitalisations for acute respiratory diseases). Within each of the analysed age groups, boys were hospitalised more frequently. Irrespective of the place of residence, infants were most commonly hospitalised. It was observed that there was a significant difference between the incidence rate of pneumonia among hospitalised children in all analysed groups depending on the province. The average length of stay was 7.29 days, with infants requiring the longest stays (7.96 days), and 1.8% of children were rehospitalised within 30 days due to recurrence of pneumonia. The most commonly coded pathogens responsible for pneumonia included Mycoplasma pneumoniae, Streptococcus pneumoniae and Chlamydia spp. A total of 19 inpatient hospital deaths in the course of pneumonia were reported.
Conclusions
Based on our findings, it is warranted to utilize epidemiological knowledge for the planning of an appropriate level of service commissioned both in outpatient and inpatient facilities as well as for the estimation of institutional and staff needs necessary to secure these services.
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6
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Nguyen PTK, Tran HT, Tran TS, Fitzgerald DA, Graham SM, Marais BJ. Predictors of Unlikely Bacterial Pneumonia and Adverse Pneumonia Outcome in Children Admitted to a Hospital in Central Vietnam. Clin Infect Dis 2021; 70:1733-1741. [PMID: 31132089 DOI: 10.1093/cid/ciz445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pneumonia is the leading cause of antibiotic use and hospitalization in Vietnam. There is a need for better prediction of unlikely bacterial pneumonia and adverse pneumonia outcome in order to guide hospital admission and improve rational antibiotic use. METHODS All children under 5 admitted with pneumonia (per clinician assessment) to the Da Nang Hospital for Women and Children were prospectively enrolled. Children were classified as having likely or unlikely bacterial pneumonia and followed for outcome assessment. A Bayesian model averaging approach was used to identify predictors of unlikely bacterial pneumonia and adverse pneumonia outcome, which guided the development of a pragmatic management algorithm. RESULTS Of 3817 patients assessed, 2199 (57.6%) met World Health Organization (WHO) pneumonia criteria. In total, 1594 (41.7%) children were classified as having unlikely and 129 (3.4%) as having likely bacterial pneumonia. The remainder (2399; 62.9%) were considered to have disease of uncertain etiology. Factors predictive of unlikely bacterial pneumonia were no fever, no consolidation on chest radiograph, and absolute neutrophil count <5 × 109/L at presentation, which had a negative predictive value (NPV) for likely bacterial pneumonia of 99.0%. Among those who met WHO pneumonia criteria, 8.6% (189/2199) experienced an adverse outcome. Not having any WHO danger sign or consolidation on chest radiograph had an NPV of 96.8% for adverse pneumonia outcome. CONCLUSIONS An algorithm that screens for predictors of likely bacterial pneumonia and adverse pneumonia outcome could reduce unnecessary antibiotic use and hospital admission, but its clinical utility requires validation in a prospective study.
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Affiliation(s)
- Phuong T K Nguyen
- Discipline of Child and Adolescent Health, Sydney Medical School, the Children's Hospital at Westmead, University of Sydney, Australia.,Da Nang Hospital for Women and Children, Vietnam
| | - Hoang T Tran
- Da Nang Hospital for Women and Children, Vietnam
| | - Thach S Tran
- Clinical Studies and Epidemiology, Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst
| | - Dominic A Fitzgerald
- Discipline of Child and Adolescent Health, Sydney Medical School, the Children's Hospital at Westmead, University of Sydney, Australia.,Respiratory Medicine, the Children's Hospital at Westmead, University of Sydney
| | - Stephen M Graham
- Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Australia
| | - Ben J Marais
- Discipline of Child and Adolescent Health, Sydney Medical School, the Children's Hospital at Westmead, University of Sydney, Australia
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7
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Mustafa F, Koekemoer L, Green RJ, Turner AC, Becker P, van Biljon G. Successful antibiotic stewardship in hospitalised children in a developing nation. J Glob Antimicrob Resist 2020; 23:217-220. [DOI: 10.1016/j.jgar.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/05/2020] [Accepted: 09/12/2020] [Indexed: 10/23/2022] Open
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8
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Do CHT, Børresen ML, Pedersen FK, Geskus RB, Kruse AY. Rates of rehospitalisation in the first 2 years among preterm infants discharged from the NICU of a tertiary children hospital in Vietnam: a follow-up study. BMJ Open 2020; 10:e036484. [PMID: 33020086 PMCID: PMC7537446 DOI: 10.1136/bmjopen-2019-036484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To describe the characteristics of rehospitalisation in Vietnamese preterm infants and to examine the time-to-first-readmission between two gestational age (GA) groups (extremely/very preterm (EVP) vs moderate/late preterm (MLP)); and further to compare rehospitalisation rates according to GA and corrected age (CA), and to examine the association between potential risk factors and rehospitalisation rates. DESIGN AND SETTING A cohort study to follow up preterm infants discharged from a neonatal intensive care unit (NICU) of a tertiary children's hospital in Vietnam. PARTICIPANTS All preterm newborns admitted to the NICU from July 2013 to September 2014. MAIN OUTCOMES Rates, durations and causes of hospital admission during the first 2 years. RESULTS Of 294 preterm infants admitted to NICU (all outborn, GA ranged from 26 to 36 weeks), 255 were discharged alive, and 211 (83%) NICU graduates were followed up at least once during the first 2 years CA, of whom 56% were hospital readmitted. The median (IQR) of hospital stay was 7 (6-10) days. Respiratory diseases were the major cause (70%). Compared with MLP infants, EVP infants had a higher risk of first rehospitalisation within the first 6 months of age (p=0.01). However, the difference in risk declined thereafter and was similar from 20 months of age. There was an interaction in rehospitalisation rates between GA and CA. Longer duration of neonatal respiratory support and having older siblings were associated with higher rehospitalisation rates. Lower rates of rehospitalisation were seen in infants with higher cognitive and motor scores (not statistically significant in cognitive scores). CONCLUSIONS Hospital readmission of Vietnamese preterm infants discharged from NICU was frequent during their first 2 years, mainly due to respiratory diseases. Scale-up of follow-up programmes for preterm infants is needed in low-income and middle-income countries and attempts to prevent respiratory diseases should be considered.
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Affiliation(s)
- Chuong Huu Thieu Do
- Neonatal Intensive Care Unit, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | | | | | - Ronald Bertus Geskus
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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9
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Hoang VT, Dao TL, Minodier P, Nguyen DC, Hoang NT, Dang VN, Gautret P. Risk Factors for Severe Pneumonia According to WHO 2005 Criteria Definition Among Children <5 Years of Age in Thai Binh, Vietnam: A Case-Control Study. J Epidemiol Glob Health 2020; 9:274-280. [PMID: 31854169 PMCID: PMC7310799 DOI: 10.2991/jegh.k.191009.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 10/07/2019] [Indexed: 11/21/2022] Open
Abstract
Vietnam is one of the 15 countries where the prevalence of child pneumonia is highest. It is a major cause of admission in pediatric hospitals. However, little is known on the burden of severe pneumonia and their risk factors in children <5 years of age in Vietnam. A case–control study was conducted among children aged 2–59 months presenting with pneumonia at the Pediatric Provincial Hospital of Thai Binh. Cases were children with severe pneumonia while controls included those with non-severe pneumonia as defined by the World Health Organization (WHO) classification of 2005. Eighty-three cases and 83 controls were included. Sex ratio was 2.19. Children with severe pneumonia were significantly less likely to receive antibiotics preadmission compared to children with non-severe pneumonia [odds ratio (OR) = 0.16, 95% confidence interval (CI) = 0.06–0.42]. The main risk factors of severe pneumonia were a lack of immunization (OR = 4.77, 95% CI = 1.80–12.65), an exposure to cigarette smoke (OR = 3.87, 95% CI = 1.62–9.23), and having a mother with a low level of education. Children with severe pneumonia were 25 times more likely to present with associated measles with p < 0.0001 and five times more likely to present with diarrhea than children with non-severe pneumonia (p < 0.0001). Improving immunization coverage, educating parents about the risks of passive smoking and the recognition of respiratory distress signs, and facilitating early antibiotic access for infants with acute pulmonary disease should reduce the burden of such illnesses. To implement a national, multicenter study about pneumonia in children, more precise inclusion criteria should be chosen, including radiological and/or biological assessment.
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Affiliation(s)
- Van Thuan Hoang
- IRD, AP-HM, SSA, VITROME, Aix-Marseille Université, Marseille, France.,IHU - Méditerranée Infection, Marseille, France.,Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Thi Loi Dao
- IRD, AP-HM, SSA, VITROME, Aix-Marseille Université, Marseille, France.,IHU - Méditerranée Infection, Marseille, France.,Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Philippe Minodier
- Department of Pediatric Emergency, Centre Hospitalier Universitaire Nord, Marseille, France.,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
| | - Duy Cuong Nguyen
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Nang Trong Hoang
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Van Nghiem Dang
- Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Philippe Gautret
- IRD, AP-HM, SSA, VITROME, Aix-Marseille Université, Marseille, France.,IHU - Méditerranée Infection, Marseille, France
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10
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Nguyen PT, Tran HT, Fitzgerald DA, Graham SM, Marais BJ. Antibiotic use in children hospitalised with pneumonia in Central Vietnam. Arch Dis Child 2020; 105:713-719. [PMID: 32079569 DOI: 10.1136/archdischild-2019-317733] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 12/11/2019] [Accepted: 01/22/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Excessive use of antibiotics has been noted in children with respiratory tract infections in Vietnam, but antibiotic use in hospitalised children is poorly documented. Antibiotic use and direct healthcare costs in children hospitalised with pneumonia in central Vietnam were assessed. METHODS A prospective descriptive study of children under 5 years old admitted with a primary admission diagnosis of 'pneumonia' to the Da Nang Hospital for Women and Children over 1 year. RESULTS Of 2911 children hospitalised with pneumonia, 2735 (94.0%) were classified as 'non-severe' pneumonia by the admitting physician. In total, 2853 (98.0%) children received antibiotics. Intravenous antibiotics were given to 336 (12.3%) children with 'non-severe' and 157/176 (89.2%) children with 'severe' pneumonia; those with 'non-severe' pneumonia accounted for 68.2% (336/493) of intravenous antibiotics given. Only 19.3% (95/493) of children on intravenous antibiotics were stepped down to an oral antibiotic. Cefuroxime was the preferred oral agent, and ceftriaxone was the preferred injectable agent. Hospital admission for oral antibiotics in 'non-severe' pneumonia was a major cost driver, with an average direct cost of US$78.9 per patient, accounting for 54.0% of the total hospitalisation cost in the study cohort. In addition, 336 (12.3%) children with non-severe pneumonia received intravenous antibiotics without indication, accounting for a further 23.2% of hospitalisation costs. CONCLUSION Limiting unnecessary hospitalisation and considering early intravenous to oral step down antibiotic will reduce direct health system costs and morbidity in children with respiratory tract infections in Vietnam.
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Affiliation(s)
- Phuong Tk Nguyen
- Department of Respirology, Da Nang Hospital for Women and Children, Da Nang, Vietnam .,Discipline of Paediatrics and Adolescent Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Hoang T Tran
- Department of Neonatology, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - Dominic A Fitzgerald
- Discipline of Paediatrics and Adolescent Medicine, The University of Sydney, Sydney, New South Wales, Australia.,Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Steve M Graham
- Department of Paediatrics, Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia, Melbourne, Victoria, Australia
| | - Ben J Marais
- Discipline of Paediatrics and Adolescent Medicine, The University of Sydney, Sydney, New South Wales, Australia
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11
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Nguyen PT, Tran HT, Truong HT, Nguyen VT, Graham SM, Marais BJ. Paediatric use of antibiotics in children with community acquired pneumonia: A survey from Da Nang, Vietnam. J Paediatr Child Health 2019; 55:1329-1334. [PMID: 30773763 DOI: 10.1111/jpc.14413] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/27/2018] [Accepted: 01/23/2019] [Indexed: 11/28/2022]
Abstract
AIM To characterise paediatricians' antibiotic-prescribing behaviour when managing community acquired pneumonia. METHODS We conducted a knowledge and attitudes survey of paediatric doctors practicing at a regional provincial hospital in central Vietnam over a 2-week period (from 12 December 2017 to 29 December 2017). RESULTS Of 79 eligible paediatric doctors, 69 (87.3%) completed the questionnaire, of whom 65 (94.2%) thought that antibiotics were overused in Vietnam. Thirty-eight doctors (55.1%) indicated that they routinely hospitalised children with pneumonia to provide intravenous antibiotics. Most doctors reported discharging children with non-severe pneumonia after 5 days (76.9%) and those with severe pneumonia after 7-10 days (88.4%); older doctors generally continued intravenous antibiotics for longer. The two most important factors driving discharge decisions were clinical assessment (95.6%) and completion of the full course of intravenous antibiotics (80.0%). Antibiotic prescription was influenced by local guidelines (62.3%), drugs used before admission (50.0%) and the opinion of senior clinicians (37.7%). Most doctors believed antibiotic stewardship was necessary (98.6%) and that over-the-counter use of antibiotics should be restricted (97.1%). CONCLUSIONS Paediatricians recognised an urgent need for more effective regulation and antibiotic stewardship in Vietnam. Routinely completing a full course of intravenous antibiotics leads to unnecessary and prolonged hospitalisation.
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Affiliation(s)
- Phuong Tk Nguyen
- Discipline of Paediatrics and Adolescent Medicine, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - Hoang T Tran
- Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | | | - Vu T Nguyen
- Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - Steve M Graham
- Centre for International Child Health, University of Melbourne, Royal Children's Hospital, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Ben J Marais
- Discipline of Paediatrics and Adolescent Medicine, Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
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12
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Impact of microbial air quality in preschools on paediatric respiratory health. SN APPLIED SCIENCES 2019. [DOI: 10.1007/s42452-019-1306-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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13
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Nguyen PTK, Tran HT, Fitzgerald DA, Tran TS, Graham SM, Marais BJ. Characterisation of children hospitalised with pneumonia in central Vietnam: a prospective study. Eur Respir J 2019; 54:13993003.02256-2018. [PMID: 30956212 DOI: 10.1183/13993003.02256-2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/29/2019] [Indexed: 02/03/2023]
Abstract
Pneumonia is the most common reason for paediatric hospital admission in Vietnam. The potential value of using the World Health Organization (WHO) case management approach in Vietnam has not been documented.We performed a prospective descriptive study of all children (2-59 months) admitted with "pneumonia" (as assessed by the admitting clinician) to the Da Nang Hospital for Women and Children to characterise their disease profiles and assess risk factors for an adverse outcome. The disease profile was classified using WHO pneumonia criteria, with tachypnoea or chest indrawing as defining clinical signs. Adverse outcome was defined as death, intensive care unit admission, tertiary care transfer or hospital stay >10 days.Of 4206 admissions, 1758 (41.8%) were classified as "no pneumonia" using WHO criteria and only 252 (6.0%) met revised criteria for "severe pneumonia". The inpatient death rate was low (0.4% of admissions) with most deaths (11 out of 16; 68.8%) occurring in the "severe pneumonia" group. An adverse outcome was recorded in 18.7% of all admissions and 60.7% of the "severe pneumonia" group. Children were hospitalised for a median of 7 days at an average cost of 253 USD per admission. Risk factors for adverse outcome included WHO-classified "severe pneumonia", age <1 year, low birth weight, previous recent admission with an acute respiratory infection and recent tuberculosis exposure. Breastfeeding, day-care attendance and pre-admission antibiotic use were associated with reduced risk.Few hospital admissions met WHO criteria for "severe pneumonia", suggesting potential unnecessary hospitalisation and use of intravenous antibiotics. Better characterisation of the underlying diagnosis requires careful consideration.
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Affiliation(s)
- Phuong T K Nguyen
- Discipline of Child and Adolescent Health, Sydney Medical School, The Children's Hospital at Westmead, The University of Sydney, Sydney, Australia .,Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - Hoang T Tran
- Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - Dominic A Fitzgerald
- Discipline of Child and Adolescent Health, Sydney Medical School, The Children's Hospital at Westmead, The University of Sydney, Sydney, Australia.,Dept of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - Thach S Tran
- Clinical Studies and Epidemiology, Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - Stephen M Graham
- Centre for International Child Health, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Ben J Marais
- Discipline of Child and Adolescent Health, Sydney Medical School, The Children's Hospital at Westmead, The University of Sydney, Sydney, Australia
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14
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Russell FM, Reyburn R, Chan J, Tuivaga E, Lim R, Lai J, Van HMT, Choummanivong M, Sychareun V, Khanh DKT, de Campo M, Enarson P, Graham S, La Vincente S, Mungan T, von Mollendorf C, Mackenzie G, Mulholland K. Impact of the change in WHO's severe pneumonia case definition on hospitalized pneumonia epidemiology: case studies from six countries. Bull World Health Organ 2019; 97:386-393. [PMID: 31210676 PMCID: PMC6560369 DOI: 10.2471/blt.18.223271] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/27/2019] [Accepted: 03/06/2019] [Indexed: 11/27/2022] Open
Abstract
Objective To quantify the impact of the change in definition of severe pneumonia on documented pneumonia burden. Methods We reviewed existing data acquired during observational hospitalized pneumonia studies, before the introduction of the pneumococcal conjugate vaccine, in infants aged 2–23 months from Fiji, Gambia, Lao People's Democratic Republic, Malawi, Mongolia and Viet Nam. We used clinical data to calculate the percentage of all-cause pneumonia hospitalizations with severe pneumonia, and with primary end-point consolidation, according to both the 2005 or 2013 World Health Organization (WHO) definitions. Where population data were available, we also calculated the incidence of severe pneumonia hospitalizations according to the different definitions. Findings At six of the seven sites, the percentages of all-cause pneumonia hospitalizations due to severe pneumonia were significantly less (P < 0.001) according to the 2013 WHO definition compared with the 2005 definition. However, the percentage of severe pneumonia hospitalizations, according to the two definitions of severe pneumonia, with primary end-point consolidation varied little within each site. The annual incidences of severe pneumonia hospitalizations per 100 000 infants were significantly less (all P < 0.001) according to the 2013 definition compared with the 2005 definition, ranging from a difference of −301.0 (95% confidence interval, CI: −405.2 to −196.8) in Fiji to −3242.6 (95% CI: −3695.2 to −2789.9) in the Gambia. Conclusion The revision of WHO’s definition of severe pneumonia affects pneumonia epidemiology, and hence the interpretation of any pneumonia intervention impact evaluation.
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Affiliation(s)
- Fiona M Russell
- Centre for International Child Health, Department of Paediatrics, University of Melbourne, 50 Flemington Road, Parkville, Melbourne, 3052, Australia
| | - Rita Reyburn
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jocelyn Chan
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia
| | - Evelyn Tuivaga
- Paediatrics Department, Ministry of Health and Medical Services, Suva, Fiji
| | - Ruth Lim
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jana Lai
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia
| | - Hoang Minh Tu Van
- Paediatric Department, Children's Hospital No. 2, Ho Chi Minh City, Viet Nam
| | - Molina Choummanivong
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Vanphanom Sychareun
- Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | | | - Margaret de Campo
- Department of Radiology, The University of Melbourne, Melbourne, Australia
| | - Penny Enarson
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Stephen Graham
- Centre for International Child Health, Department of Paediatrics, University of Melbourne, 50 Flemington Road, Parkville, Melbourne, 3052, Australia
| | - Sophie La Vincente
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia
| | - Tuya Mungan
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Grant Mackenzie
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia
| | - Kim Mulholland
- New Vaccines, Murdoch Children's Research Institute, Melbourne, Australia
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