Functional gastrointestinal disorders in Jordanian infants: a pilot study

Introduction

Functional gastrointestinal disorders (FGIDs) encompass a wide spectrum of disorders that may be diagnosed using the Rome criteria.

Aim

To identify the prevalence and risk factors for the development of FGIDs in Jordanian infants.

Material and methods

We conducted a cross-sectional study to investigate the prevalence of FGIDs among infants and characterise any possible risk factors. Between 1 January 2020, and 30 December 2020, patients who presented to the paediatric follow-up clinic at King Abdullah University Hospital were recruited. Parents were interviewed and asked to complete an Arabic version of the Rome IV diagnostic questionnaire for pediatric gastrointestinal disorders for neonates and toddlers. Data regarding the parents' gastrointestinal symptoms and children's medical history were collected. Children's electronic medical files were also reviewed.

Results

The study included 127 children, 78 (61%) were males. The median age was 40 days. According to the Rome IV criteria eighty-two (64%) of the infants fit the diagnosis for at least one disorder. The most prevalent disorder was functional constipation (n = 78, 95%) followed by infant dyschezia (n = 11, 13%). Compared to infants who did not meet the diagnostic criteria, herb intake and circumcision rates were significantly higher among those who did. Univariate analyses revealed that Infants with FGIDs were more likely to ingest herbs.

Conclusions

FGIDs were common among young infants. Functional constipation was the most commonly diagnosed FGID. Infants with with FGIDs were more likely to intake herbs to ease the symtpoms.

Impact of an antimicrobial stewardship programme on reducing broad-spectrum antibiotic use and its effect on carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitals in Jordan

OBJECTIVES

To evaluate the impact of an antimicrobial stewardship programme (ASP) on reducing broad-spectrum antibiotic use and its effect on carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitalized patients.

METHODS

The study was a retrospective, ecological assessment in a tertiary teaching hospital over 6 years (January 2014 to December 2019). The intervention involved the implementation of an ASP in February 2018, which remains in effect today. This ASP consists of several components, including education, antibiotic guidelines, antibiotic restriction policy with prior approval, audit of compliance to the restriction policy and feedback. Restricted antibiotics were imipenem/cilastatin, ertapenem, meropenem, vancomycin, teicoplanin, tigecycline, colistin, amikacin, piperacillin/tazobactam, levofloxacin and ciprofloxacin. The intervention was evaluated by time-series methods.

RESULTS

Statistically significant decreases in the level of antibiotic use, after the introduction of the ASP, were observed for the following antibiotics: imipenem/cilastatin (P = 0.0008), all carbapenems (P = 0.0001), vancomycin (P = 0.0006), colistin (P = 0.0016) and third-generation cephalosporins (P = 0.0004). A statistically significant decrease in the slope, after the introduction of the ASP, for ertapenem (P = 0.0044) and ciprofloxacin (P = 0.0117) was observed. For piperacillin/tazobactam, there was a significant increasing trend (P = 0.0208) before the introduction of the ASP. However, this increased trend was halted post-introduction of the ASP (P = 0.4574). The introduction of the ASP was associated with a significant impact on reducing the levels of CRAb (P = 0.0237).

CONCLUSIONS

The introduced antimicrobial stewardship interventions contributed to a reduction in the use of several broad-spectrum antibiotics, reversed the trends of increasing use of other antibiotics and were associated with a significant reduction in CRAb.

Identification of thresholds in relationships between specific antibiotic use and carbapenem-resistant Acinetobacter baumannii (CRAb) incidence rates in hospitalized patients in Jordan

BACKGROUND

Antibiotic resistance is a major threat to public health worldwide. The relationship between the intensity of antibiotic use and resistance might not be linear, suggesting that there might be a threshold of antibiotic use, beyond which resistance would be triggered.

OBJECTIVES

To identify thresholds in antibiotic use, below which specific antibiotic classes have no significant measurable impact on the incidence of carbapenem-resistant Acinetobacter baumannii (CRAb), but above which their use correlates with an increase in the incidence of CRAb.

METHODS

The study took place at a tertiary teaching hospital in Jordan. The study was ecological in nature and was carried out retrospectively over the period January 2014 to December 2019. The outcome time series for this study was CRAb cases. The primary explanatory variables were monthly use of antibiotics and the use of alcohol-based hand rub (ABHR). Non-linear time-series methods were used to identify thresholds in antibiotic use.

RESULTS

Non-linear time-series analysis determined a threshold in third-generation cephalosporin and carbapenem use, where the maximum use of third-generation cephalosporins and carbapenems should not exceed 8 DDD/100 occupied bed days (OBD) and 10 DDD/100 OBD, respectively. ABHR had a significant reducing effect on CRAb cases even at lower usage quantities (0.92 L/100 OBD) and had the most significant effect when ABHR exceeded 3.4 L/100 OBD.

CONCLUSIONS

The identification of thresholds, utilizing non-linear time-series methods, can provide a valuable tool to inform hospital antibiotic policies through identifying quantitative targets that balance access to effective therapies with control of resistance. Further studies are needed to validate the identified thresholds, through being prospectively adopted as a target for antimicrobial stewardship programmes, and then to evaluate the impact on reducing CRAb incidence.

Knowledge of health care workers regarding COVID-19 pandemic response plan; A study from a university affiliated hospital in Jordan

Background

The education and training of healthcare workers (HCWs) about pandemic response plans, infection control protocols (ICP), and precautions are critical for breaking the virus transmission chain. This study aimed to assess the knowledge of HCWs regarding the COVID-19 pandemic response plan and the ICP. Concomitantly, evaluating the effectiveness and impact of institutional measures, policies, and training programs.

Methods

A cross-sectional study using an electronic questionnaire was used to collect data from 267 HCWs at a University-affiliated-hospital during April 2020.

Results

In this study, 90.7% of participants were nurses and 66% were females. 60.3% of participants received specific training about caring for COVID-19 patients while at least 94.3% reviewed the pandemic response plan and ICP for COVID-19. 47.5% and 29.2% of participants provided direct care for suspected or confirmed COVID-19 patients, respectively. Between 85.7% and 100% of the participants answered all items correctly regarding the COVID-19 pandemic response plan, measures, and precautions. Furthermore, the correct answers were above 95% for each item.

Conclusion

HCWs have a high level of knowledge about the COVID-19 pandemic response plan and ICP. Training and disseminating updated plans and protocols in different methods such as an intranet and onsite training in addition to regular methods were very effective.

Brucella Septic Hip Arthritis: A Case Report

Patient: Female, 7-year-old

Final Diagnosis: Septic hip brucelosis

Symptoms: Hip pain

Medication: —

Clinical Procedure: —

Specialty: Orthopedics and Traumatology

The impact of cesarean section on neonatal outcomes at a university-based tertiary hospital in Jordan

Background

Over the past two decades, there has been a steady rise in the rate of Cesarean section delivery globally. As a result, short-term and long-term maternal and neonatal complications are rising. The objective of this study is to determine the rate and indications for Cesarean section at King Abdullah University Hospital (KAUH) in Jordan and to assess the resulting neonatal outcomes.

Methods

A retrospective chart review was conducted for all women and neonates delivered by Cesarean section during the period January 2016 to July 2017 at KAUH tertiary academic center. Collected data include demographic characteristics, indication for delivery, and neonatal outcomes such as NICU admission, respiratory complications, sepsis, mortality, and length of hospitalization.

Results

Two thousand five hundred ninety-five Cesarean section deliveries were performed over 18 months representing a rate of 50.5% of all deliveries. Sixty percent were scheduled procedures. Seventy-two percent were performed at full term gestation. The most common indication was previously scarred uterus (42.8%) followed by fetal distress (15.5%). The rate of admission to the neonatal ICU was 30% (800/2595). After multilogistic conditional regression analysis, the factors associated with increased risk of neonatal ICU admission were found to include grandmultiparity (Adjusted OR 1.46), gestational diabetes (Adjusted OR 1.92), maternal employment (Adjusted OR 1.84), prolonged rupture of membranes (Adjusted OR 5), fetal distress (Adjusted OR 1.84), prematurity (Adjusted OR 43.78), low birth weight (Adjusted OR 42), high order multiple gestation (Adjusted OR 9.58) and low 5-min APGAR score (Adjusted OR 10). Among the babies electively delivered at early term (37–38.6 weeks), 16% were admitted to the NICU for a median length of stay of 4 days (IQR 2, 8). The most common diagnoses for admitted term neonates were transient tachypnea of newborns and respiratory distress syndrome.

Conclusions

CS deliveries account for more than half the number of deliveries at our institution and almost one third of the delivered babies are admitted to the NICU. Together with the resulting maternal and neonatal consequences, this carries a major burden on the newborns, health care facilities, and involved families. Local strategies and policies should be established and implemented to improve the outcome of births.

Large Outbreak of Coronavirus Disease among Wedding Attendees, Jordan

In March 2020, a wedding in Jordan led to a large outbreak of coronavirus disease (COVID-19). We collected data on 350 wedding attendees, 76 who of whom developed COVID-19. Our study shows high communicability of COVID-19 and the enormous risk for severe acute respiratory syndrome 2 virus transmission during mass gatherings.

Inguinal hernia repair among Jordanian infants; A cohort study from a university based tertiary center

BACKGROUND

Inguinal hernia is the most common surgical procedure performed in infants. Still, there is major debate about the optimal timing of performing this procedure. The goal of this review is to determine the incidence of inguinal hernia among our infant population in Jordan, review the current practice regarding the timing of repair, and identify the risk of incarceration and postoperative apnea.

METHODS

A retrospective cohort study of chart review of infants admitted with inguinal hernia in the period 2012-2016. Data collected about demographics, timing of diagnosis, timing of repair, exploration of contralateral side, incarceration, and postoperative apnea.

RESULTS

A total of 272 infants were diagnosed with inguinal hernia. The overall incidence was 1.9%, compared with 11% among premature babies <32-week gestation. Half were term, and 23% less than 32-week gestation. Male to female ratio was 5 : 1. Of the 172 babies admitted to the neonatal ICU, only 19 cases (11%) were diagnosed during their NICU stay, and one case got repaired emergently. All cases were repaired by open herniorrhaphy. The median postconceptional age at time of repair was 49 weeks (IQR 45-55), and the median interval between diagnosis and repair was 8 days (IQR 1-17). Incarceration affected 9% and the main risk factor was >7-day delay in repair. Only one case developed apnea and required intubation postoperatively.

CONCLUSIONS

Our approach of elective inguinal hernia repair seems to be safe without increasing risk of complications like incarceration or postoperative apnea if performed within seven days following diagnosis.

Bronchiolitis clinical practice guidelines implementation: surveillance study of hospitalized children in Jordan

INTRODUCTION

Bronchiolitis is a leading cause of hospital admissions and death in young children. Clinical practice guidelines (CPG) to diagnose and manage bronchiolitis have helped healthcare providers to avoid unnecessary investigations and interventions and to provide evidence-based treatment. Aim of this study is to determine the effect of implementing CPG for the diagnosis and management of bronchiolitis in a tertiary hospital in Jordan.

METHODS

The study compared children (age <24 months) diagnosed with bronchiolitis and who required admission to King Abdullah University Hospital in Irbid during the winter of 2017 (after CPG implementation) and age-matched children admitted in the winter of 2016. The proportion of patients receiving diagnostic tests and treatments in the two groups were compared.

RESULTS

Eighty-eight and 91 patients were diagnosed with bronchiolitis before and after CPG implementation, respectively. Respiratory syncytial virus rapid antigen detection testing decreased after CPG implementation [n=64 (72.7%) vs n=46 (50.5%), p=0.002]. However, there was no significant change in terms of other diagnostic tests. The use of nebulized salbutamol [n=44 (50%) vs n=29 (31.9%), p=0.01], hypertonic saline [n=39 (44.3%) vs n=8 (8.8%), p<0.001], and inappropriate antibiotics [n=31 (35.2%) vs n=15 (16.5%), p=0.004] decreased after CPG implementation. There was no difference in mean LOS (standard deviation; SD) between the pre- and post-CPG groups [3.5(2) vs 4 (3.4) days, p=0.19]. The mean cost of stay (SD) was 449.4 (329.1) US dollars for pre-CPG compared to 507.3 (286.1) US dollars for the post-CPG group (p=0.24).

CONCLUSION

We observed that the implementation of CPG for bronchiolitis diagnosis and management helped change physicians' behavior toward evidence-based practices. However, adherence to guidelines must be emphasized to improve practices in developing countries, focusing on the rational use of diagnostic testing, and avoiding use of unnecessary medications when managing children with a diagnosis of bronchiolitis.

Community-acquired serious bacterial infections in the first 90 days of life: a revisit in the era of multi-drug-resistant organisms

BACKGROUND

Infants in the first 90 days of life are more prone to develop serious bacterial infections (SBIs). Multi-drug-resistant organisms (MDROs) are emerging as important pathogens causing SBIs. We reviewed the epidemiology of SBIs in infants 0-90 days old and compared the clinical features, laboratory values and final outcome for SBIs due to MDROs vs. non-MDROs.

METHODS

Episodes of culture-proven SBIs (bacteremia, urinary tract infections, or meningitis) with age at onset of 0-90 days during a 7-year period were retrospectively reviewed. Health care-associated infections were excluded. We collected demographics, clinical features, and laboratory and microbiology data. We compared clinical characteristics, laboratory data, microbiologic results and final outcome for SBIs due to MDROs vs. non-MDROs.

RESULTS

Ninety-four episodes (88 patients) including bacteremia (42.6%), urinary tract infections (54.3%) and meningitis (3.1%) were caused by Gram-negative bacteria (67%), and Gram-positive bacteria (33%). Escherichia coli, Klebsiella pneumoniae and GBS were the most common causes. MDROs caused SBIs in 39 patients (44.3%). SBIs due to MDROs were associated with more delay in providing targeted antimicrobial therapy compared to non-MDROs (74.4% vs. 0%, P ≤ 0.001), but no difference in case-fatality rate (12.8% vs. 12.2%, P = 1.0). Clinical features or basic laboratory values were not statistically different between the two groups.

CONCLUSIONS

The bacteriology of SBIs in the first 90 days of life is changing to include more MDROs, which causes more delay in providing targeted antimicrobial therapy. Awareness of the local epidemiology is crucial to ensure appropriate antibiotics are provided in a timely manner.

Viral Surveillance of Children with Acute Respiratory Infection in Two Main Hospitals in Northern Jordan, Irbid, during Winter of 2016

Acute lower respiratory infection (ALRI) is a major cause of morbidity and mortality worldwide. Data regarding the etiology of acute respiratory infection (ARI) is scarce in developing countries. The aim of this study was to identify the viral etiology of ARI/ALRI in hospitalized children and factors associated with increased length of stay (LoS) and severe disease presentation in Northern Jordan. This was a prospective viral surveillance study using real-time reverse transcriptase-polymerase chain reaction in children younger than 5 years admitted with ARI to two main hospitals in Northern Jordan during the winter of 2016. Nasopharyngeal swabs were obtained and tested for respiratory syncytial virus (RSV) and other viruses. Demographic and clinical characteristics of RSV-positive patients were compared with those of RSV-negative patients. There were 479 patients hospitalized with ARI. Their mean age (standard deviation) was 10.4 (11.6) months. 53.9% tested positive for at least one virus, with RSV being the most commonly detected virus (34%). Compared with RSV-negative patients, RSV-positive patients were younger, more likely to have chronic lung disease, and more likely to present with cough, rhinorrhea, difficulty in breathing, retraction, flaring, grunting, wheezing, and a higher respiratory rate. Prematurity, presence of a chronic illness, oxygen saturation < 90%, and atelectasis and consolidation on chest X-rays were significantly associated with an increased mean LoS. Patients with a history of prematurity had higher risk of severe disease (odds ratio = 2.6; 95% confidence interval: 1.5, 4.7; p  = 0.001). Compared with patients 6 months old and younger, patients aged 6.1 to 12 months were less likely to have severe disease. Human metapneumovirus (HMPV)-positive ALRI was associated with increased odds of severe disease. Viruses are recognized as etiological agent of ARI/ALRI-associated morbidity in developing countries that need more attention and implementation of targeted strategies for prevention and detection. HMPV can be a cause of severe ALRI.

Knowledge, attitudes and practices related to influenza illness and vaccination in children: Role of awareness campaigns in changing parents' attitudes toward influenza vaccination in Jordan

BACKGROUND

Influenza infection is associated with a significant health burden in children, especially in developing countries. The influenza vaccine is an important preventive strategy for flu illness. Aim of this study to assess knowledge, attitudes and practices (KAP) related to influenza illness and vaccination in children in the Jordanian population and to study the effect of awareness campaigns on changing the attitudes of parents toward vaccinating their children against influenza.

METHODS

A cross-sectional study was conducted among families visiting shopping malls and parks in November 2016. A questionnaire was administered via in-person interviews. Answers to KAP questions regarding influenza illness and vaccination were summed, with a total KAP score of 30. Facts about influenza illness and vaccination were explained to parents and provided in printed pamphlets.

RESULTS

There were 1241 respondents. 10.9% of participants had vaccinated their children during the last season 2015/2016. The mean KAP score (standard deviation) was 16.21 (4.61). People living in urban areas, with high monthly income >600 JD and healthcare workers had higher KAP scores than their counterparts. Compared to other sources of information about the influenza vaccine, health resources correlated most with vaccinating children. Awareness and educational pamphlets changed attitudes positively in 29% of parents who refused the influenza vaccine for their children.

CONCLUSIONS

Awareness about influenza illness and vaccination is insufficient, and the coverage rate of influenza vaccination in children is low in the Jordanian population. Implementing public health policies is necessary to spread knowledge about influenza illness and vaccination and to promote the practice of receiving the influenza vaccine in children. Educational campaigns are helpful in changing the attitudes of parents toward vaccinating their children against the flu.

Knowledge, practices & attitude toward antibiotics use and bacterial resistance in Jordan: A cross-sectional study

BACKGROUND

Antimicrobial resistance represents a significant public health problem worldwide. Irrational use of antibiotics is the main driving factor for the evolution of antimicrobials-resistant organisms. The aim of this study is to evaluate the areas of defects in the knowledge and practices of the community about antibiotic use.

METHODS

A cross-sectional study on a sample of 1060 randomly-selected adults residing in the North of Jordan using a pre-validated questionnaire to evaluate knowledge, practices and attitude toward antimicrobial use and misuse, as well as to assess knowledge about antimicrobial resistance.

RESULTS

Of all respondents, 41% (n = 437) stated that they have received oral antibiotics in the past two months, of which 38% acquired the antibiotics without a prescription. 32% of those who received antibiotics did not complete the recommended course of treatment. 39-54% of the sample population believe in common misconceptions/malpractices of antibiotics use. The majority (70%) of the respondents have not known about the term "antimicrobials resistance". Although people with higher education and higher income were generally more knowledgeable about appropriate antibiotics use and antimicrobial resistance, responses to some of the most important aspects in the assessment of knowledge showed no statistical difference between the different groups.

CONCLUSIONS

Our data revealed major defects in the public knowledge about appropriate antibiotics use, as well as lack of awareness on "antimicrobial resistance" problem. Awareness about appropriate antibiotic use and the serious consequences of antibiotic misuse should reach everyone in the community regardless of their educational or economic status.

Concurrent pulmonary sequestration and pulmonary hydatid cyst in a child: A case report

Pulmonary sequestration (PS) happens when an area of the lung receives its arterial blood supply from systemic circulation, resulting in a non-functional lesion (Intralobar or extralobar). Hydatid cyst results from infection of the tapeworm Echinococcus. We report a case of hydatid cyst existed concurrently with intralobar PS. A 12-year-old girl presented with recurrent hemoptysis of 2 years duration. Serology for Echinococcus granulosus was positive. CT chest suggested intralobar PS in the right middle lobe, which was surgically removed. In conclusion, recurrent localized pulmonary infections should raise the suspicion of intralobar PS which may rarely coexist with hydatid cyst.