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Kok HC, McCallum GB, Yerkovich ST, Grimwood K, Fong SM, Nathan AM, Byrnes CA, Ware RS, Nachiappan N, Saari N, Morris PS, Yeo TW, Oguoma VM, Masters IB, de Bruyne JA, Eg KP, Lee B, Ooi MH, Upham JW, Torzillo PJ, Chang AB. Twenty-four Month Outcomes of Extended- Versus Standard-course Antibiotic Therapy in Children Hospitalized With Pneumonia in High-risk Settings: A Randomized Controlled Trial. Pediatr Infect Dis J 2024; 43:872-879. [PMID: 38830139 DOI: 10.1097/inf.0000000000004407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND Pediatric community-acquired pneumonia (CAP) can lead to long-term respiratory sequelae, including bronchiectasis. We determined if an extended (13-14 days) versus standard (5-6 days) antibiotic course improves long-term outcomes in children hospitalized with CAP from populations at high risk of chronic respiratory disease. METHODS We undertook a multicenter, double-blind, superiority, randomized controlled trial involving 7 Australian, New Zealand, and Malaysian hospitals. Children aged 3 months to ≤5 years hospitalized with radiographic-confirmed CAP who received 1-3 days of intravenous antibiotics, then 3 days of oral amoxicillin-clavulanate, were randomized to either extended-course (8-day oral amoxicillin-clavulanate) or standard-course (8-day oral placebo) arms. Children were reviewed at 12 and 24 months. The primary outcome was children with the composite endpoint of chronic respiratory symptoms/signs (chronic cough at 12 and 24 months; ≥1 subsequent hospitalized acute lower respiratory infection by 24 months; or persistent and/or new chest radiographic signs at 12-months) at 24-months postdischarge, analyzed by intention-to-treat, where children with incomplete follow-up were assumed to have chronic respiratory symptoms/signs ("worst-case" scenario). RESULTS A total of 324 children were randomized [extended-course (n = 163), standard-course (n = 161)]. For our primary outcome, chronic respiratory symptoms/signs occurred in 97/163 (60%) and 94/161 (58%) children in the extended-courses and standard-courses, respectively [relative risk (RR) = 1.02, 95% confidence interval (CI): 0.85-1.22]. Among children where all sub-composite outcomes were known, chronic respiratory symptoms/signs between groups, RR = 1.10, 95% CI: 0.69-1.76 [extended-course = 27/93 (29%) and standard-course = 24/91 (26%)]. Additional sensitivity analyses also revealed no between-group differences. CONCLUSION Among children from high-risk populations hospitalized with CAP, 13-14 days of antibiotics (versus 5-6 days), did not improve long-term respiratory outcomes.
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Affiliation(s)
- Hing C Kok
- From the Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Pediatrics, Sabah Women and Children's Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Gabrielle B McCallum
- From the Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Stephanie T Yerkovich
- From the Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Keith Grimwood
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Departments of Infectious Diseases and Pediatrics, Gold Coast Health, Gold Coast, Queensland,, Australia
| | - Siew M Fong
- Department of Pediatrics, Sabah Women and Children's Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Anna M Nathan
- Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Catherine A Byrnes
- Department of Pediatrics, University of Auckland, Auckland, New Zealand
- Respiratory Department, Starship Children's Hospital, Auckland, New Zealand
| | - Robert S Ware
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Nachal Nachiappan
- Department of Pediatrics, Tengku Ampuan Rahimah Hospital, Klang, Selangor, Malaysia
| | - Noorazlina Saari
- Department of Pediatrics, Tengku Ampuan Rahimah Hospital, Klang, Selangor, Malaysia
| | - Peter S Morris
- From the Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Pediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Tsin W Yeo
- From the Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Victor M Oguoma
- From the Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
| | - I Brent Masters
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | | | - Kah P Eg
- Department of Pediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Bilawara Lee
- From the Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- First Nations Leadership & Engagement, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Mong H Ooi
- Department of Pediatrics, Sarawak General Hospital, Sarawak, Malaysia
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - John W Upham
- Diamantina Institute, The University of Queensland, and Translational Research Institute, Brisbane, Queensland, Australia
| | - Paul J Torzillo
- Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Anne B Chang
- From the Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Extended Versus Standard Antibiotic Course Duration in Children <5 Years of Age Hospitalized With Community-acquired Pneumonia in High-risk Settings: Four-week Outcomes of a Multicenter, Double-blind, Parallel, Superiority Randomized Controlled Trial. Pediatr Infect Dis J 2022; 41:549-555. [PMID: 35476706 DOI: 10.1097/inf.0000000000003558] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND High-level evidence is limited for antibiotic duration in children hospitalized with community-acquired pneumonia (CAP) from First Nations and other at-risk populations of chronic respiratory disorders. As part of a larger study, we determined whether an extended antibiotic course is superior to a standard course for achieving clinical cure at 4 weeks in children 3 months to ≤5 years old hospitalized with CAP. METHODS In our multinational (Australia, New Zealand, Malaysia), double-blind, superiority randomized controlled trial, children hospitalized with uncomplicated, radiographic-confirmed, CAP received 1-3 days of intravenous antibiotics followed by 3 days of oral amoxicillin-clavulanate (80 mg/kg, amoxicillin component, divided twice daily) and then randomized to extended (13-14 days duration) or standard (5-6 days) antibiotics. The primary outcome was clinical cure (complete resolution of respiratory symptoms/signs) 4 weeks postenrollment. Secondary outcomes included adverse events, nasopharyngeal bacterial pathogens and antimicrobial resistance at 4 weeks. RESULTS Of 372 children enrolled, 324 fulfilled the inclusion criteria and were randomized. Using intention-to-treat analysis, between-group clinical cure rates were similar (extended course: n = 127/163, 77.9%; standard course: n = 131/161, 81.3%; relative risk = 0.96, 95% confidence interval = 0.86-1.07). There were no significant between-group differences for adverse events (extended course: n = 43/163, 26.4%; standard course, n = 32/161, 19.9%) or nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus or antimicrobial resistance. CONCLUSIONS Among children hospitalized with pneumonia and at-risk of chronic respiratory illnesses, an extended antibiotic course was not superior to a standard course at achieving clinical cure at 4 weeks. Additional research will identify if an extended course provides longer-term benefits.
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Loto‐Aso E, Howie SRC, Grant CC. Childhood pneumonia in New Zealand. J Paediatr Child Health 2022; 58:752-757. [PMID: 35244959 PMCID: PMC9311843 DOI: 10.1111/jpc.15941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/30/2022]
Abstract
While deaths from pneumonia during childhood in New Zealand (NZ) are now infrequent, childhood pneumonia remains a significant cause of morbidity. In this viewpoint, we describe pneumonia epidemiology in NZ and identify modifiable risk factors. During recent decades, pneumonia hospitalisation rates decreased, attributable in part to inclusion of pneumococcal conjugate vaccine in NZ's immunisation schedule. Irrespective of these decreases, pneumonia hospitalisation rates are four times higher for Pacific and 60% higher for Māori compared with children of other ethnic groups. Consistent with other developed countries, hospitalisation rates for pneumonia with pleural empyema increased in NZ during the 2000s. Numerous factors contribute to childhood pneumonia acquisition, hospitalisation and morbidity in NZ include poor quality living environments, malnutrition during pregnancy and early childhood, incomplete and delayed vaccination during pregnancy and childhood and variable primary and secondary care management. To reduce childhood pneumonia disease burden, interventions should focus on addressing modifiable risk factors for pneumonia. These include using non-polluting forms of household heating; decreasing cigarette smoke exposure; reducing household acute respiratory infection transmission; improving dietary nutritional content and nutrition during pregnancy and early childhood; breastfeeding promotion; vaccination during pregnancy and childhood and improving the quality of and decreasing the variance in primary and secondary care management of pneumonia.
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Affiliation(s)
- Eseta Loto‐Aso
- Kidz First Neonatal CareCounties Manukau District Health BoardAucklandNew Zealand
| | - Stephen RC Howie
- Department of Paediatrics: Child & Youth HealthUniversity of AucklandAucklandNew Zealand,Child, Women and Family ServicesWaitematā District Health BoardAucklandNew Zealand
| | - Cameron C Grant
- Child, Women and Family ServicesWaitematā District Health BoardAucklandNew Zealand,General Paediatrics, Starship Children's HospitalAuckland District Health BoardAucklandNew Zealand
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Distribution and Drug Resistance of Bacterial Pathogens Associated with Lower Respiratory Tract Infection in Children and the Effect of COVID-19 on the Distribution of Pathogens. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2022; 2022:1181283. [PMID: 35368516 PMCID: PMC8965734 DOI: 10.1155/2022/1181283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/26/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022]
Abstract
By studying the distribution and drug resistance of bacterial pathogens associated with lower respiratory tract infection (LRTI) in children in Chengdu and the effect of the COVID-19 on the distribution of pathogens and by analyzing the epidemic trend and drug resistance changes of the main pathogens of LRTI, this research is supposed to provide a useful basis for the prevention of LRTI in children and the rational use of drugs in clinical practice. Hospitalized children clinically diagnosed with LRTI in Chengdu Women and Children's Central Hospital from 2011 to 2020 were selected as the study subjects. The pathogens of LRTI in children and the distribution of pathogens in different ages, genders, seasons, years, and departments and before and after the pandemic situation of COVID-19 were counted. The drug resistance distribution of the top six pathogens with the highest infection rate in the past three years and the trend of drug resistance in the past decade were analyzed. A total of 26,469 pathogens were isolated. Among them, 6240 strains (23.6%) were Gram-positive bacteria, 20152 strains (76.1%) were Gram-negative bacteria, and 73 strains (0.3%) were fungi. Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, and Staphylococcus aureus were highly isolated in the group of infants aged 0-1 (P < 0.01), Moraxella catarrhalis and Streptococcus pneumoniae were highly isolated in children aged 1–6 (P < 0.01), and Haemophilus influenzae was highly isolated in children over 1 (P < 0.01). The isolation rates of Enterobacteriaceae, Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Staphylococcus aureus, and Candida albicans in the lower respiratory tract of 0-1 year-old male infants were higher than those of female infants (p < 0.05). Haemophilus influenzae was highly isolated in spring and summer, and Moraxella catarrhalis was highly isolated in autumn and winter, while the infection of Streptococcus pneumoniae was mainly concentrated in winter. This difference was statistically significant (P < 0.01). Affected by the COVID-19 pandemic, the isolation rates of Haemophilus influenzae and Streptococcus pneumoniae were significantly lower than those before the pandemic, and the isolation rate of Moraxella catarrhalis was significantly higher. The difference was statistically significant (P < 0.01). The proportion of isolated negative bacteria in NICU and PICU was higher than that in positive bacteria, and the infection rates of Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, and Acinetobacter baumannii were higher than those in other departments. The differences were statistically significant (P < 0.01). The results of drug sensitivity test showed that the drug resistance of Haemophilus influenzae and Moraxella catarrhalis was mainly concentrated in Ampicillin, First- and Second-generation cephalosporins, and Cotrimoxazole, with stable sensitivity to Third-generation cephalosporins, while the drug resistance of Streptococcus pneumoniae was concentrated in Macrolides, Sulfonamides, and Tetracyclines, with stable sensitivity to Penicillin. Staphylococcus aureus is highly resistant to penicillins and macrolides and susceptible to vancomycin. Enterobacteriaceae resistance is concentrated in cephalosporins, with a low rate of carbapenem resistance. From 2018 to 2020, 1557 strains of Staphylococcus aureus were isolated, of which 416 strains were MRSA, accounting for 27% of the isolates; 1064 strains of Escherichia coli were isolated, of which 423 strains were ESBL and 23 strains were CRE, accounting for 40% and 2% of the isolates, respectively; and 1400 strains of Klebsiella pneumoniae were isolated, of which 385 strains were ESBL and 402 strains were CRE, accounting for 28% and 29% of the isolates, respectively. Since 2011, the resistance of Escherichia coli and Klebsiella pneumoniae to Third-generation cephalosporins has increased, peaking in 2017, and has decreased after 2018, years after which carbapenem resistance has increased significantly, corresponding to an increase in the detection rate of Carbapenem-resistant Enterobacteriaceae CRE. Findings from this study revealed that there are significant differences in community-associated infectious pathogens before and after the COVID-19 pandemic, and there are significant age differences, seasonal epidemic trends, and high departmental correlation of pathogens related to lower respiratory tract disease infection in children. There was a significant gender difference in the isolation rate of pathogens associated with LRTI in infants under one year. Vaccination, implementation of isolation measures and social distance, strengthening of personal protective measures, aseptic operation of invasive medical treatment, hand hygiene, and environmental disinfection are beneficial to reducing community-associated pathogen infection, opportunistic pathogen infection, and an increase in resistant bacteria. The strengthening of bacterial culture of lower respiratory tract samples by pediatricians is conducive to the diagnosis of respiratory tract infections caused by different pathogens, contributing to the selection of effective drugs for treatment according to drug susceptibility results, which is important for the rational use of antibiotics and curbing bacterial resistance.
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Shao J, Hassouna A, Wang Y, Zhang R, Zhen L, Li R, Chen M, Liu C, Wang X, Zhang M, Wang P, Yuan S, Chen J, Lu J. Next-generation sequencing as an advanced supplementary tool for the diagnosis of pathogens in lower respiratory tract infections: An observational trial in Xi'an, China. Biomed Rep 2021; 16:14. [PMID: 35070298 PMCID: PMC8764650 DOI: 10.3892/br.2021.1497] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/07/2021] [Indexed: 11/06/2022] Open
Abstract
The application of next-generation sequencing (NGS) in routine clinical analysis is still limited. The significance of NGS in the identification of pathogens of lower respiratory tract infection should be assessed as part of routine clinical bacterial examinations and chest imaging results. In the present study, the alveolar lavage fluid samples of 30 patients (25 males and 5 females, aged 19-92 years old, with a median age of 62) were examined by routine bacterial culture and NGS, and the results of pathogen detection and identification were compared. Chest imaging showed consolidation in all 30 patients (100%), and pleural effusion in 13 of the 30 patients (43.33%). The routine bacterial culture of the lavage solution was only positive in 14 of the 30 patients (46.6%), and negative in 16 patients (53.33%). However, the positive rate of NGS test results of the lavage fluid was 100%. A total of 12 cases (40%) were completely consistent with the routine bacterial culture test, with 56 other pathogens of mixed infection detected, accounting for the short comings of the routine bacterial examination. Although NGS cannot distinguish between live and dead bacteria, it is still a useful detection technology for accurate diagnosis of clinical infectious diseases. It is worthy of adaptation in the clinic for more effective clinical management and treatment of the lower respiratory airway infection in addition to the routine bacterial culture testing.
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Affiliation(s)
- Jie Shao
- Norinco 521 Hospital, Xi'an, Shaanxi 710065, P.R. China
| | - Amira Hassouna
- School of Public Health and Interdisciplinary Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 0622, New Zealand
| | - Yaqin Wang
- Norinco 521 Hospital, Xi'an, Shaanxi 710065, P.R. China
| | - Ruirui Zhang
- Norinco 521 Hospital, Xi'an, Shaanxi 710065, P.R. China
| | - Lifang Zhen
- Norinco 521 Hospital, Xi'an, Shaanxi 710065, P.R. China
| | - Ruidan Li
- Norinco 521 Hospital, Xi'an, Shaanxi 710065, P.R. China
| | - Mingli Chen
- Norinco 521 Hospital, Xi'an, Shaanxi 710065, P.R. China
| | - Chengjie Liu
- Norinco 521 Hospital, Xi'an, Shaanxi 710065, P.R. China
| | - Xiangye Wang
- Norinco 521 Hospital, Xi'an, Shaanxi 710065, P.R. China
| | | | - Peng Wang
- Norinco 521 Hospital, Xi'an, Shaanxi 710065, P.R. China
| | - Shenghua Yuan
- Norinco 521 Hospital, Xi'an, Shaanxi 710065, P.R. China
| | - Jie Chen
- Guangzhou Sagene Biotech Co., Ltd., Guangzhou, Guangdong 510320, P.R. China
| | - Jun Lu
- School of Public Health and Interdisciplinary Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 0622, New Zealand
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McBride-Henry K, Miller C, Trenholm A, Officer TN. 'You have to do what is best': The lived reality of having a child who is repeatedly hospitalized because of acute lower respiratory infection. Health Expect 2021; 25:466-475. [PMID: 34931416 PMCID: PMC8849375 DOI: 10.1111/hex.13408] [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: 09/05/2021] [Revised: 11/04/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Hospitalization of children is traumatic for children and their families. Little is known about the impact of repeated acute admissions on families, or of these experiences in Indigenous populations and ethnic minorities. This study explores the societal and health experiences for families who have a child under two years of age, admitted to hospitals more than twice for lower respiratory infections. Methods Underpinned by a reflective lifeworld research methodology, this article presents results from 14 in‐depth interviews in Aotearoa/New Zealand. Results Families learn to identify illness early and then navigate hospital systems. These families struggle to create safe spaces for their children at home or in society. Wider social and economic support are central to family resilience, without which they struggle. Conclusion This study reinforces the importance of bringing meaningful, culturally‐responsive care to the fore of treatment, particularly when managing vulnerable minorities. Formal referral and support processes are key to this responsiveness to lessen the burdens of acute admissions for families. Patient or Public Contribution Families chose to be involved in this study to highlight the importance of the topic and their experiences with accessing health care. The cultural advisors to the project provided feedback on the analysis and its applicability for the participant community.
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Affiliation(s)
- Karen McBride-Henry
- School of Nursing, Midwifery and Health Practice, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Charissa Miller
- Kidz First Hospital, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Adrian Trenholm
- Kidz First Hospital, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.,Paediatrics, Child and Youth Health, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tara N Officer
- Health Services Research Centre, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
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Duan N, Du J, Huang C, Li H. Microbial Distribution and Antibiotic Susceptibility of Lower Respiratory Tract Infections Patients From Pediatric Ward, Adult Respiratory Ward, and Respiratory Intensive Care Unit. Front Microbiol 2020; 11:1480. [PMID: 32695092 PMCID: PMC7338583 DOI: 10.3389/fmicb.2020.01480] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Lower respiratory tract infections (LRTIs) account for significant morbidity and mortality in patients admitted to hospitals worldwide, especially in children and elderly. The prevalent microorganisms and antibiotic susceptibility were investigated among LRTI patients from the pediatric ward, adult respiratory ward, and respiratory intensive care unit (RICU) in order to achieve more efficient treatment protocols and better recovery. Methods In this retrospective cross-sectional study (January 2016 to December 2019), 4,161 positive culture samples out of 18,798 different specimens (9,645 respiratory tract samples and 9,153 blood samples) from LRTI patients were analyzed for pathogen incidence and antibiotic sensitivity. Results Among the respiratory tract cultures, the frequency of Gram-negative bacterial strains was higher than Gram-positive bacterial strains. Pseudomonas aeruginosa was the dominant pathogen in both the adult respiratory ward (n = 156, 21.49%) and RICU (n = 975, 35.67%), whereas Staphylococcus aureus (n = 66, 19.19%) was the most common bacterium in the pediatric ward. Among the blood cultures, Gram-positive bacteria remained the major microorganisms involved in LRTIs, and the most frequent pathogen was Staphylococcus epidermidis (n = 59, 47.20%) in the pediatric ward and Staphylococcus aureus (n = 10, 21.8%) in adult respiratory ward. However, Gram-negative bacteria were the main pathogens in the RICU, of which Klebsiella pneumoniae (n = 51, 27.57%) is the most prevalent. Pseudomonas aeruginosa of LRTI patients remained highly susceptible (>70%) to routine antibiotics in pediatric ward. However, it only had high susceptibility to amikacin, tobramycin, gentamicin in both the adult respiratory ward and RICU and its antibiotic sensitivity to meropenem and imipenem was moderate in the adult respiratory ward and mild (<30%) in the RICU. Staphylococcus aureus isolated from LRTI patients was highly susceptible to linezolid, daptomycin, teicoplanin, vancomycin, tigecycline, rifampicin, and trimethoprim/sulfamethoxazole in all three wards, moderately susceptible to gentamicin in both the adult respiratory ward and RICU and to clindamycin, oxacillin, moxifloxacin only in the adult respiratory ward. Conclusions Microbial distribution and their patterns of antibiotic susceptibility revealed a high divergence among LRTI patients admitted to different wards in this hospital. Thus, different antibiotic therapies should be considered for distinct age groups.
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Affiliation(s)
- Nan Duan
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Jialin Du
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Chenwei Huang
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Haixia Li
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
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Byrnes CA, Trenholme A, Lawrence S, Aish H, Higham JA, Hoare K, Elborough A, McBride C, Le Comte L, McIntosh C, Chan Mow F, Jaksic M, Metcalfe R, Coomarasamy C, Leung W, Vogel A, Percival T, Mason H, Stewart J. Prospective community programme versus parent-driven care to prevent respiratory morbidity in children following hospitalisation with severe bronchiolitis or pneumonia. Thorax 2020; 75:298-305. [PMID: 32094154 PMCID: PMC7231446 DOI: 10.1136/thoraxjnl-2019-213142] [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] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 12/07/2019] [Accepted: 01/10/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hospitalisation with severe lower respiratory tract infection (LRTI) in early childhood is associated with ongoing respiratory symptoms and possible later development of bronchiectasis. We aimed to reduce this intermediate respiratory morbidity with a community intervention programme at time of discharge. METHODS This randomised, controlled, single-blind trial enrolled children aged <2 years hospitalised for severe LRTI to 'intervention' or 'control'. Intervention was three monthly community clinics treating wet cough with prolonged antibiotics referring non-responders. All other health issues were addressed, and health resilience behaviours were encouraged, with referrals for housing or smoking concerns. Controls followed the usual pathway of parent-initiated healthcare access. After 24 months, all children were assessed by a paediatrician blinded to randomisation for primary outcomes of wet cough, abnormal examination (crackles or clubbing) or chest X-ray Brasfield score ≤22. FINDINGS 400 children (203 intervention, 197 control) were enrolled in 2011-2012; mean age 6.9 months, 230 boys, 87% Maori/Pasifika ethnicity and 83% from the most deprived quintile. Final assessment of 321/400 (80.3%) showed no differences in presence of wet cough (33.9% intervention, 36.5% controls, relative risk (RR) 0.93, 95% CI 0.69 to 1.25), abnormal examination (21.7% intervention, 23.9% controls, RR 0.92, 95% CI 0.61 to 1.38) or Brasfield score ≤22 (32.4% intervention, 37.9% control, RR 0.85, 95% CI 0.63 to 1.17). Twelve (all intervention) were diagnosed with bronchiectasis within this timeframe. INTERPRETATION We have identified children at high risk of ongoing respiratory disease following hospital admission with severe LRTI in whom this intervention programme did not change outcomes over 2 years. TRIAL REGISTRATION NUMBER ACTRN12610001095055.
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Affiliation(s)
- Catherine Ann Byrnes
- Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Paediatric Respiratory Department, Starship Children's Health, Auckland, New Zealand
| | - Adrian Trenholme
- Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Department of Paediatrics, KidzFirst Hospital Middlemore, Auckland, New Zealand
| | - Shirley Lawrence
- Department of Paediatrics, KidzFirst Hospital Middlemore, Auckland, New Zealand
| | - Harley Aish
- Otara Family and Christian Health Centre, Otara, Auckland, New Zealand
| | | | - Karen Hoare
- Greenstone Family Clinic, Manurewa, Auckland, New Zealand
| | | | - Charissa McBride
- Department of Paediatrics, KidzFirst Hospital Middlemore, Auckland, New Zealand
| | - Lyndsay Le Comte
- Counties Manukau District Health Board, Middlemore Clinical Trials Unit, Auckland, New Zealand
| | - Christine McIntosh
- Department of Paediatrics, KidzFirst Hospital Middlemore, Auckland, New Zealand
| | - Florina Chan Mow
- Department of Paediatrics, KidzFirst Hospital Middlemore, Auckland, New Zealand
| | - Mirjana Jaksic
- Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Paediatric Respiratory Department, Starship Children's Health, Auckland, New Zealand
- Department of Paediatrics, KidzFirst Hospital Middlemore, Auckland, New Zealand
| | - Russell Metcalfe
- Department of Radiology, Starship Children's Health, Auckland, New Zealand
| | | | - William Leung
- Department of Health Economy, Wellington School of Medicine, University of Otago, Wellington, New Zealand
| | - Alison Vogel
- Department of Paediatrics, KidzFirst Hospital Middlemore, Auckland, New Zealand
| | - Teuila Percival
- Department of Paediatrics, KidzFirst Hospital Middlemore, Auckland, New Zealand
| | - Henare Mason
- Koawatea, Middlemore Hospital, Auckland, New Zealand
| | - Joanna Stewart
- Department of Population Health, The University of Auckland, Auckland, New Zealand
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Nathan AM, Teh CSJ, Eg KP, Jabar KA, Zaki R, Hng SY, Westerhout C, Thavagnanam S, de Bruyne JA. Respiratory sequelae and quality of life in children one-year after being admitted with a lower respiratory tract infection: A prospective cohort study from a developing country. Pediatr Pulmonol 2020; 55:407-417. [PMID: 31846223 DOI: 10.1002/ppul.24598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/29/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Respiratory tract infections in children can result in respiratory sequelae. We aimed to determine the prevalence of, and factors associated with persistent respiratory sequelae 1 year after admission for a lower respiratory tract infection (LRTI). METHODOLOGY This prospective cohort study involved children 1 month to 5-years-old admitted with an LRTI. Children with asthma were excluded. Patients were reviewed at 1-, 6-, and 12-months post-hospital discharge. The parent cough-specific quality of life, the depression, anxiety, and stress scale questionnaire and cough diary for 1 month, were administered. Outcomes reviewed were number of unscheduled healthcare visits, respiratory symptoms and final respiratory diagnosis at 6 and/or 12 month-review by pediatric pulmonologists. RESULTS Three hundred patients with a mean ± SD age of 14 ± 15 months old were recruited. After 1 month, 239 (79.7%) returned: 28.5% (n = 68/239) had sought medical advice and 18% (n = 43/239) had cough at clinic review. Children who received antibiotics in hospital had significantly lower total cough scores (P = .005) as per the cough diary. After 1 year, 26% (n = 78/300) had a respiratory problem, predominantly preschool wheezing phenotype (n = 64/78, 82.1%). Three children had bronchiectasis or bronchiolitis obliterans. The parent cough-specific quality of life (PCQOL) was significantly lower in children with respiratory sequelae (P < .01). In logistic regression, the use of antibiotics in hospitals (adjusted odds ratio, 0.46; P = .005) was associated with reduced risk of respiratory sequelae. CONCLUSION In children admitted for LRTI, a quarter had respiratory sequelae, of which preschool wheeze was the commonest. The use of antibiotics was associated with a lower risk of respiratory sequelae.
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Affiliation(s)
- Anna M Nathan
- Department of Paediatrics, University Malaya, Kuala Lumpur, Malaysia.,Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
| | - Cindy S J Teh
- Department of Microbiology, University Malaya, Kuala Lumpur, Malaysia
| | - Kah Peng Eg
- Department of Paediatrics, University Malaya, Kuala Lumpur, Malaysia.,Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
| | - Kartini A Jabar
- Department of Microbiology, University Malaya, Kuala Lumpur, Malaysia
| | - Rafdzah Zaki
- Department of Social & Preventive Medicine, Centre for Epidemiology and Evidence-Based Practice, Kuala Lumpur, Malaysia
| | - Shih Ying Hng
- Department of Paediatrics, University Malaya, Kuala Lumpur, Malaysia
| | - Caroline Westerhout
- Department of Biomedical Imaging, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Surendran Thavagnanam
- Department of Paediatrics, University Malaya, Kuala Lumpur, Malaysia.,Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
| | - Jessie A de Bruyne
- Department of Paediatrics, University Malaya, Kuala Lumpur, Malaysia.,Child Health Research Group, University Malaya, Kuala Lumpur, Malaysia
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10
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McBride-Henry K, Miller C, Trenholm A, Officer TN. Occupying 'in-hospitable' spaces: Parental/primary-caregiver perceptions of the impact of repeated hospitalisation in children under two years of age. PLoS One 2020; 15:e0228354. [PMID: 31999770 PMCID: PMC6992218 DOI: 10.1371/journal.pone.0228354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/13/2020] [Indexed: 11/18/2022] Open
Abstract
The experience of having a child hospitalised is stressful and disrupts families in myriad ways; however, the experiences of parents/caregivers who encounter repeated admissions of a child with acute lower respiratory infections are under-researched. This project aims to explore these experiences, from a qualitative perspective, using the philosophical tenets of reflective lifeworld research. The research included 14 face-to-face interviews with parents, grandparents, or primary caregivers, of children who, whilst under two years of age, were admitted to hospital multiple times with a lower respiratory infection diagnosis. Many of the participants were from Māori or Samoan ethnic backgrounds. The findings of this single site study revealed that these parents/caregivers' experiences were characterised by feelings of powerlessness, offering descriptions of hospitals as harsh and difficult places to reside, they are 'in-hospitable'. The findings suggest that repeated hospitalisations created a cycle of stressful experiences that impacted both familial relationships and interactions with society. This study draws attention to this previously obscured population group, and calls health care practitioners and policy advisors to engage differently over issues involving families in similar positions.
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Affiliation(s)
- Karen McBride-Henry
- School of Nursing, Midwifery, and Health Practice, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
- Health Services Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Charissa Miller
- School of Nursing, Midwifery, and Health Practice, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
- Kidz First Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Adrian Trenholm
- Kidz First Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Tara N. Officer
- Health Services Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
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11
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Chang AB, Fong SM, Yeo TW, Ware RS, McCallum GB, Nathan AM, Ooi MH, de Bruyne J, Byrnes CA, Lee B, Nachiappan N, Saari N, Torzillo P, Smith-Vaughan H, Morris PS, Upham JW, Grimwood K. HOspitalised Pneumonia Extended (HOPE) Study to reduce the long-term effects of childhood pneumonia: protocol for a multicentre, double-blind, parallel, superiority randomised controlled trial. BMJ Open 2019; 9:e026411. [PMID: 31023759 PMCID: PMC6502017 DOI: 10.1136/bmjopen-2018-026411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/06/2018] [Accepted: 01/08/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Early childhood pneumonia is a common problem globally with long-term complications that include bronchiectasis and chronic obstructive pulmonary disease. It is biologically plausible that these long-term effects may be minimised in young children at increased risk of such sequelae if any residual lower airway infection and inflammation in their developing lungs can be treated successfully by longer antibiotic courses. In contrast, shortened antibiotic treatments are being promoted because of concerns over inducing antimicrobial resistance. Nevertheless, the optimal treatment duration remains unknown. Outcomes from randomised controlled trials (RCTs) on paediatric pneumonia have focused on short-term (usually <2 weeks) results. Indeed, no long-term RCT-generated outcome data are available currently. We hypothesise that a longer antibiotic course, compared with the standard treatment course, reduces the risk of chronic respiratory symptoms/signs or bronchiectasis 24 months after the original pneumonia episode. METHODS AND ANALYSIS This multicentre, parallel, double-blind, placebo-controlled randomised trial involving seven hospitals in six cities from three different countries commenced in May 2016. Three-hundred-and-fourteen eligible Australian Indigenous, New Zealand Māori/Pacific and Malaysian children (aged 0.25 to 5 years) hospitalised for community-acquired, chest X-ray (CXR)-proven pneumonia are being recruited. Following intravenous antibiotics and 3 days of amoxicillin-clavulanate, they are randomised (stratified by site and age group, allocation-concealed) to receive either: (i) amoxicillin-clavulanate (80 mg/kg/day (maximum 980 mg of amoxicillin) in two-divided doses or (ii) placebo (equal volume and dosing frequency) for 8 days. Clinical data, nasopharyngeal swab, bloods and CXR are collected. The primary outcome is the proportion of children without chronic respiratory symptom/signs of bronchiectasis at 24 months. The main secondary outcomes are 'clinical cure' at 4 weeks, time-to-next respiratory-related hospitalisation and antibiotic resistance of nasopharyngeal respiratory bacteria. ETHICS AND DISSEMINATION The Human Research Ethics Committees of all the recruiting institutions (Darwin: Northern Territory Department of Health and Menzies School of Health Research; Auckland: Starship Children's and KidsFirst Hospitals; East Malaysia: Likas Hospital and Sarawak General Hospital; Kuala Lumpur: University of Malaya Research Ethics Committee; and Klang: Malaysian Department of Health) have approved the research protocol version 7 (13 August 2018). The RCT and other results will be submitted for publication. TRIAL REGISTRATION ACTRN12616000046404.
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Affiliation(s)
- Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin Univ, Darwin, Northern Territory, Australia
- Qld Children's Hospital, Brisbane, Queensland, Australia
| | | | - Tsin Wen Yeo
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Robert S Ware
- School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Gabrielle B McCallum
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Mong H Ooi
- Universiti Malaysia Sarawak, Kuching, Malaysia
| | | | | | - Bilawara Lee
- Charles Darwin University, Darwin, Northern Territory, Australia
| | | | | | - Paul Torzillo
- Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Heidi Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Peter S Morris
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - John W Upham
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Keith Grimwood
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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12
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Hare KM, Leach AJ, Smith-Vaughan HC, Chang AB, Grimwood K. Streptococcus pneumoniae and chronic endobronchial infections in childhood. Pediatr Pulmonol 2017; 52:1532-1545. [PMID: 28922566 DOI: 10.1002/ppul.23828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/06/2017] [Indexed: 01/03/2023]
Abstract
Streptococcus pneumoniae (pneumococcus) is the main cause of bacterial pneumonia worldwide and has been studied extensively in this context. However, its role in chronic endobronchial infections and accompanying lower airway neutrophilic infiltration has received little attention. Severe and recurrent pneumonia are risk factors for chronic suppurative lung disease (CSLD) and bronchiectasis; the latter causes considerable morbidity and, in some populations, premature death in children and adults. Protracted bacterial bronchitis (PBB) is another chronic endobronchial infection associated with substantial morbidity. In some children, PBB may progress to bronchiectasis. Although nontypeable Haemophilus influenzae is the main pathogen in PBB, CSLD and bronchiectasis, pneumococci are isolated commonly from the lower airways of children with these diagnoses. Here we review what is known currently about pneumococci in PBB, CSLD and bronchiectasis, including the importance of pneumococcal nasopharyngeal colonization and how persistence in the lower airways may contribute to the pathogenesis of these chronic pulmonary disorders. Antibiotic treatments, particularly long-term azithromycin therapy, are discussed together with antibiotic resistance and the impact of pneumococcal conjugate vaccines. Important areas requiring further investigation are identified, including immune responses associated with pneumococcal lower airway infection, alone and in combination with other respiratory pathogens, and microarray serotyping to improve detection of carriage and infection by multiple serotypes. Genome wide association studies of pneumococci from the upper and lower airways will help identify virulence and resistance determinants, including potential therapeutic targets and vaccine antigens to treat and prevent endobronchial infections. Much work is needed, but the benefits will be substantial.
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Affiliation(s)
- Kim M Hare
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia.,Department of Respiratory Medicine, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Keith Grimwood
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Gold Coast Health, Gold Coast, Queensland, Australia
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13
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Basnayake TL, Morgan LC, Chang AB. The global burden of respiratory infections in indigenous children and adults: A review. Respirology 2017; 22:1518-1528. [PMID: 28758310 DOI: 10.1111/resp.13131] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/10/2017] [Accepted: 05/22/2017] [Indexed: 01/07/2023]
Abstract
This review article focuses on common lower respiratory infections (LRIs) in indigenous populations in both developed and developing countries, where data is available. Indigenous populations across the world share some commonalities including poorer health and socio-economic disadvantage compared with their non-indigenous counterparts. Generally, acute and chronic respiratory infections are more frequent and more severe in both indigenous children and adults, often resulting in substantial consequences including higher rates of bronchiectasis and poorer outcomes for patients with chronic obstructive pulmonary disease (COPD). Risk factors for the development of respiratory infections require recognition and action. These risk factors include but are not limited to socio-economic factors (e.g. education, household crowding and nutrition), environmental factors (e.g. smoke exposure and poor access to health care) and biological factors. Risk mitigation strategies should be delivered in a culturally appropriate manner and targeted to educate both individuals and communities at risk. Improving the morbidity and mortality of respiratory infections in indigenous people requires provision of best practice care and awareness of the scope of the problem by healthcare practitioners, governing bodies and policy makers.
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Affiliation(s)
- Thilini L Basnayake
- Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,School of Medicine, Flinders University, Darwin, Northern Territory, Australia
| | - Lucy C Morgan
- Department of Respiratory Medicine, Concord Hospital, Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Queensland University of Technology, Children's Health Queensland, Brisbane, Queensland, Australia
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14
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Trenholme AA, Best EJ, Vogel AM, Stewart JM, Miller CJ, Lennon DR. Respiratory virus detection during hospitalisation for lower respiratory tract infection in children under 2 years in South Auckland, New Zealand. J Paediatr Child Health 2017; 53:551-555. [PMID: 28430397 DOI: 10.1111/jpc.13529] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 11/17/2016] [Accepted: 12/03/2016] [Indexed: 11/29/2022]
Abstract
AIM To describe respiratory virus detection in children under 2 years of age in a population admitted with lower respiratory infection and to assess correlation with measures of severity. METHODS Nasopharyngeal aspirates from infants admitted with lower respiratory tract infection (n = 1645) over a 3-year time period were tested by polymerase chain reaction. We collected epidemiological and clinical data on all children. We assessed the correlation of presence of virus with length of hospital stay, intensive care admission and consolidation on chest X-ray. RESULTS Of the children admitted 34% were Maori, 43% Pacific and 75% lived in areas in the bottom quintile for socio-economic deprivation. A virus was found in 94% of those tested including 30% with multiple viruses. Picornavirus was present in 59% including 34% as the sole virus. Respiratory syncytial virus was found in 39%. Virus co-detection was not associated with length of stay, chest X-ray changes or intensive care unit admission. CONCLUSION In this disadvantaged predominately Maori and Pacific population, picornavirus is commonly found as a sole virus, respiratory syncytial virus is frequent but immunisation preventable influenza is infrequent. We did not find that co-detection of viruses was linked to severity.
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Affiliation(s)
- Adrian A Trenholme
- Kidz First, Counties Manukau District Health Board, Auckland, New Zealand
| | - Emma J Best
- Department of Paediatrics, University of Auckland, Auckland, New Zealand.,Paediatric Infectious Diseases Department, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Alison M Vogel
- Kidz First, Counties Manukau District Health Board, Auckland, New Zealand
| | - Joanna M Stewart
- Faculty of Medicine and Health Science, University of Auckland, Auckland, New Zealand
| | - Charissa J Miller
- Kidz First, Counties Manukau District Health Board, Auckland, New Zealand
| | - Diana R Lennon
- Kidz First, Counties Manukau District Health Board, Auckland, New Zealand.,Department of Paediatrics, University of Auckland, Auckland, New Zealand.,Paediatric Infectious Diseases Department, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
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15
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Hare KM, Smith-Vaughan HC, Chang AB, Pizzutto S, Petsky HL, McCallum GB, Leach AJ. Propensity of pneumococcal carriage serotypes to infect the lower airways of children with chronic endobronchial infections. Vaccine 2017; 35:747-756. [PMID: 28062125 DOI: 10.1016/j.vaccine.2016.12.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/05/2016] [Accepted: 12/22/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic endobronchial infections in children are responsible for a high disease burden. Streptococcus pneumoniae is frequently isolated; however, few publications have described serotypes associated with non-invasive lower airway infection. METHODS Paired nasopharyngeal (NP) swabs and bronchoalveolar lavage (BAL) fluids were collected from children undergoing bronchoscopy for chronic cough. NP swabs were also collected from asymptomatic children in otitis media surveillance studies (controls). Specimens were processed and lower airway infection defined (⩾104 colony forming units/mL BAL) as previously described. Serotype-specific odds ratios (ORs) were calculated (as described for invasive pneumococcal disease) to indicate propensity for infection. RESULTS From 2007-2015, paired specimens were processed from 435 children with protracted bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD) or bronchiectasis. S. pneumoniae lower airway infection was detected in 95 children: 27% with PBB and 20% with CSLD/bronchiectasis. Most (91%) children were vaccinated with ⩾2 doses of 7-valent, 10-valent or 13-valent pneumococcal conjugate vaccine. Paired NP and BAL serotype distributions were very similar; prevalent serotypes (>10 isolates) were 19A (9%), 19F, 6C, 35B, 15B, 16F, 15A, 15C, 23A, 23F and 11A. For 21 serotypes found in both NP and BAL specimens, ORs for infection were low; range 0.46 (serotype 23B) to 2.15 (serotype 6A). In the 2008-2013 surveillance studies, NP swabs were collected from 1565 asymptomatic children; 74% were pneumococcal carriers. For 21 of 22 serotypes found in both control NP swabs and BAL specimens, ORs for infection were similarly low; range 0.33 (serotype 23B) to 3.29 (serotype 22F); none was significantly different from 1. The exception was serotype 7B with OR 8.84 (95% CI 1.46, 38.1). CONCLUSIONS Most NP carriage serotypes have a similar propensity to cause lower airway infection in children with suppurative lung diseases. Further development of pneumococcal vaccines is needed to prevent non-invasive disease caused by commonly carried serotypes.
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Affiliation(s)
- Kim M Hare
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia.
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia; Queensland Children's Health Service and Queensland University of Technology, Graham Street, South Brisbane, QLD 4101, Australia
| | - Susan Pizzutto
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
| | - Helen L Petsky
- Queensland Children's Health Service and Queensland University of Technology, Graham Street, South Brisbane, QLD 4101, Australia
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
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16
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Redding GJ, Carter ER. Chronic Suppurative Lung Disease in Children: Definition and Spectrum of Disease. Front Pediatr 2017; 5:30. [PMID: 28289673 PMCID: PMC5326795 DOI: 10.3389/fped.2017.00030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/03/2017] [Indexed: 01/01/2023] Open
Abstract
The most common clinical suppurative lung conditions in children are empyema, lung abscess, and bronchiectasis, and to a less often necrotizing pneumonia. Until recently, bronchiectasis was the most common form of persistent suppurative lung disease in children. Protracted bacterial bronchitis is a newly described chronic suppurative condition in children, which is less persistent but more common than bronchiectasis (1). In addition, the term "chronic suppurative lung disease" has been used recently to describe the clinical features of bronchiectasis when the radiographic features needed to make a diagnosis of bronchiectasis are absent. Webster's New College Dictionary defines suppuration as the process of forming and/or discharging pus. Pus is a body fluid resulting from intense inflammation in response to infection that leads to neutrophil influx and apoptosis, microbial clearance, and often necrosis of nearby tissue. Pus is primarily composed of white blood cell debris.
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Affiliation(s)
- Gregory J Redding
- Pulmonary Division, Seattle Children's Hospital, University of Washington School of Medicine , Seattle, WA , USA
| | - Edward R Carter
- Pulmonary and Sleep Medicine, Banner Children's Specialists, Banner Medical Group , Phoenix, AZ , USA
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17
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Onakpoya IJ, Hayward G, Heneghan CJ. Antibiotics for preventing lower respiratory tract infections in high-risk children aged 12 years and under. Cochrane Database Syst Rev 2015; 2015:CD011530. [PMID: 26408070 PMCID: PMC10624245 DOI: 10.1002/14651858.cd011530.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lower respiratory tract infections (LRTIs) in young children account for 1.4 million deaths annually worldwide. Antibiotics could be beneficial in preventing LRTIs in high-risk children, and may also help prevent school absenteeism and work days missed by children and/or carers. While it is well documented that the efficacy of antibiotic prophylaxis for RTIs decreases over time, there are no reviews that describe the use of antibiotic prophylaxis to prevent LRTIs in high-risk children aged 12 years and under. OBJECTIVES To assess the effectiveness and safety of antibiotic prophylaxis in the prevention of bacterial LRTIs in high-risk children aged 12 years and under. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 1) and the Database of Abstracts of Reviews of Effects (DARE), MEDLINE and MEDLINE In-Process (OvidSP) (1946 to 13 February 2015), EMBASE (OvidSP) (1974 to 12 February 2015), Science Citation Index Expanded (1945 to 13 February 2015) and Conference Proceedings Citation Index-Science (Web of Science Core Collection) (1990 to 13 February 2015). We searched for ongoing studies on ClinicalTrials.gov and the World Health Organization ICTRP. We handsearched the bibliographies of retrieved full texts of relevant studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing oral or intravenous antibiotics versus placebo or no treatment to prevent infections in high-risk children aged 12 years and under. We used a combination of the Centers for Disease Control and Prevention (CDC), National Health Service (NHS), American Academy of Paediatrics (AAP) and National Institute for Health and Care Excellence (NICE) guidelines to define conditions at higher risk of complications. Our primary outcome was the incidence of bacterial lower respiratory infections. Secondary outcomes included clinical function, hospital admission, mortality, growth, use of secondary antibiotics, time off school or parental work, quality of life and adverse events. DATA COLLECTION AND ANALYSIS We extracted data using a customised data extraction sheet, assessed the risk of bias of included studies using the Cochrane 'Risk of bias' criteria, and used the GRADE criteria to rate the quality of the evidence. We used a random-effects model for meta-analysis. We presented the results narratively where we could not statistically combine data. MAIN RESULTS We included 10 RCTs of high-risk children using antibiotics (azithromycin, ciprofloxacin, co-trimoxazole, isoniazid, oral penicillin V or vancomycin) to prevent LRTIs. Three studies included HIV-infected children (n = 1345), four cystic fibrosis (n = 429) and one each sickle cell disease (n = 219), cancer (n = 160) and low birth weight neonates with underlying respiratory disorders (n = 40). The study duration ranged from seven days to three years. The quality of the evidence from studies including children with HIV infection, cystic fibrosis or cancer was moderate. Due to inadequate data, we were unable to rate the quality of the evidence for two studies: one in children with sickle cell disease (low risk of bias), and another in low birth weight neonates with underlying respiratory disorders (high risk of bias).In HIV-infected children receiving continuous isoniazid prophylaxis, there was no significant difference in the incidence of pulmonary tuberculosis (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.32 to 1.29, I(2) statistic = 47%, P value = 0.21). There was no significant effect on mortality with co-trimoxazole or isoniazid prophylaxis (RR 0.82, 0.46 to 1.46, I(2) statistic = 76%, P value = 0.58); however, analysis of one study that used co-trimoxazole showed a significant reduction in mortality (RR 0.67, 95% CI 0.53 to 0.85, P value = 0.001). There was a significant decrease in the rates of hospital admission per child-year of follow-up with co-trimoxazole prophylaxis in one study (P value = 0.01). There was no evidence of increased adverse events due to antibiotic prophylaxis (RR 1.10, 95% CI 0.75 to 1.64, I(2) statistic = 22%, P value = 0.28); however, there was scant reporting of antibiotic resistance - the one study that did assess this found no increase.In two studies of children with cystic fibrosis receiving ciprofloxacin prophylaxis, there was no significant difference in Pseudomonas infections (RR 0.76, 0.44 to 1.31, I(2) statistic = 0%, P value = 0.33). In two studies assessing the benefit of azithromycin prophylaxis, there was a significant reduction in the frequency of pulmonary exacerbations (RR 0.60, 95% CI 0.48 to 0.76, I(2) statistic = 0%, P value < 0.0001). The effect of antibiotic prophylaxis on growth in children with cystic fibrosis was inconsistent across the studies. There was an increased risk of emergence of pathogenic strains with either azithromycin or ciprofloxacin prophylaxis in two studies reporting this outcome. There was no significant difference in the quality of life (one study). In three studies, there was no significant increase in the frequency of adverse events with prophylaxis with azithromycin (two studies) or ciprofloxacin (one study). There was no evidence of increased antibiotic resistance in two studies.In the one study of children with sickle cell disease, a significantly lesser proportion of children with pneumococcal septicaemia was reported with penicillin V prophylaxis (P value = 0.0025).In the one study of children with cancer there was a significant decrease in Pneumocystis carinii pneumonia with trimethoprim-sulfamethoxazole prophylaxis (RR 0.03, 95% CI 0.00 to 0.47, P value < 0.01). There was no significant increase in the frequency of adverse events with antibiotic prophylaxis.In low birth weight children with underlying respiratory disorders, there was no significant difference in the proportion of children with pulmonary infection with vancomycin prophylaxis (P value = 0.18).No included studies reported time off school or carer time off work. AUTHORS' CONCLUSIONS There is inconclusive evidence that antibiotic prophylaxis in certain groups of high-risk children can reduce pneumonia, exacerbations, hospital admission and mortality in certain conditions. However, limitations in the evidence base mean more clinical trials assessing the effectiveness of antibiotics for preventing LRTIs in children at high risk should be conducted. Specifically, clinical trials assessing the effectiveness of antibiotics for preventing LRTIs in congenital heart disease, metabolic disease, endocrine and renal disorders, neurological disease or prematurity should be a priority.
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Affiliation(s)
- Igho J Onakpoya
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK, Oxon
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18
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Onakpoya IJ, Hayward G, Heneghan CJ. The use of antibiotics for preventing lower respiratory tract infections in at risk children less than 12 years old. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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McCallum GB, Morris PS, Grimwood K, Maclennan C, White AV, Chatfield MD, Sloots TP, Mackay IM, Smith-Vaughan H, McKay CC, Versteegh LA, Jacobsen N, Mobberley C, Byrnes CA, Chang AB. Three-weekly doses of azithromycin for indigenous infants hospitalized with bronchiolitis: a multicentre, randomized, placebo-controlled trial. Front Pediatr 2015; 3:32. [PMID: 25954737 PMCID: PMC4404864 DOI: 10.3389/fped.2015.00032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/05/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Bronchiolitis is a major health burden in infants globally, particularly among Indigenous populations. It is unknown if 3 weeks of azithromycin improve clinical outcomes beyond the hospitalization period. In an international, double-blind randomized controlled trial, we determined if 3 weeks of azithromycin improved clinical outcomes in Indigenous infants hospitalized with bronchiolitis. METHODS Infants aged ≤24 months were enrolled from three centers and randomized to receive three once-weekly doses of either azithromycin (30 mg/kg) or placebo. Nasopharyngeal swabs were collected at baseline and 48 h later. Primary endpoints were hospital length of stay (LOS) and duration of oxygen supplementation monitored every 12 h until judged ready for discharge. Secondary outcomes were: day-21 symptom/signs, respiratory rehospitalizations within 6 months post-discharge and impact upon nasopharyngeal bacteria and virus shedding at 48 h. RESULTS Two hundred nineteen infants were randomized (n = 106 azithromycin, n = 113 placebo). No significant between-group differences were found for LOS (median 54 h for each group, difference = 0 h, 95% CI: -6, 8; p = 0.8), time receiving oxygen (azithromycin = 40 h, placebo = 35 h, group difference = 5 h, 95% CI: -8, 11; p = 0.7), day-21 symptom/signs, or rehospitalization within 6 months (azithromycin n = 31, placebo n = 25 infants, p = 0.2). Azithromycin reduced nasopharyngeal bacterial carriage (between-group difference 0.4 bacteria/child, 95% CI: 0.2, 0.6; p < 0.001), but had no significant effect upon virus detection rates. CONCLUSION Despite reducing nasopharyngeal bacterial carriage, three large once-weekly doses of azithromycin did not confer any benefit over placebo during the bronchiolitis illness or 6 months post hospitalization. Azithromycin should not be used routinely to treat infants hospitalized with bronchiolitis. CLINICAL TRIAL REGISTRATION The trial was registered with the Australian and New Zealand Clinical Trials Register: Clinical trials number: ACTRN1261000036099.
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Affiliation(s)
- Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Peter S Morris
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia ; Department of Paediatrics, Royal Darwin Hospital , Darwin, NT , Australia
| | - Keith Grimwood
- Menzies Health Institute Queensland, Griffith University and Gold Coast University Hospital , Gold Coast, QLD , Australia
| | - Carolyn Maclennan
- Department of Paediatrics, Royal Darwin Hospital , Darwin, NT , Australia
| | - Andrew V White
- Department of Paediatrics, Townsville Hospital , Townsville, QLD , Australia
| | - Mark D Chatfield
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Theo P Sloots
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, Sir Albert Sakzewski Virus Research Centre, Children's Health Queensland Hospital and Health Service, University of Queensland , Herston, QLD , Australia
| | - Ian M Mackay
- Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, Sir Albert Sakzewski Virus Research Centre, Children's Health Queensland Hospital and Health Service, University of Queensland , Herston, QLD , Australia ; Clinical Medical Virology Centre, School of Chemistry and Molecular Biosciences, University of Queensland , St Lucia, QLD , Australia
| | - Heidi Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Clare C McKay
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Lesley A Versteegh
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Nerida Jacobsen
- Department of Paediatrics, Townsville Hospital , Townsville, QLD , Australia
| | - Charmaine Mobberley
- The University of Auckland and Starship Children's Hospital , Auckland , New Zealand
| | - Catherine A Byrnes
- The University of Auckland and Starship Children's Hospital , Auckland , New Zealand
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia ; Queensland Children's Medical Research Institute, Children's Health Queensland, Queensland University of Technology , Brisbane, QLD , Australia
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Chang AB, Brown N, Toombs M, Marsh RL, Redding GJ. Lung disease in indigenous children. Paediatr Respir Rev 2014; 15:325-32. [PMID: 24958089 DOI: 10.1016/j.prrv.2014.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 12/20/2022]
Abstract
Children in indigenous populations have substantially higher respiratory morbidity than non-indigenous children. Indigenous children have more frequent respiratory infections that are, more severe and, associated with long-term sequelae. Post-infectious sequelae such as chronic suppurative lung disease and bronchiectasis are especially prevalent among indigenous groups and have lifelong impact on lung function. Also, although estimates of asthma prevalence among indigenous children are similar to non-indigenous groups the morbidity of asthma is higher in indigenous children. To reduce the morbidity of respiratory illness, best-practice medicine is essential in addition to improving socio-economic factors, (eg household crowding), tobacco smoke exposure, and access to health care and illness prevention programs that likely contribute to these issues. Although each indigenous group may have unique health beliefs and interfaces with modern health care, a culturally sensitive and community-based comprehensive care system of preventive and long term care can improve outcomes for all these conditions. This article focuses on common respiratory conditions encountered by indigenous children living in affluent countries where data is available.
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Affiliation(s)
- A B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia; Queensland Respiratory Centre, Royal Children's Hospital, Brisbane, Queensland Medical Research Institute, Queensland University of Technology, Brisbane, Australia.
| | - N Brown
- National Aboriginal Community Controlled Health Organisation and University of Wollongong, Wollongong, New South Wales, Australia
| | - M Toombs
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia; Indigenous Health, Toowoomba Rural Clinical School, University of Queensland
| | - R L Marsh
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Brisbane, Australia
| | - G J Redding
- University of Washington School of Medicine, Pediatric Pulmonary Division, Children's Hospital and Regional Medical Center, Seattle, Washington, USA
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Clinical risk factors for life-threatening lower respiratory tract infections in children: a retrospective study in an urban city in Malaysia. PLoS One 2014; 9:e111162. [PMID: 25360811 PMCID: PMC4215925 DOI: 10.1371/journal.pone.0111162] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/23/2014] [Indexed: 11/19/2022] Open
Abstract
AIM Lower respiratory tract infections (LRTIs) are an important cause of morbidity and mortality, especially in low income countries. The aim of this study was to determine risk factors of life-threatening LRTIs in hospitalised children in Malaysia. METHODS This retrospective study included children aged less than 18 years admitted for LRTIs over 13 months in a tertiary referral centre in Kuala Lumpur, Malaysia. Neonates, children with asthma and those with either no or a normal chest radiograph were excluded. Life-threatening infection was defined as that needing non-invasive ventilation or admission to the paediatric intensive care unit. Routine blood investigations and nasopharyngeal secretion results (bacterial and viral) were obtained. Chest radiographs were reviewed by a designated radiologist. Environmental data (rainfall, particulate matter ≤ 10 µm [PM10] and air pollution index [API]) was obtained from the respective government departments. RESULTS Three hundred and ninety-one episodes of LRTIs were included. Viruses were implicated in 48.5% of LRTIs, with respiratory syncytial virus (RSV) being detected in 44% of viral LRTIs. Forty-six (11.8%) children had life-threatening disease and the overall mortality rate was 1.3% (5 children). RSV was detected in 26% of children with life-threatening LRTIs. In multivariate logistic regression, chronic lung disease, presenting history of apnoea and signs of hypoxia, was associated with life threatening LRTIs. Increased LRTI admissions were associated with low rainfall but not PM10 nor API. Of those on follow-up, 39% had persistent respiratory symptoms. CONCLUSION One in nine children admitted with LRTI had a life-threatening LRTI. The aetiology was viral in almost half of admitted children. RSV was detected in a quarter of children with life-threatening LRTIs. Children who present with LRTIs and either have chronic lung disease, presenting history of apnoea or signs of hypoxia, should be observed carefully as the risk of deterioration to life-threatening illness is high.
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Chang AB, Ooi MH, Perera D, Grimwood K. Improving the Diagnosis, Management, and Outcomes of Children with Pneumonia: Where are the Gaps? Front Pediatr 2013; 1:29. [PMID: 24400275 PMCID: PMC3864194 DOI: 10.3389/fped.2013.00029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 10/06/2013] [Indexed: 11/13/2022] Open
Abstract
Pneumonia is the greatest contributor to childhood mortality and morbidity in resource-poor regions, while in high-income countries it is one of the most common reasons for clinic attendance and hospitalization in this age group. Furthermore, pneumonia in children increases the risk of developing chronic pulmonary disorders in later adult life. While substantial advances in managing childhood pneumonia have been made, many issues remain, some of which are highlighted in this perspective. Multiple studies are required as many factors that influence outcomes, such as etiology, patient characteristics, and prevention strategies can vary between and within countries and regions. Also, outside of vaccine studies, most randomized controlled trials (RCTs) on pneumonia have been based in resource-poor countries where the primary aim is usually prevention of mortality. Few RCTs have focused on medium to long-term outcomes or prevention. We propose different tiers of primary outcomes, where in resource-rich countries medium to long-term sequelae should also be included and not just the length of hospitalization and readmission rates.
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Affiliation(s)
- Anne B Chang
- Queensland Children's Respiratory Centre, Queensland Children's Medical Research Institute, Queensland University of Technology , Brisbane, QLD , Australia ; Child Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, NT , Australia
| | - Mong H Ooi
- Department of Pediatrics, Kuching Hospital , Sarawak , Malaysia
| | - David Perera
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak , Kota Samarahan , Malaysia
| | - Keith Grimwood
- Queensland Children's Medical Research Institute, The University of Queensland , Brisbane, QLD , Australia ; Queensland Paediatric Infectious Diseases Laboratory, Royal Children's Hospital , Brisbane, QLD , Australia
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Long-term azithromycin for Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease (Bronchiectasis Intervention Study): a multicentre, double-blind, randomised controlled trial. THE LANCET RESPIRATORY MEDICINE 2013; 1:610-620. [DOI: 10.1016/s2213-2600(13)70185-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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McCallum GB, Morris PS, Chatfield MD, Maclennan C, White AV, Sloots TP, Mackay IM, Chang AB. A single dose of azithromycin does not improve clinical outcomes of children hospitalised with bronchiolitis: a randomised, placebo-controlled trial. PLoS One 2013; 8:e74316. [PMID: 24086334 PMCID: PMC3783434 DOI: 10.1371/journal.pone.0074316] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 07/30/2013] [Indexed: 11/25/2022] Open
Abstract
Objective Bronchiolitis, one of the most common reasons for hospitalisation in young children, is particularly problematic in Indigenous children. Macrolides may be beneficial in settings where children have high rates of nasopharyngeal bacterial carriage and frequent prolonged illness. The aim of our double-blind placebo-controlled randomised trial was to determine if a large single dose of azithromycin (compared to placebo) reduced length of stay (LOS), duration of oxygen (O2) and respiratory readmissions within 6 months of children hospitalised with bronchiolitis. We also determined the effect of azithromycin on nasopharyngeal microbiology. Methods Children aged ≤18 months were randomised to receive a single large dose (30 mg/kg) of either azithromycin or placebo within 24 hrs of hospitalisation. Nasopharyngeal swabs were collected at baseline and 48hrs later. Primary endpoints (LOS, O2) were monitored every 12 hrs. Hospitalised respiratory readmissions 6-months post discharge was collected. Results 97 children were randomised (n = 50 azithromycin, n = 47 placebo). Median LOS was similar in both groups; azithromycin = 54 hours, placebo = 58 hours (difference between groups of 4 hours 95%CI -8, 13, p = 0.6). O2 requirement was not significantly different between groups; Azithromycin = 35 hrs; placebo = 42 hrs (difference 7 hours, 95%CI -9, 13, p = 0.7). Number of children re-hospitalised was similar 10 per group (OR = 0.9, 95%CI 0.3, 2, p = 0.8). At least one virus was detected in 74% of children. The azithromycin group had reduced nasopharyngeal bacterial carriage (p = 0.01) but no difference in viral detection at 48 hours. Conclusion Although a single dose of azithromycin reduces carriage of bacteria, it is unlikely to be beneficial in reducing LOS, duration of O2 requirement or readmissions in children hospitalised with bronchiolitis. It remains uncertain if an earlier and/or longer duration of azithromycin improves clinical and microbiological outcomes for children. The trial was registered with the Australian and New Zealand Clinical Trials Register. Clinical trials number: ACTRN12608000150347. http://www.anzctr.org.au/TrialSearch.aspx.
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Affiliation(s)
- Gabrielle B. McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- * E-mail:
| | - Peter S. Morris
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Mark D. Chatfield
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Carolyn Maclennan
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Andrew V. White
- Department of Paediatrics, The Townsville Hospital, Townsville, Queensland, Australia
| | - Theo P. Sloots
- Queensland Paediatric Infectious Diseases Laboratory, Sir Albert Sakzewski Virus Research Centre, Queensland Children's Medical Research Institute, Children's Health Queensland Hospital and Health Service, The University of Queensland, Brisbane, Australia
| | - Ian M. Mackay
- Queensland Paediatric Infectious Diseases Laboratory, Sir Albert Sakzewski Virus Research Centre, Queensland Children's Medical Research Institute, Children's Health Queensland Hospital and Health Service, The University of Queensland, Brisbane, Australia
| | - Anne B. Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Queensland Children's Respiratory Centre, Royal Children's Hospital, Brisbane, Queensland, Queensland University of Technology, Kelvin Grove, Australia
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Drescher BJ, Chang AB, Phillips N, Acworth J, Marchant J, Sloots TP, David M, O'Grady KAF. The development of chronic cough in children following presentation to a tertiary paediatric emergency department with acute respiratory illness: study protocol for a prospective cohort study. BMC Pediatr 2013; 13:125. [PMID: 23947914 PMCID: PMC3766129 DOI: 10.1186/1471-2431-13-125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 07/09/2013] [Indexed: 05/27/2023] Open
Abstract
Background Acute respiratory illness, a leading cause of cough in children, accounts for a substantial proportion of childhood morbidity and mortality worldwide. In some children acute cough progresses to chronic cough (>4 weeks duration), impacting on morbidity and decreasing quality of life. Despite the importance of chronic cough as a cause of substantial childhood morbidity and associated economic, family and social costs, data on the prevalence, predictors, aetiology and natural history of the symptom are scarce. This study aims to comprehensively describe the epidemiology, aetiology and outcomes of cough during and after acute respiratory illness in children presenting to a tertiary paediatric emergency department. Methods/design A prospective cohort study of children aged <15 years attending the Royal Children’s Hospital Emergency Department, Brisbane, for a respiratory illness that includes parent reported cough (wet or dry) as a symptom. The primary objective is to determine the prevalence and predictors of chronic cough (≥4 weeks duration) post presentation with acute respiratory illness. Demographic, epidemiological, risk factor, microbiological and clinical data are completed at enrolment. Subjects complete daily cough dairies and weekly follow-up contacts for 28(±3) days to ascertain cough persistence. Children who continue to cough for 28 days post enrolment are referred to a paediatric respiratory physician for review. Primary analysis will be the proportion of children with persistent cough at day 28(±3). Multivariate analyses will be performed to evaluate variables independently associated with chronic cough at day 28(±3). Discussion Our protocol will be the first to comprehensively describe the natural history, epidemiology, aetiology and outcomes of cough during and after acute respiratory illness in children. The results will contribute to studies leading to the development of evidence-based clinical guidelines to improve the early detection and management of chronic cough in children during and after acute respiratory illness.
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Affiliation(s)
- Benjamin J Drescher
- Queensland Children's Medical Research Institute, The University of Queensland, Level 4, Foundation Building, Royal Children's Hospital, Herston Road, Brisbane, Herston QLD 4029, Australia.
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