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Cottrell J, Namavarian A, Yip J, Campisi P, Chadha NK, Damji A, Hong P, Lachance S, Leitao D, Nguyen LHP, Saunders N, Strychowsky J, Yunker W, Vaccani JP, Chan Y, de Almeida JR, Eskander A, Witterick IJ, Monteiro E. Proposed Quality Indicators for Aspects of Pediatric Acute Otitis Media Management. J Otolaryngol Head Neck Surg 2024; 53:19160216241248538. [PMID: 38888942 PMCID: PMC11098001 DOI: 10.1177/19160216241248538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The high incidence of pediatric acute otitis media (AOM) makes the implications of overdiagnosis and overtreatment far-reaching. Quality indicators (QIs) for AOM are limited, drawing from generalized upper respiratory infection QIs, or locally developed benchmarks. Recognizing this, we sought to develop pediatric AOM QIs to build a foundation for future quality improvement efforts. METHODS Candidate indicators (CIs) were extracted from existing guidelines and position statements. The modified RAND Corporation/University of California, Los Angeles (RAND/UCLA) appropriateness methodology was used to select the final QIs by an 11-member expert panel consisting of otolaryngology-head and neck surgeons, a pediatrician and family physician. RESULTS Twenty-seven CIs were identified after literature review, with an additional CI developed by the expert panel. After the first round of evaluations, the panel agreed on 4 CIs as appropriate QIs. After an expert panel meeting and subsequent second round of evaluations, the panel agreed on 8 final QIs as appropriate measures of high-quality care. The 8 final QIs focus on topics of antimicrobial management, specialty referral, and tympanostomy tube counseling. CONCLUSIONS Evidence of variable and substandard care persists in the diagnosis and management of pediatric AOM despite the existence of high-quality guidelines. This study proposes 8 QIs which compliment guideline recommendations and are meant to facilitate future quality improvement initiatives that can improve patient outcomes.
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Affiliation(s)
- Justin Cottrell
- Department of Otolaryngology—Head and Neck Surgery, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Amirpouyan Namavarian
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Jonathan Yip
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Paolo Campisi
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Neil K. Chadha
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Ali Damji
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Hong
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery, Dalhousie University, QEII Health Sciences Centre, Halifax, NS, Canada
| | - Sophie Lachance
- Département d’Oto-rhino-laryngologie et chirurgie cervico-faciale, CHUL, Pavillon Ferdinand-Vandry, Université Laval, Québec, QC, Canada
| | - Darren Leitao
- Department of Otolaryngology—Head and Neck Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Lily H. P. Nguyen
- Department of Otolaryngology—Head and Neck Surgery, McGill University, Montréal, QC, Canada
| | - Natasha Saunders
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Julie Strychowsky
- Department of Otolaryngology—Head and Neck Surgery, Western University, London Health Sciences Centre—Victoria Hospital, London, ON, Canada
| | - Warren Yunker
- Section of Pediatric Surgery and Otolaryngology—Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Jean-Philippe Vaccani
- Department of Otolaryngology—Head and Neck Surgery, The University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Yvonne Chan
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - John R. de Almeida
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Antoine Eskander
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Ian J. Witterick
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology—Head & Neck Surgery, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
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Liu Y, Xu H, Xu Z, Kudinha T, Fan X, Xiao M, Kong F, Sun H, Xu Y. High-Level Macrolide-Resistant Moraxella catarrhalis and Development of an Allele-Specific PCR Assay for Detection of 23S rRNA Gene A2330T Mutation: A Three-Year Study at a Chinese Tertiary Hospital. Microb Drug Resist 2015; 21:507-11. [PMID: 25923017 DOI: 10.1089/mdr.2014.0217] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Previous studies indicate that macrolide resistance in Moraxella catarrhalis isolates is less common in adults than in children. However, few studies have investigated M. catarrhalis macrolide resistance mechanisms in adult patients. In this study, 124 M. catarrhalis isolates were collected from adult patients in a Chinese tertiary hospital, between 2010 and 2013, and investigated for antimicrobial resistance. We found that only seven isolates were macrolide resistant and all exhibited high-level macrolide resistance (minimum inhibitory concentrations >256 μg/ml). Multilocus sequence typing (MLST) suggested that M. catarrhalis has a diverse population; in particular, both pulsed-field gel electrophoresis and MLST revealed that all the seven high-level macrolide-resistant M. catarrhalis belonged to different clones. A 934-bp 23S rRNA gene sequencing showed that only nine isolates (including all the seven macrolide-resistant isolates) had mutations within the studied region, and only the seven macrolide-resistant isolates had mutation of A2330T. No other known macrolide-resistance determinant genes (ermA, ermB, mefA, or mefE) were detected. These findings support previous studies in children on M. catarrhalis macrolide-resistant isolates and suggest that the 23S rRNA gene A2330T mutation is responsible for the high M. catarrhalis macrolide resistance. The findings prompted us to successfully develop a simple allele-specific polymerase chain reaction assay for high-level macrolide-resistant 23S rRNA gene A2330T mutation for future clinical and further surveillance use.
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Affiliation(s)
- Yali Liu
- 1 Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College , Chinese Academy of Medical Sciences, Beijing, China
| | - Heping Xu
- 2 Department of Clinical Laboratory, The First Affiliated Hospital of Xiamen University , Xiamen, China
| | - Zhipeng Xu
- 1 Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College , Chinese Academy of Medical Sciences, Beijing, China
| | - Timothy Kudinha
- 3 Charles Sturt University , Orange, New South Wales, Australia .,4 Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, University of Sydney , Westmead, New South Wales, Australia
| | - Xin Fan
- 1 Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College , Chinese Academy of Medical Sciences, Beijing, China
| | - Meng Xiao
- 1 Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College , Chinese Academy of Medical Sciences, Beijing, China
| | - Fanrong Kong
- 4 Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, University of Sydney , Westmead, New South Wales, Australia
| | - Hongli Sun
- 1 Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College , Chinese Academy of Medical Sciences, Beijing, China
| | - Yingchun Xu
- 1 Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College , Chinese Academy of Medical Sciences, Beijing, China
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Ilić K, Jakovljević E, Skodrić-Trifunović V. Social-economic factors and irrational antibiotic use as reasons for antibiotic resistance of bacteria causing common childhood infections in primary healthcare. Eur J Pediatr 2012; 171:767-77. [PMID: 21987082 DOI: 10.1007/s00431-011-1592-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 09/21/2011] [Indexed: 11/28/2022]
Abstract
The most prevalent childhood bacterial infections in primary healthcare are respiratory, gastrointestinal and urogenital infections. The main aim of this paper was to consider factors (socio-economic factors and irrational antibiotic use) that contribute to the development of bacterial resistance, as well as measures that resulted in a reduction of this problem. Computerized search through the Medline of published articles on antibiotic resistance from 1996 to 2011 in English or Serbian was completed in August 2011. Combinations of used terms were antimicrobial/antibacterial/antibiotic and resistance/susceptibility in pediatric/children, and Streptococcus pneumoniae/Streptococci/Haemophilus influenzae/Salmonellae/Escherichia coli/Shigella/Staphylococcus aureus as well as antibiotics/antimicrobials/antibacterials and consumption/utilization/use. In many developing countries, antibiotic dispensing and its use in medicine, cattle breeding and agriculture are inadequately regulated, or existing laws are not being appropriately implemented. In addition, human travel contributes to antimicrobial drug resistance around the world. All of these factors have led to a very high level of bacterial resistance. On the contrary, in countries with a clearly defined and implemented legal framework concerning antibiotic prescribing, dispensing and utilization, the use of antibiotics is under constant surveillance. That resulted in a significantly lower antibacterial resistance. In conclusion, bacterial resistance could be reduced by the implementation of systemic and long-term measures at a country level as well as at all levels of healthcare. In order to reduce bacterial resistance, antibiotic use needs to be precisely regulated, and regulations should be coherent with practice. The international community must have a more active role in solving this global problem.
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Affiliation(s)
- Katarina Ilić
- Department of Pharmacology, School of Pharmacy, University of Belgrade, PO BOX 146, Vojvode Stepe 450, 11221, Belgrade, Republic of Serbia.
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Wang H, Chen M, Xu Y, Sun H, Yang Q, Hu Y, Cao B, Chu Y, Liu Y, Zhang R, Yu Y, Sun Z, Zhuo C, Ni Y, Hu B, Tan TY, Hsueh PR, Wang JH, Ko WC, Chen YH, Wahjono H. Antimicrobial susceptibility of bacterial pathogens associated with community-acquired respiratory tract infections in Asia: report from the Community-Acquired Respiratory Tract Infection Pathogen Surveillance (CARTIPS) study, 2009–2010. Int J Antimicrob Agents 2011; 38:376-83. [DOI: 10.1016/j.ijantimicag.2011.06.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/29/2011] [Accepted: 06/30/2011] [Indexed: 11/27/2022]
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Poor adherence to antibiotic prescribing guidelines in acute otitis media--obstacles, implications, and possible solutions. Eur J Pediatr 2011; 170:323-32. [PMID: 20862492 PMCID: PMC3068524 DOI: 10.1007/s00431-010-1286-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 08/19/2010] [Indexed: 02/04/2023]
Abstract
Many countries now have guidelines on the clinical management of acute otitis media. In almost all, the public health goal of containing acquired resistance in bacteria through reduced antibiotic prescribing is the main aim and basis for recommendations. Despite some partial short-term successes, clinical activity databases and opinion surveys suggest that such restrictive guidelines are not followed closely, so this aim is not achieved. Radical new solutions are needed to tackle irrationalities in healthcare systems which set the short-term physician-patient relationship against long-term public health. Resolving this opposition will require comprehensive policy appraisal and co-ordinated actions at many levels, not just dissemination of evidence and promotion of guidelines. The inappropriate clinical rationales that underpin non-compliance with guidelines can be questioned by evidence, but also need specific developments promoting alternative solutions, within a framework of whole-system thinking. Promising developments would be (a) physician training modules on age-appropriate analgesia and on detection plus referral of rare complications like mastoiditis, and (b) vaccination against the most common and serious bacterial pathogens.
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Imöhl M, René Reinert R, van der Linden M. Serotype-specific penicillin resistance of Streptococcus pneumoniae in Germany from 1992 to 2008. Int J Med Microbiol 2010; 300:324-30. [DOI: 10.1016/j.ijmm.2009.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 11/25/2009] [Accepted: 11/28/2009] [Indexed: 11/15/2022] Open
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Marra F, Monnet DL, Patrick DM, Chong M, Brandt CT, Winters M, Kaltoft MS, Tyrrell GJ, Lovgren M, Bowie WR. A comparison of antibiotic use in children between Canada and Denmark. Ann Pharmacother 2007; 41:659-66. [PMID: 17374628 DOI: 10.1345/aph.1h293] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND High rates of antibiotic prescribing in children lead to antibiotic resistance in the community. Surveillance on utilization rates and comparisons with other jurisdictions are methods for benchmarking. Surveillance on antibiotic use is well established in Europe, including Denmark, but until recently, similar data from Canada were lacking. OBJECTIVE To compare pediatric antibiotic prescribing rates in British Columbia, Canada, with those in Denmark. METHODS Population-based data on antibiotic prescriptions from British Columbia and Denmark were obtained from 1999 to 2003 for children less than 15 years of age. Annual trends in prescription rates per 1000 children were analyzed by using generalized linear models for all children less than 15 years of age; they were stratified by age group (0-4, 5-9, 10-14 y) for all antibiotics. Class-specific trends were also evaluated for penicillins, cephalosporins, macrolides, sulfonamides and trimethoprim, tetracyclines, and fluoroquinolones. RESULTS From 1999 to 2003, the overall British Columbia prescription rate was significantly higher than that of Denmark (p < 0.0001) at all age stratifications. In 2003, the British Columbia prescription rate was twice that of Denmark, at 608 versus 385 prescriptions per 1000 children, respectively. In both jurisdictions, the majority of antibiotics used were penicillins (Anatomical Therapeutic Chemical class J01C). However, in British Columbia, most penicillins used were extended-spectrum (83% in 2003); in Denmark, 34% of penicillins used in 2003 were extended-spectrum and 56% were beta-lactamase sensitive. In British Columbia, use of penicillins (-4.5%), cephalosporins (-5.5%), trimethoprim/sulfamethoxazole (-36%), and tetracycline (-1.6%) decreased over time, whereas in Denmark, use of penicillins increased by 11% over time and non-penicillin antibiotics remained stable. A significant increase in macrolide consumption was seen in British Columbia due to use of clarithromycin and azithromycin; in contrast, macrolide consumption declined in Denmark. CONCLUSIONS Compared with Denmark, the antibiotic prescription rate for children is substantially higher in British Columbia. In addition, there has been a significant increase in the use of macrolides, especially the second-generation agents, in British Columbia compared with the use in Denmark. Further studies are required to delineate reasons for antibiotic prescribing patterns in these 2 jurisdictions.
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Affiliation(s)
- Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
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Zbinden R. Trends in antibiotic resistance among respiratory tract pathogens in children in two regions near France, a high level resistance country. Eur J Pediatr 2006; 165:1-2. [PMID: 16133243 DOI: 10.1007/s00431-005-1736-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 06/08/2005] [Indexed: 10/25/2022]
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