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González Rodríguez JD, Fraga Rodríguez GM, García Vera CJ, Gómez Fraile A, Martín Sánchez JI, Mengual Gil JM, Ochoa Sangrador C, Valenciano Fuentes B, Escribano Subías J. Update of the Spanish clinical practice guideline for urinary tract infection in infants and children. Summary of recommendations for diagnosis, treatment and follow-up. An Pediatr (Barc) 2024; 101:132-144. [PMID: 39098586 DOI: 10.1016/j.anpede.2024.07.010] [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: 05/04/2024] [Accepted: 06/03/2024] [Indexed: 08/06/2024] Open
Abstract
The management of urinary tract infection (UTI) in infants and children has changed significantly over the past few decades based on scientific evidence that questioned the efficacy of strategies used to prevent kidney injury and subsequent progression to chronic kidney disease, which is very unlikely in most paediatric cases. However, there is still substantial heterogeneity in its management and uncertainty regarding the diagnosis, indication of imaging tests, treatment or follow-up in these patients. The Spanish clinical practice guideline has been updated through the review of the literature published since 2009 and a rigorous evaluation of current clinical practice aspects, taking into account the evidence on the benefits of each intervention in addition to its risks and drawbacks to attempt to provide more precise recommendations.
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Affiliation(s)
| | | | | | | | | | | | | | - Blanca Valenciano Fuentes
- Nefrología Pediátrica, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
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Pérez Solís D, Gómez de Oña C, Nicieza García ML, Suárez Gil P, Pérez Solís P, Suárez Mier B, Rolle Sóñora V. Use of antibiotics in Paediatric Primary Health Care before and during the COVID-19 pandemic. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:529-534. [PMID: 36624035 PMCID: PMC9792423 DOI: 10.1016/j.eimce.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Consumption of antibiotics is high in Spain, primarily in children. Excessive use of then contributes to the development of antimicrobial resistance. The aim of our study is to analyse the evolution of antibiotic consumption at the Primary Health Care in the paediatric population of Asturias, Spain, from 2014 to 2021, and to evaluate the impact of COVID-19 pandemic on it. METHODS Retrospective and observational study using data about antibacterial agents for systemic use dispensed for official prescriptions to children under 14 years in Primary Care. Antibiotic consumption is expressed as defined daily dose (DDD) per 1000 inhabitants per day (DID). RESULTS The antibiotic consumption rate dropped from 13.9 DID in 2014 to 4.0 in 2021 (β=-1,42, p=0,002), with and inflection point in 2019. From 2019 to 2020 antibiotic use dropped by 47.1%. Antibiotic consumption remained very low from April 2020 to September 2021, and then moderately increased from October 2021. Prevalence of antibiotic use dropped from 39.9% in 2014 to 17.5% in 2021 (β=-3,64, p=0,006). Relative consumption of amoxicillin/clavulanic acid decreased, while those of amoxiciline and third-generation cephalosporins increased. CONCLUSIONS Paediatric antibiotic consumption collapsed in Asturias in 2020, coinciding with COVID-19 pandemic. Monitoring of antimicrobial usage indicators will allow to check if these changes are sustained over time.
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Affiliation(s)
- David Pérez Solís
- Servicio de Pediatría, Hospital Universitario San Agustín, Avilés, Spain.
| | - Constanza Gómez de Oña
- Servicio de Farmacia de Atención Primaria, Área Sanitaria V del Servicio de Salud del Principado de Asturias, Gijón, Asturias, Spain
| | - María Luisa Nicieza García
- Servicio de Farmacia, Dirección General de Política y Planificación Sanitarias, Consejería de Salud, Asturias, Spain
| | - Patricio Suárez Gil
- Plataforma de Bioestadística y Epidemiología, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Pablo Pérez Solís
- Medicina Familiar y Comunitaria, Centro de Salud Laviada, Gijón, Asturias, Spain
| | - Belén Suárez Mier
- Estrategia de Seguridad del Paciente, Dirección General de Calidad, Transformación y Gestión del Conocimiento, Consejería de Salud, Asturias, Spain
| | - Valeria Rolle Sóñora
- Plataforma de Bioestadística y Epidemiología, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
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Herreros ML, Barrios A, Sánchez A, Del Valle R, Pacheco M, Gili P. Urine collection methods in precontinent children treated at the paediatric emergency department. Acta Paediatr 2023; 112:550-556. [PMID: 36463432 DOI: 10.1111/apa.16614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/05/2022]
Abstract
AIM To describe the urine collection methods used in precontinent children presenting at the Paediatric Emergency Department (PED) and compare results and contamination rates. METHODS Retrospective observational cohort study that included 1678 urine cultures collected in infants <24 months of age between January 2016 and December 2019. Urine cultures were compared based on collection technique, sex and patient age. RESULTS In total, 60.4% of samples were collected by clean-catch urine collection (CCUC), 26.4% by urethral catheterisation (UC) and 13.2% by urine bag (UB). Contamination rates were 2.9% (95% CI 1.3, 4.4) for UC, 11.3% (95% CI 9.3, 13.2) for CCUC and 23.4% (95% CI 17.8, 29.0) for UB. Significant differences in contamination rates were found between UC and CCUC in the 6-12-month age group (1.9% [95% CI 0.0-4.0] versus 12.0% [95% CI 7.2-16.8] [p < 0.0009]), and between UC and UB for all ages. CONCLUSIONS CCUC is the most common method for urine culture collection in infants <24 months of age at the PED in our centre. UC has the lowest contamination rates, but significant differences were only observed between CCUC and UC in the 6-12-month age group. CCUC is a non-invasive alternative for urine collection in infants.
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Affiliation(s)
- María Luisa Herreros
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Ana Barrios
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Aida Sánchez
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Rut Del Valle
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Mónica Pacheco
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Pablo Gili
- Hospital Universitario Fundación Alcorcón, Alcorcon, Spain
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Redondo Sánchez J, Domínguez Lázaro AM, Rodríguez Barrientos R, Barrio Cortes J, Seoane Sanz A, Bravo Acuna J, Del Cura-González I. Trends in hospitalization for urinary tract infection in the paediatric age group in the 2000-2015 period in Spain. An Pediatr (Barc) 2023; 98:175-184. [PMID: 36804332 DOI: 10.1016/j.anpede.2023.01.009] [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: 05/31/2022] [Accepted: 09/07/2022] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE To analyse the trends in hospital admissions related to urinary tract infection among children aged 0-14 years in Spain in the 2000-2015 period. METHODS We conducted a retrospective observational study using the minimum basic hospital discharge dataset system of Spain, which applies the International Classification of Diseases, version 9 (ICD-9) coding system. We included every hospitalisation due to cystitis, pyelonephritis and unspecified UTI among children aged less than 15 years. We collected data on patient sex and age, type of discharge, main diagnosis, comorbidities, length of stay and overall cost. We calculated crude hospitalization rates per 1000 inhabitants aged less than 15 years and performed a joinpoint regression analysis to identify temporal trends. RESULTS In the 2000-2015 period, there were 124 696 hospitalizations in children under 15 years. Of these patients, 72.97% were aged 0-1 year and 60.12% had a diagnosis of unspecified UTI, 39.27% of pyelonephritis, and 0.52% of cystitis. The crude rate of hospitalization due to UTI ranged from 1.24 in year 2000 to 0.98 in 2015. The rate of hospitalization was higher in female versus male patients. The joinpoint analysis found a decreasing trend in the rate of hospitalization due to UTI, with an average annual percent change (AAPC) of -1.5% (95% confidence interval [CI], -2.4 a -0.6). The largest decreases occurred in female patients (AAPC, -1.8; 95% CI, -2.5 a -1.0) and children aged 7-10 years (AAPC - 5.9; 95% CI, -6.7 a -5.2). CONCLUSIONS The rate of hospitalization related to UTI in Spain in patients aged up to 14 years decreased during the 2000-2015 period. The highest hospitalization rates occurred in female patients and in the 0-to-1 year age group.
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Affiliation(s)
- Jesús Redondo Sánchez
- Centro de Salud Ramon y Cajal, Alcorcón, Spain; Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Departamento de Especialidades Médicas y Salud Pública, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - Alberto Manuel Domínguez Lázaro
- Medicina Preventiva y Salud Pública, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Ricardo Rodríguez Barrientos
- Instituto de Investigación Sanitaria Gregorio Marañón, Servicio Madrileño de Salud, Madrid, Spain; Unidad de Investigación, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) y Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Instituto de Salud Carlos III, Madrid, Spain
| | - Jaime Barrio Cortes
- Unidad de Investigación, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Fundación para la Investigación e Innovación Biosanitaria en Atención Primaria, Madrid, Spain
| | - Andrea Seoane Sanz
- Servicio de Pediatría, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juan Bravo Acuna
- Centro de Salud El Greco, Getafe. Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Isabel Del Cura-González
- Departamento de Especialidades Médicas y Salud Pública, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Servicio Madrileño de Salud, Madrid, Spain; Unidad de Investigación, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) y Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Instituto de Salud Carlos III, Madrid, Spain
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Xia Q, Li J, Yang Z, Zhang D, Tian J, Gu B. Discovery of novel 1,3,5-triazines as potent antibacterial agent against urinary tract infection-causing clinical isolates of Escherichia coli via inhibition of DNA Gyrase. Chem Biol Drug Des 2023; 101:271-277. [PMID: 35544284 DOI: 10.1111/cbdd.14066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/23/2022] [Accepted: 05/08/2022] [Indexed: 01/14/2023]
Abstract
A novel series of 1,3,5-triazine-phenylthiazole-pyrazole derivatives were synthesized and subsequently tested for Escherichia coli DNA Gyrase inhibitory activity where they showed excellent inhibitory activity. The top-three ranked DNA gyrase inhibitor (4e, 4g and 4h) were further subjected to antibacterial and anti-biofilm activity against clinical isolates of resistant E. coli strains obtained from Urinary Tract Infection (UTI) patients (CREC81, CREC106, CREC163). Compound 4h was identified as most potent antibacterial agent in the above study. The compound 4h was further evaluated in murine model of E. coli UTI in BALB/c mice infected by transurethral injection of CREC106 strain. Results of the study suggest that compound 4h reduces bacterial load of CREC106 in the treated mice and found approximately equipotent to Novobiocin as standard.
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Affiliation(s)
- Qier Xia
- Department of Urology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Jun Li
- Department of Urology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Zhenyu Yang
- Department of Urology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Dingguo Zhang
- Department of Urology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Jinjun Tian
- Department of Urology, Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Bin Gu
- Department of Urology, Shanghai Pudong New Area People's Hospital, Shanghai, China
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Tendencias en la hospitalización por infección del tracto urinario en la población pediátrica de España en el período 2000-2015. An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Piñeiro-Pérez R, Ochoa-Sangrador C, López-Martín D, Martínez-Campos L, Calvo-Rey C, Nievas-Soriano BJ. Adherence of Spanish pediatricians to "do not do" guidelines to avoid low-value care in pediatrics. Eur J Pediatr 2022; 181:3965-3975. [PMID: 36102996 DOI: 10.1007/s00431-022-04613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022]
Abstract
UNLABELLED The main objective of this study was to analyze the degree of knowledge and compliance of Spanish pediatricians with the "do not do" recommendations of the Spanish Association of Pediatrics. A nationwide cross-sectional, descriptive study was carried out using a 25-item questionnaire among Spanish pediatricians. Univariate, bivariate, and multivariate analyses were performed. A total of 1137 pediatricians participated in the study. Most of them were women (75.1%), older than 55 (28.3%), worked in specialized care (56.9%), with public financing (91.2%), and had been working for more than 20 years (44.9%). The median of inappropriate answers per question was 9.1%. The bivariate and multivariate analyses showed that the factors that influenced higher adequacy to the "do not do" recommendations were younger than 45 years, working in specialized care, and working in the public health system. CONCLUSION This research is the first nationwide study in Spain to analyze the adequacy of "do not do" pediatric clinical recommendations. The study showed a high level of compliance by Spanish pediatricians with these recommendations. However, there is a lack of knowledge in less frequent infectious pathologies such as HIV or fungal infections, in not prolonging antibiotic treatment unnecessarily and directing it appropriately according to the antibiogram results. These aspects may be improved by designing measures to enhance pediatricians' knowledge in these specific aspects. Some demographical factors are related to higher adequacy. Performing this research in other countries may allow assessing the current clinical practice of pediatricians. WHAT IS KNOWN • Low-value care is defined as care that delivers little or no benefit, may cause patients harm, or outcomes marginal benefits at a disproportionately increased cost. • Few nationwide studies have assessed adherence to "do not do" guidelines, especially in pediatric settings. WHAT IS NEW • Albeit there is a high level of compliance by Spanish pediatricians with the «do not do» recommendations, there is a lack of knowledge in different aspects that may be improved. • Some demographical factors are related to higher adequacy. Performing this research in other countries may allow assessing the current clinical practice of pediatricians.
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Affiliation(s)
- Roi Piñeiro-Pérez
- Pediatrics Service, Villalba General University Hospital, Collado-Villalba, Madrid, Spain
| | | | | | | | | | - Bruno José Nievas-Soriano
- Nursing, Physiotherapy, and Medicine Department, University of Almería, Ctra de Sacramento, s/n, 1410 La Cañada, Almería, Spain.
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Stolarek P, Bernat P, Różalski A. Combined Application of Aminoglycosides and Ascorbic Acid in the Elimination of Proteus mirabilis Rods Responsible for Causing Catheter-Associated Urinary Tract Infections (CAUTIs)-A Molecular Approach. Int J Mol Sci 2022; 23:13069. [PMID: 36361855 PMCID: PMC9659235 DOI: 10.3390/ijms232113069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 11/26/2023] Open
Abstract
Proteus mirabilis is a common cause of catheter-associated urinary tract infections (CAUTIs). In this study, we verified the effectiveness of amikacin or gentamicin and ascorbic acid (AA) co-therapy in eliminating uropathogenic cells, as well as searched for the molecular basis of AA activity by applying chromatographic and fluorescent techniques. Under simulated physiological conditions, a combined activity of the antibiotic and AA supported the growth (threefold) of the P. mirabilis C12 strain, but reduced catheter colonization (≤30%) in comparison to the drug monotherapy. Slight modifications in the phospholipid and fatty acid profiles, as well as limited (≤62%) 2',7'-dichlorofluorescein fluorescence, corresponding to the hydroxyl radical level, allowed for the exclusion of the hypothesis that the anti-biofilm effect of AA was related to membrane perturbations of the C12 strain. However, the reduced (≤20%) fluorescence intensity of propidium iodide, as a result of a decrease in membrane permeability, may be evidence of P. mirabilis cell defense against AA activity. Quantitative analyses of ascorbic acid over time with a simultaneous measurement of the pH values proved that AA can be an effective urine acidifier, provided that it is devoid of the presence of urease-positive cells. Therefore, it could be useful in a prevention of recurrent CAUTIs, rather than in their treatment.
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Affiliation(s)
- Paulina Stolarek
- Department of Biology of Bacteria, Faculty of Biology and Environmental Protection, University of Lodz, Banacha 12/16, 90-237 Lodz, Poland
| | - Przemysław Bernat
- Department of Industrial Microbiology and Biotechnology, Faculty of Biology and Environmental Protection, University of Lodz, Banacha 12/16, 90-237 Lodz, Poland
| | - Antoni Różalski
- Department of Biology of Bacteria, Faculty of Biology and Environmental Protection, University of Lodz, Banacha 12/16, 90-237 Lodz, Poland
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Rius-Gordillo N, Ferré N, González JD, Ibars Z, Parada-Ricart E, Fraga MG, Chocron S, Samper M, Vicente C, Fuertes J, Escribano J. Dexamethasone to prevent kidney scarring in acute pyelonephritis: a randomized clinical trial. Pediatr Nephrol 2022; 37:2109-2118. [PMID: 35041042 PMCID: PMC9307518 DOI: 10.1007/s00467-021-05398-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Urinary tract infection (UTI) is one of the most common bacterial infections in childhood and is associated with long-term complications. We aimed to assess the effect of adjuvant dexamethasone treatment on reducing kidney scarring after acute pyelonephritis (APN) in children. METHODS Multicenter, prospective, double-blind, placebo-controlled, randomized clinical trial (RCT) where children from 1 month to 14 years of age with proven APN were randomly assigned to receive a 3-day course of either an intravenous corticosteroid (dexamethasone 0.30 mg per kg/day) twice daily or placebo. The late technetium 99 m-dimercaptosuric acid scintigraphy (> 6 months after acute episode) was performed to assess kidney scar persistence. Kidney scarring risk factors (vesicoureteral reflux, kidney congenital anomalies, or urinary tract dilatation) were also assessed. RESULTS Ninety-one participants completed the follow-up and were finally included (dexamethasone n = 49 and placebo n = 42). Both groups had similar baseline characteristics. Twenty participants showed persistent kidney scarring after > 6 months of follow-up without differences in incidence between groups (22% and 21% in the dexamethasone and placebo groups, p = 0.907). Renal damage severity in the early DMSA (β = 0.648, p = 0.023) and procalcitonin values (β = 0.065 p = 0.027) significantly modulated scar development. Vesicoureteral reflux grade showed a trend towards significance (β = 0.545, p = 0.054), but dexamethasone treatment showed no effect. CONCLUSION Dexamethasone showed no effect on reducing the risk of scar formation in children with APN. Hence, there is no evidence for an adjuvant corticosteroid treatment recommendation in children with APN. However, the study was limited by not achieving the predicted sample size and the expected scar formation. TRIAL REGISTRATION Clinicaltrials.gov, NCT02034851. Registered in January 14, 2014. "A higher resolution version of the Graphical abstract is available as Supplementary information."
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Affiliation(s)
- Neus Rius-Gordillo
- Pediatrics Unit, Hospital Universitari Sant Joan de Reus, Reus, Spain
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, Reus, Spain
- Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Natàlia Ferré
- Pediatrics Unit, Hospital Universitari Sant Joan de Reus, Reus, Spain
- Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Juan David González
- Pediatrics Unit, Hospital General Universitario Santa Lucia, Cartagena, Spain
| | - Zaira Ibars
- Pediatrics Unit, Hospital Universitari Arnau de Vilanova, 25198, Lleida, Spain
| | - Ester Parada-Ricart
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, Reus, Spain
- Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
- Pediatrics Unit, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | | | - Sara Chocron
- Pediatrics Unit, Hospital Universitari General Catalunya, Sant Cugat, Spain
| | - Manuel Samper
- Pediatrics Unit, Pius Hospital de Valls, Valls, Spain
| | - Carmen Vicente
- Nephrology Department, Pediatrics Service, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain
| | - Jordi Fuertes
- Nuclear Medicine Service, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Joaquín Escribano
- Pediatrics Unit, Hospital Universitari Sant Joan de Reus, Reus, Spain.
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, Reus, Spain.
- Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain.
- Institut d'Investigació Sanitaria Pere Virgili, Sant Lloreç 21, 43201, Reus, Spain.
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Solís DP, de Oña CG, García MLN, Gil PS, Solís PP, Mier BS, Sóñora VR. [Use of antibiotics in Paediatric Primary Health Care before and during the COVID-19 pandemic]. Enferm Infecc Microbiol Clin 2022; 41:S0213-005X(22)00159-8. [PMID: 35911852 PMCID: PMC9318689 DOI: 10.1016/j.eimc.2022.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022]
Abstract
Introduction Consumption of antibiotics is high in Spain, primarily in children. Excessive use of then contributes to the development of antimicrobial resistance. The aim of our study is to analyse the evolution of antibiotic consumption at the Primary Health Care in the paediatric population of Asturias, Spain, from 2014 to 2021, and to evaluate the impact of COVID-19 pandemic on it.Methods Retrospective and observational study using data about antibacterial agents for systemic use dispensed for official prescriptions to children under 14 years in Primary Care. Antibiotic consumption is expressed as defined daily dose (DDD) per 1000 inhabitants per day (DID).Results The antibiotic consumption rate dropped from 13.9 DID in 2014 to 4.0 in 2021 (β = -1,42, p=0,002), with and inflection point in 2019. From 2019 to 2020 antibiotic use dropped by 47.1%. Antibiotic consumption remained very low from April 2020 to September 2021, and then moderately increased from October 2021. Prevalence of antibiotic use dropped from 39.9% in 2014 to 17.5% in 2021 (β = -3,64, p=0,006). Relative consumption of amoxicillin/clavulanic acid decreased, while those of amoxiciline and third-generation cephalosporins increased.Conclusions Paediatric antibiotic consumption collapsed in Asturias in 2020, coinciding with COVID-19 pandemic. Monitoring of antimicrobial usage indicators will allow to check if these changes are sustained over time.
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Affiliation(s)
- David Pérez Solís
- Servicio de Pediatría, Hospital Universitario San Agustín, Avilés, España
| | - Constanza Gómez de Oña
- Servicio de Farmacia de Atención Primaria. Área Sanitaria V del Servicio de Salud del Principado de Asturias, Gijón, España
| | - María Luisa Nicieza García
- Servicio de Farmacia, Dirección General de Política y Planificación Sanitarias, Consejería de Salud, Asturias, España
| | - Patricio Suárez Gil
- Plataforma de Bioestadística y Epidemiología, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España
| | - Pablo Pérez Solís
- Medicina Familiar y Comunitaria. Centro de Salud Laviada, Gijón, España
| | - Belén Suárez Mier
- Estrategia de Seguridad del Paciente, Dirección General de Calidad, Transformación y Gestión del Conocimiento, Consejería de Salud, Asturias, España
| | - Valeria Rolle Sóñora
- Plataforma de Bioestadística y Epidemiología, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, España
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Catheter-Associated Urinary Tract Infection in Intensive Care Unit Patients at a Tertiary Care Hospital, Hail, Kingdom of Saudi Arabia. Diagnostics (Basel) 2022; 12:diagnostics12071695. [PMID: 35885599 PMCID: PMC9322978 DOI: 10.3390/diagnostics12071695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Catheter-associated urinary tract infections (CAUTIs) are some of the most common hospital-acquired infections (HAIs). Prolonged hospitalization, invasive devices such as catheters, and irrational use of antimicrobial agents are believed to be the major causes of high rates of HAIs. Infections such as pyelonephritis, urethritis, cystitis, and prostatitis are the main concerns in catheterized ICU patients. In these cases, Gram-negative bacteria are the most common bacteria. The present study was undertaken to determine the frequency, antibiograms, disease pattern, and risk factors involved in providing an advocacy recommendation to prevent CAUTI. A total of 1078 patients were admitted to the hospital ICU, out of which healthcare-associated infection was reported in 316 patients. CAUTI was reported only in 70 patients. Klebsiella pneumoniae (20%) was the predominant isolate, with Serratia (3%) and Providencia (3%) species being the least common isolates in this study. The present study provides CAUTI incidence rates in a tertiary care hospital in Hail, Saudi Arabia. Furthermore, information on the risk factors of common associated CAUTI causative organisms and their antibiogram patterns are also presented. This study provides vital information that can be used to formulate an effective antibiotic stewardship program that can be implemented throughout the kingdom.
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Vázquez-Pérez Á, Alonso-Acero L, Baquero-Artigao F, de Pablos Gómez M, Calvo C. [Community-acquired urinary tract infections: Etiological, resistance and patient's profile at a tertiary hospital]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00232-0. [PMID: 34340941 DOI: 10.1016/j.anpedi.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Álvaro Vázquez-Pérez
- Servicio de Pediatría y Enfermedades Infecciosas Pediátricas, Hospital Universitario La Paz, Madrid, España.
| | - Laura Alonso-Acero
- Servicio de Microbiología, Hospital Universitario La Paz, Madrid, España
| | - Fernando Baquero-Artigao
- Servicio de Pediatría y Enfermedades Infecciosas Pediátricas, Hospital Universitario La Paz, Madrid, España
| | | | - Cristina Calvo
- Servicio de Pediatría y Enfermedades Infecciosas Pediátricas, Hospital Universitario La Paz, Madrid, España
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Brandström P, Lindén M. How Swedish guidelines on urinary tract infections in children compare to Canadian, American and European guidelines. Acta Paediatr 2021; 110:1759-1771. [PMID: 33341101 PMCID: PMC8247322 DOI: 10.1111/apa.15727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/24/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022]
Abstract
Urinary tract infections (UTI) are common in children and the guidelines focus on preventing kidney damage. We compared the 2013 national Swedish guidelines on UTIs in children with the guidelines from America, Canada, UK, Spain, Italy and European urologists. This showed that urinalysis and urine cultures are endorsed by all the guidelines, but sampling techniques and bacteria levels differ. They all recommend initial oral treatment and renal ultrasound to detect major anomalies in infants. The Swedish guidelines are more liberal on antibiotic prophylaxis. Conclusion Differences in diagnostic criteria, workup and accepted methods for urine sampling were noted and are discussed.
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Affiliation(s)
- Per Brandström
- Dept of Paediatrics Institute of Medical Sciences Sahlgrenska AcademyUniversity of Gothenburg Sweden
- Queen Silvia Children’s HospitalSahlgrenska University Hospital Gothenburg Sweden
| | - Magnus Lindén
- Dept of Paediatrics Hospital of Halland Halmstad Sweden
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[Urinary tract infection in children with nephrourological pathology]. An Pediatr (Barc) 2021:S1695-4033(21)00166-1. [PMID: 33931351 DOI: 10.1016/j.anpedi.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 11/22/2022] Open
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Lorente Romero J, Marañón R, Jové Blanco A. [Obtaining a urine sample through the perineal bag without replacement: Analysis of the contamination rate]. An Pediatr (Barc) 2021; 94:272-273. [PMID: 33436312 DOI: 10.1016/j.anpedi.2020.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Rafael Marañón
- Urgencias Pediátricas, Hospital Gregorio Marañón, Madrid, España
| | - Ana Jové Blanco
- Urgencias Pediátricas, Hospital Gregorio Marañón, Madrid, España
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Piñeiro Pérez R, Martínez Campos L, Cilleruelo Ortega MJ. [Obtaining a urine sample through the perineal bag without replacement: Analysis of the contamination rate. Author's reply]. An Pediatr (Barc) 2021; 94:273-274. [PMID: 33414076 DOI: 10.1016/j.anpedi.2020.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 10/22/2022] Open
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Prevalence of Urinary Tract Infection in Febrile Infants With Upper Respiratory Tract Symptomatology. Pediatr Infect Dis J 2020; 39:e380-e382. [PMID: 33075038 DOI: 10.1097/inf.0000000000002829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Among 439 infants presenting with symptoms of upper respiratory tract infection and temperature ≥39°C, 19 (4.3% [95% confidence interval, 2.8-6.7]) received a diagnosis of urinary tract infection (abnormal urine dipstick from a sterile urine sample and positive urine culture). Regardless of respiratory presentation, all infants presenting with a temperature of 39°C should be screened for urinary tract infection.
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[Access to complementary tests for the diagnosis of infectious diseases in primary care paediatric clinics]. An Pediatr (Barc) 2020; 94:82-91. [PMID: 32430217 DOI: 10.1016/j.anpedi.2020.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The performing of complementary tests in infectious processes can increase the diagnostic precision, the adequacy of treatments, as well as determining the epidemiology and pattern of bacterial resistance of the community. The Infectious Pathology Group of the Spanish Association of Primary Care Paediatrics (GPI-AEPap) has designed this study in order to determine the availability of complementary tests (CT) for paediatricians working in Primary Care of the public health system as well as their results. MATERIAL AND METHODS Observational cross-sectional descriptive national study was carried out using a voluntary self-report questionnaire distributed online to all AEPap members and to the subscribers of the PEDIAP distribution list between the months of April and May 2017. RESULTS A total of 517 responses were obtained. An analysis was made of the data from the professional environment, as well as those related to the request for basic supplementary tests (blood count, biochemistry, and routine urine analysis), the use of Rapid Antigen Detection Test for group A Streptococcus, bacterial cultures, serology, diagnostic tests for pertussis and tuberculosis (Mantoux), as well as imaging tests. CONCLUSIONS There is variability between Autonomous Communities and healthcare areas. Areas for improvement were found in the accessibility to different CT, collection time and sending of samples, delay in receiving results, as well as waiting times for non-urgent imaging tests. These affect the intervention and resolution capacity of the primary care paediatrician.
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Ecografía clínica en la infección del trato urinario. An Pediatr (Barc) 2020; 92:182-183. [DOI: 10.1016/j.anpedi.2019.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 11/23/2022] Open
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Selección del tratamiento antibiótico empírico en pielonefritis según el perfil del paciente. An Pediatr (Barc) 2020; 92:181-182. [DOI: 10.1016/j.anpedi.2019.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 11/23/2022] Open
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Piñeiro Pérez R, Martínez Campos L, Cilleruelo Ortega MJ, Piñeiro Pérez R, José Cilleruelo Ortega M, Ares Álvarez J, Baquero-Artigao F, Carlos Silva Rico J, Velasco Zuñiga R, Martínez Campos L, Carazo Gallego B, José Conejo Fernández A, Calvo Rey C, Alfayate Miguélez S, Berghezan Suárez A, García Vera C, José García García J, Herreros Fernández M, Rodrigo Gonzalo de Liria C. «Recomendaciones sobre el diagnóstico y tratamiento de la infección urinaria», respuesta de los autores. An Pediatr (Barc) 2020; 92:184-186. [DOI: 10.1016/j.anpedi.2019.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 12/27/2019] [Indexed: 01/05/2023] Open
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Kaufman J, Temple-Smith M, Sanci L. Urinary tract infections in children: an overview of diagnosis and management. BMJ Paediatr Open 2019; 3:e000487. [PMID: 31646191 PMCID: PMC6782125 DOI: 10.1136/bmjpo-2019-000487] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 01/05/2023] Open
Abstract
Urinary tract infections (UTIs) are a common and potentially serious bacterial infection of childhood. History and examination findings can be non-specific, so a urine sample is required to diagnose UTI. Sample collection in young precontinent children can be challenging. Bedside dipstick tests are useful for screening, but urine culture is required for diagnostic confirmation. Antibiotic therapy must be guided by local guidelines due to increasing antibiotic resistance. Duration of therapy and indications for imaging remain controversial topics and guidelines lack consensus. This article presents an overview of paediatric UTI diagnosis and management, with highlights of recent advances and evidence updates.
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Affiliation(s)
- Jonathan Kaufman
- Department of Paediatrics, Western Health, Sunshine Hospital, St Albans, Victoria, Australia.,Health Services Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of General Practice, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Meredith Temple-Smith
- Department of General Practice, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lena Sanci
- Department of General Practice, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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