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Antimicrobial Utilization among Neonates and Children: A Multicenter Point Prevalence Study from Leading Children’s Hospitals in Punjab, Pakistan. Antibiotics (Basel) 2022; 11:antibiotics11081056. [PMID: 36009925 PMCID: PMC9405424 DOI: 10.3390/antibiotics11081056] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 01/25/2023] Open
Abstract
Antimicrobial resistance (AMR) compromises global health due to the associated morbidity, mortality, and costs. The inappropriate use of antimicrobial agents is a prime driver of AMR. Consequently, it is imperative to gain a greater understanding of current utilization patterns especially in high-risk groups including neonates and children. A point prevalence survey (PPS) was conducted among three tertiary care children’s hospitals in the Punjab province using the World Health Organization (WHO) methodology. Antibiotic use was documented according to the WHO AWaRe classification. Out of a total of 1576 neonates and children, 1506 were prescribed antibiotics on the day of the survey (prevalence = 95.5%), with an average of 1.9 antibiotics per patient. The majority of antibiotics were prescribed in the medical ward (75%), followed by surgical ward (12.8%). Furthermore, 56% of antibiotics were prescribed prophylactically, with most of the antibiotics (92.3%) administered via the parenteral route. The top three indications for antibiotics were respiratory tract infections (34.8%), gastrointestinal infections (15.8%), and prophylaxis for medical problems (14.3%). The three most common antibiotics prescribed were ceftriaxone (25.8%), amikacin (9.2%), and vancomycin (7.9%). Overall, 76.6% of the prescribed antibiotics were from Watch category followed by 21.6% from the Access group. There was a very high prevalence of antibiotic use among hospitalized neonates and children in this study. Urgent measures are needed to engage all the stakeholders to formulate effective ASPs in Pakistan, especially surrounding Watch antibiotics.
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McMullan BJ, Hall L, James R, Mostaghim M, Jones CA, Konecny P, Blyth CC, Thursky KA. Antibiotic appropriateness and guideline adherence in hospitalized children: results of a nationwide study. J Antimicrob Chemother 2021; 75:738-746. [PMID: 31697335 DOI: 10.1093/jac/dkz474] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/01/2019] [Accepted: 10/16/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Information on the nature and appropriateness of antibiotic prescribing for children in hospitals is important, but scarce. OBJECTIVES To analyse antimicrobial prescribing and appropriateness, and guideline adherence, in hospitalized children across Australia. PATIENTS AND METHODS We analysed data from the National Antimicrobial Prescribing Survey (NAPS) from 2014 to 2017. Surveys were performed in hospital facilities of all types (public and private; major city, regional and remote). Participants were admitted children <18 years old. Risk factors associated with inappropriate prescribing were explored using logistic regression models. RESULTS Among 6219 prescriptions for 3715 children in 253 facilities, 19.6% of prescriptions were deemed inappropriate. Risk factors for inappropriate prescribing included non-tertiary paediatric hospital admission [OR 1.37 (95% CI 1.20-1.55)] and non-major city hospital location [OR 1.52 (95% CI 1.30-1.77)]. Prescriptions for neonates, immunocompromised children and those admitted to an ICU were less frequently inappropriate. If a restricted antimicrobial was prescribed and not approved, the prescription was more likely to be inappropriate [OR 12.9 (95% CI 8.4-19.8)]. Surgical prophylaxis was inappropriate in 59% of prescriptions. CONCLUSIONS Inappropriate antimicrobial prescribing in children was linked to specific risk factors identified here, presenting opportunities for targeted interventions to improve prescribing. This information, using a NAPS dataset, allows for analysis of antimicrobial prescribing among different groups of hospitalized children. Further exploration of barriers to appropriate prescribing and facilitators of best practice in this population is recommended.
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Affiliation(s)
- Brendan J McMullan
- National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia.,Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Lisa Hall
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Rodney James
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Mona Mostaghim
- Department of Pharmacy, Sydney Children's Hospital, Randwick, Sydney, Australia
| | - Cheryl A Jones
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Pamela Konecny
- Department of Infectious Diseases, Immunology & Sexual Health, St George Hospital, Kogarah, Sydney, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia
| | - Christopher C Blyth
- School of Medicine, University of Western Australia, Perth, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.,Department of Paediatric Infectious Diseases, Perth Children's Hospital, Perth, Australia.,Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Australia
| | - Karin A Thursky
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
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Oğuz E, Bebitoğlu BT, Nuhoğlu Ç, Çağ Y, Hodzic A, Temel F, Çırtlık P, Kurtdan Dalkılıç AE. Evaluation of antibiotic use among hospitalised patients in a paediatric department of a training hospital in Turkey. Int J Clin Pract 2021; 75:e13782. [PMID: 33098730 DOI: 10.1111/ijcp.13782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 10/15/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Antibiotics are widely used and inaccurate or inappropriate prescription of antibiotics causes a significant increase in the prevalence of multidrug-resistant bacterial infections among children. This research aimed to study antibiotic prescriptions in hospitalised paediatric patients and to determine the prevalence of inappropriate antimicrobial use and the main types of prescribing errors. METHODS After obtaining the Ethics Committee approval, screening was conducted among 535 patients admitted to the Department of Pediatrics at Haydarpasa Numune Training and Research Hospital in the period from 01 January 2016 to 31 December 2016 who had been treated with an antibiotic. Patients' demographics, diagnosis and antibiotic therapy details were collected using a standardised case report form and assessed by a clinical pharmacologist and an infectious disease specialist regarding the convenience and accurateness of prescription of antibiotics. RESULTS Out of 535 antibiotic prescriptions, single antibiotics were used inappropriately in 216 (56.10%) of the patients and there were 39 (26%) unnecessary antibiotic combinations. Most of the errors were made in the dose frequency (55.69%), followed by indication (25.88%), administration route (16.08%) and dosage (2.67%). CONCLUSIONS The results of our study show that a high level of antibiotics in the paediatric clinic was misprescribed. Inappropriate usage increases the chances of microbial resistance and the cost of treatment. Precautions should be taken in this regard.
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Affiliation(s)
- Elif Oğuz
- Department of Medical Pharmacology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Berna Terzioğlu Bebitoğlu
- Department of Medical Pharmacology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Çağatay Nuhoğlu
- Department of Pediatrics, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Yasemin Çağ
- Department of Infectious Diseases, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ajla Hodzic
- Department of Medical Pharmacology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Fatime Temel
- Department of Medical Pharmacology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Pelin Çırtlık
- Department of Pediatrics, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Mahboobipour AA, Baniasadi S, Shahrebabaki ES, Nejad ST, Hassanzad M. Antibiotic use evaluation in hospitalized pediatric patients with respiratory tract infections: A retrospective chart review study. Curr Drug Saf 2021; 17:17-23. [PMID: 33602106 DOI: 10.2174/1574886316666210218104644] [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: 09/08/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Respiratory tract infections (RTIs) are a common cause of antibiotic usage in hospitalized pediatric patients. Inappropriate use of antibiotics may lead to the emergence of multidrug-resistant microorganisms and increased treatment costs. OBJECTIVE This study was designed to assess antibiotic usage in hospitalized pediatric patients with RTIs. METHODS Medical charts of the patients admitted to the pediatric ward (PW) and pediatric intensive care unit (PICU) of a tertiary respiratory center were reviewed. Patients' demographic and clinical data including gender, age, weight, history of allergy, length of hospital stay, clinical diagnosis, prescribed antibiotics (indication, dose, and frequency of administration) were collected. The appropriateness of antibiotic usage was evaluated in each patient according to international guidelines. RESULTS Two hundred seventy-nine hospitalized patients were included in the study. The most common reason for hospitalization was pneumonia (38%), followed by cystic fibrosis (20.1%) and bronchitis (5%). The most commonly used antimicrobial agents were ceftriaxone, azithromycin, and clindamycin which guideline adherence for their usage was 85.3%, 23.3%, and 47%; respectively. Inappropriate dose selection was the main reason for non-adherence to the guidelines. The adherence rate to RTIs' guidelines (considering all parameters for each patient) was 27.6%. Multivariate logistic regression analysis demonstrated CF and prescription of azithromycin are predictors of guideline non-adherence. CONCLUSION We found relatively low adherence to international guidelines in our center that could be related to restricted definitions of optimal antibiotic therapy. Despite most patients received logical antimicrobial therapy, actions should be taken into account to reach optimal antibiotic usage.
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Affiliation(s)
| | - Shadi Baniasadi
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran. Iran
| | - Elahe Saberi Shahrebabaki
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran. Iran
| | - Sabereh Tashayoie Nejad
- Pediatric Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran. Iran
| | - Maryam Hassanzad
- Pediatric Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran. Iran
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Quality Analysis of Antimicrobial Restriction Policy in Pediatrics. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2021. [DOI: 10.5812/pedinfect.100986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Antimicrobial stewardship programs (ASPs) are coordinated programs developed in recent years to promote the appropriate use of antimicrobials and reduce microbial resistance. One important action for a successful ASP is the implementation of an antimicrobial policy restriction. Objective: The study analyzed the quality of target-antimicrobial requisitions after the introduction of an antimicrobial policy restriction for children. Methods: We conducted a retrospective study in a neonatal intensive care unit (NICU) and three pediatric intensive care units (PICUs). An ASP was implemented in October 2016, and 14 target antimicrobials were selected to be prescribed after pre-approval by a pediatric infectious disease specialist. All requisitions were analyzed according to indication, antimicrobial type, dose, duration, and collection of cultures before administration. There were no exclusion criteria for requisition analysis. Results: Between October 2016 and December 2017, 1,173 patients were admitted to the units with 120 requisitions of target antimicrobials. Sepsis (43/120; 35.8%) was the most common indication, followed by respiratory infections (23/120; 19.2%) and infections in two or more sites (11/120; 9.2%). The most common target antimicrobials requested were meropenem (68/120; 56.7%), amphotericin B lipid formulations (12/120; 10%), teicoplanin (11/120; 9.2%), and linezolid (11/120; 9.2%). In 98 (81.7%) cases, previous cultures before antimicrobial administration were collected. An infectious agent was detected in 52 of the 98 cultures (53.1%), and Gram-negative and Gram-positive bacteria represented 50% and 26.9% of all positive samples, respectively. Besides, 111 (92.5%) requisitions were approved. In five refused requisitions, a narrow-spectrum antimicrobial was prescribed after further discussion; four were refused due to lack of information, and in one case, the de-escalation of the antimicrobial was possible. No mistake regarding dosage and duration was detected. Conclusions: We found a high-quality rate of target antimicrobial requisition. Antimicrobial policy restriction could contribute to improving the quality of antimicrobial prescription, even in NICUs and PICUs.
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Velasco-Arnaiz E, Simó-Nebot S, Ríos-Barnés M, López Ramos MG, Monsonís M, Urrea-Ayala M, Jordan I, Mas-Comas A, Casadevall-Llandrich R, Ormazábal-Kirchner D, Cuadras-Pallejà D, Pérez-Pérez C, Millet-Elizalde M, Sánchez-Ruiz E, Fortuny C, Noguera-Julian A. Benefits of a Pediatric Antimicrobial Stewardship Program in Antimicrobial Use and Quality of Prescriptions in a Referral Children's Hospital. J Pediatr 2020; 225:222-230.e1. [PMID: 32522527 DOI: 10.1016/j.jpeds.2020.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/11/2020] [Accepted: 06/03/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate the results of the first 24 months of a postprescription review with feedback-based antimicrobial stewardship program in a European referral children's hospital. STUDY DESIGN We performed a pre-post study comparing antimicrobial use between the control (2015-2016) and the intervention periods (2017-2018) expressed in days of therapy/100 days present. Quality of prescriptions was evaluated by quarterly cross-sectional point-prevalence surveys. Length of stay, readmission rates, in-hospital mortality rates, cost of systemic antimicrobial agents, and antimicrobial resistance rates were included as complementary outcomes. RESULTS Total antimicrobial use and antibacterial use significantly decreased during the intervention period (P = .002 and P = .001 respectively), and total antifungal use remained stable. A significant decline in parenteral antimicrobial use was also observed (P < .001). In 8 quarterly point-prevalence surveys (938 prescriptions evaluated), the mean prevalence of use of any antimicrobial among inpatients was 39%. An increasing trend in the rate of optimal prescriptions was observed after the first point-prevalence survey (P = .0898). Nonoptimal prescriptions were more common in surgical than in medical departments, in antibacterial prescriptions with prophylactic intention, and in empirical more than in targeted treatments. No significant differences were observed in terms of mortality or readmission rates. Only minor changes in antimicrobial resistance rates were noted. CONCLUSIONS Our antimicrobial stewardship program safely decreased antimicrobial use and expenditure, and a trend toward improvement in quality of prescription was also observed.
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Affiliation(s)
- Eneritz Velasco-Arnaiz
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Sant Joan de Déu Hospital Research Foundation, Barcelona, Spain
| | - Silvia Simó-Nebot
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Sant Joan de Déu Hospital Research Foundation, Barcelona, Spain; Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - María Ríos-Barnés
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Sant Joan de Déu Hospital Research Foundation, Barcelona, Spain
| | | | - Manuel Monsonís
- Clinical Microbiology Department, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Mireia Urrea-Ayala
- Infection Control Department, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Iolanda Jordan
- Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Barcelona, Spain; Department of Pediatrics, University of Barcelona, Barcelona, Spain; Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Anna Mas-Comas
- Pharmacy Department, Sant Joan de Déu Hospital, Barcelona, Spain
| | | | | | | | | | | | - Emilia Sánchez-Ruiz
- Blanquerna School of Health Science, Ramon Llull University, Barcelona, Spain
| | - Clàudia Fortuny
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Sant Joan de Déu Hospital Research Foundation, Barcelona, Spain; Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Pediatrics, University of Barcelona, Barcelona, Spain; Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Antoni Noguera-Julian
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Sant Joan de Déu Hospital Research Foundation, Barcelona, Spain; Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Pediatrics, University of Barcelona, Barcelona, Spain; Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.
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Chautrakarn S, Anugulruengkitt S, Puthanakit T, Rattananupong T, Hiransuthikul N. Antimicrobial prescription patterns in a tertiary-care pediatric unit in Thailand. Pediatr Int 2020; 62:683-687. [PMID: 31957141 DOI: 10.1111/ped.14153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/08/2020] [Accepted: 01/15/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Antimicrobial resistance is one of the greatest public health threats worldwide. The improper prescription of antibiotics is one factor that promotes antibiotic resistance. Access to antimicrobial surveillance data is essential when assessing the pattern and appropriateness of antimicrobial prescriptions in hospitals and for the establishment of an antimicrobial stewardship program. This study aimed to describe the rate of antimicrobial use and the pattern of prescriptions in a tertiary care pediatric unit in Thailand. METHODS A point prevalence survey on antimicrobial use was conducted monthly between January and June 2016, using standardized tools. The survey included all inpatient pediatric beds and identified all children receiving antimicrobial treatment on the day of the survey. RESULTS The study included 644 children, 43.3% of whom received antimicrobial treatment during hospitalization. In general wards, the rate of antimicrobial prescriptions was 37.2%; in oncology wards it was 47.0%; in intensive care units it was 38.7%, and in surgical wards it was 67.7%. Meropenem was the most prescribed antimicrobial in the general wards (24.5%) and intensive care units (28.6%), whereas antipseudomonas was the most commonly prescribed antimicrobial in the oncology ward (26.6%). For the surgical ward, the most prescribed antimicrobial was third-generation cephalosporin for both prophylaxis and treatment (39.0%). The most common reason for antimicrobial use was the treatment of infections. CONCLUSIONS Nearly half of hospitalized children received at least one antimicrobial. This was comparable with other pediatric tertiary care centers, although the high use of meropenem was different. This study provides important baseline information on antimicrobial use in a large tertiary-care pediatric unit and could lead to a nationwide survey in the future.
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Affiliation(s)
- Sineenart Chautrakarn
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | - Suvaporn Anugulruengkitt
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Thanyawee Puthanakit
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Thanapoom Rattananupong
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Narin Hiransuthikul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Saleem Z, Hassali MA, Godman B, Versporten A, Hashmi FK, Saeed H, Saleem F, Salman M, Rehman IU, Khan TM. Point prevalence surveys of antimicrobial use: a systematic review and the implications. Expert Rev Anti Infect Ther 2020; 18:897-910. [PMID: 32394754 DOI: 10.1080/14787210.2020.1767593] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: In view of increasing concerns with antimicrobial resistance (AMR), the World Health Organization (WHO) instituted a Global Action Plan (GAP) to address this. Area covered: One of the strategies to achieve the goals of GAP is to conduct regular surveillance of antimicrobial use through point prevalence surveys (PPS). In this review, PubMed, EBSCO, Proquest, Cinahl, and Scopus were searched for PPS of antimicrobial use published in English between January 2000 and December 2019. After systematic database screening of 2,893 articles, 60 PPS met the inclusion criteria and consequently were incorporated in this systematic review. Expert opinion: This review highlighted that most of the PPS were conducted in upper-middle and high-income countries. Prevalence of antimicrobial use was significantly higher in non-European hospitals compared with European hospitals. The domination of third-generation cephalosporin and fluoroquinolones use across all the regions suggests substantial use of broad-spectrum antimicrobials across countries. Among all identified regions around the world, India was the region where the highest use of antimicrobials was observed. Although PPS is a useful tool to assess the pattern of antimicrobial use and provides a robust baseline; however, a standardized surveillance method is needed. In order to optimize antimicrobial use, more efforts are required to improve antimicrobial use.
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Affiliation(s)
- Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia , George Town, Malaysia.,Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Mohamed Azmi Hassali
- School of Pharmaceutical Sciences, Universiti Sains Malaysia , George Town, Malaysia
| | - Brian Godman
- Health Economics Centre, University of Liverpool Management School , Liverpool, UK.,Department of Clinical Pharmacology, Karolinska Institute , Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University , Glasgow, UK
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp, Belgium
| | | | - Hamid Saeed
- University College of Pharmacy, University of the Punjab , Lahore, Pakistan
| | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences, University of Balochistan , Quetta, Pakistan
| | - Muhammad Salman
- Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan , Mardan, Pakistan.,School of Pharmacy, Monash University Malaysia , Bandar Sunway, Malaysia
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences , Lahore, Pakistan
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Ilieva N, Nikolova M, Pankov D, Simonoska Crcarevska M, Mladenovska K, Shalabalija D, Mihailova L, Gigopulu O, Glavas Dodov M. Antibiotic consumption and management at Kocani General Hospital – Annual report. MAKEDONSKO FARMACEVTSKI BILTEN 2019. [DOI: 10.33320/maced.pharm.bull.2019.65.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The aim of the study was to get detailed insight into the antibiotic consumption trends in the three year period (2016-2018) in Kocani Hospital, to identify the most often prescribed antibiotics and to determine whether the treatment of given diagnosis was in accordance with the official guidelines. The survey covered all pediatric and infant patients admitted to the pediatric ward. Patients’ data included gender, age, diagnosis, antibiotic used and doses. The majority of admitted patients were in the age group of 0-1 (27.48%, 25.94% and 30.77% for 2016, 2017 and 2018, accordingly) followed by age group of 1-2 years (20.86%, 22,0% and 23.83% for 2016, 2017 and 2018, consequently) and 2-3 years (16.06%, 16.1% and 14.63% for 2016, 2017 and 2018, consequently) .The most frequent diagnosis was acute tonsillitis which was determined in ~21% of patients, pneumonia without complications in ~18% and acute bronchitis in ~16% of patients in the period 2016-2018. Results from conducted survey identified high prescription rate and use of antibiotics predominantly ceftriaxone (82.58%, 81.05% and 50.85% in 2016, 2017 and 2018, respectively) contrary to official recommendations and evidences based on clinical data for treatment of the diagnoses in question. So, it is foreseeable to conclude that there is urgent need for restrictive and educational measures i.e. to strength the surveillance and monitoring of antibiotic prescription and usage and hence to promote awareness for rational use of antibiotics on all health-care levels.
Key words: antibiotic prescription, antibiotic consumption, pediatric wards, annual report
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Affiliation(s)
- Nada Ilieva
- Faculty of pharmacy, Ss. Cyril and Methodius University, Majka Tereza 47, 1000 Skopje, R. North Macedonia
| | - Milena Nikolova
- Faculty of pharmacy, Ss. Cyril and Methodius University, Majka Tereza 47, 1000 Skopje, R. North Macedonia
| | - Donka Pankov
- Faculty of pharmacy, Ss. Cyril and Methodius University, Majka Tereza 47, 1000 Skopje, R. North Macedonia
| | - Maja Simonoska Crcarevska
- Faculty of pharmacy, Ss. Cyril and Methodius University, Majka Tereza 47, 1000 Skopje, R. North Macedonia
| | - Kristina Mladenovska
- Faculty of pharmacy, Ss. Cyril and Methodius University, Majka Tereza 47, 1000 Skopje, R. North Macedonia
| | - Dushko Shalabalija
- Faculty of pharmacy, Ss. Cyril and Methodius University, Majka Tereza 47, 1000 Skopje, R. North Macedonia
| | - Ljubica Mihailova
- Faculty of pharmacy, Ss. Cyril and Methodius University, Majka Tereza 47, 1000 Skopje, R. North Macedonia
| | - Olga Gigopulu
- Faculty of pharmacy, Ss. Cyril and Methodius University, Majka Tereza 47, 1000 Skopje, R. North Macedonia
| | - Marija Glavas Dodov
- Faculty of pharmacy, Ss. Cyril and Methodius University, Majka Tereza 47, 1000 Skopje, R. North Macedonia
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10
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Zhang JS, Liu G, Zhang WS, Shi HY, Lu G, Zhao CA, Li CC, Li YQ, Shao YN, Tian DY, Ding MJ, Li CY, Luo LJ, Dong XY, Jin P, Wang P, Zhu CM, Wang CQ, Zheng YJ, Deng JK, Sharland M, Hsia YF, Shen KL, Yang YH. Antibiotic usage in Chinese children: a point prevalence survey. World J Pediatr 2018; 14:335-343. [PMID: 30062648 DOI: 10.1007/s12519-018-0176-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 07/11/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Children as a population have high antimicrobial prescribing rates which may lead to high resistance of bacteria according to data from some single-center surveys of antibiotic prescribing rates in China. The acquirement of baseline data of antibiotic prescribing is the basis of developing intervention strategies on inappropriate antimicrobial prescriptions. Few studies show clearly the pattern and detailed information on classes of antibiotics and distribution of indications of antibiotic prescriptions in children in China. This study aims to assess the antibiotic prescribing patterns among children and neonates hospitalized in 18 hospitals in China. METHODS A 24-hour point prevalence survey on antimicrobial prescribing was conducted in hospitalized neonates and children in China from December 1st, 2016 to February 28th, 2017. Information on the antibiotic use of patients under 18 years of age who were administered one or more on-going antibiotics in the selected wards over a 24-hour period was collected. These data were submitted to the GARPEC (Global Antimicrobial Resistance, Prescribing and Efficacy in Children and Neonates) web-based application ( https://pidrg-database.sgul.ac.uk/redcap/ ). For statistical analysis, Microsoft Excel 2007 and SPSS 22.0 were used. RESULTS The antibiotic data were collected in 35 wards in 18 hospitals from 9 provinces. In total, 67.76% (975/1439) of the patients (n = 1439) were given at least one antibiotic, including 58.1% (173/298) of neonates (n = 298) and 70.3% (802/1141) of children (n = 1141). In neonates, the three most frequently prescribed antibiotics were third-generation cephalosporins (41.7%), penicillins plus enzyme inhibitor (23.8%), and carbapenems (11.2%). In children, the three most frequently prescribed antibiotics were third-generation cephalosporins (35.5%), macrolides (23.2%), and penicillins plus enzyme inhibitors (15.9%). The most common indication for antibiotics was proven or probable bacterial lower respiratory tract infection (30.9% in neonates and 66.6% in children). CONCLUSIONS Antibiotics are commonly prescribed in the Chinese children population. It is likely that the third-generation cephalosporins and macrolides are currently overused in Chinese children. Efforts must be made to ensure safe and appropriate antibiotic prescribing to reduce and prevent the future development of antibiotic resistance.
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Affiliation(s)
- Jiao-Sheng Zhang
- Department of Infectious diseases, Shenzhen Children's Hospital, Shenzhen, China
| | - Gang Liu
- Department of Infectious diseases, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
| | - Wen-Shuang Zhang
- Department of Respiratory Medicine, Tianjin Children's Hospital, Tianjin, China
| | - Hai-Yan Shi
- Department of Pharmacology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Gen Lu
- Department of Respiratory Medicine, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Chang-An Zhao
- Emergency Department, Guangdong Maternal and Child Health Care Hospital, Guangzhou, China
| | - Chang-Chong Li
- Department of Pediatric Respiratory Medicine, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yan-Qi Li
- Department of Respiratory Medicine, Xi'an Children's Hospital, Xi'an, China
| | - Ya-Nan Shao
- Department of Respiratory Medicine, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dai-Yin Tian
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ming-Jie Ding
- Department of Respiratory Medicine, Jinan Children's Hospital, Jinan, China
| | - Chun-Yan Li
- Department of Respiratory Medicine, The First Hospital of Jilin University, Changchun, China
| | - Li-Juan Luo
- Department of Infectious diseases, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiao-Yan Dong
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai, China
| | - Ping Jin
- Pediatric Intensive Care Unit, Bao'an Maternity and Child Health Hospital, Shenzhen, China
| | - Ping Wang
- Neonatal Department, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Chun-Mei Zhu
- Department of Respiratory Medicine, Children's Hospital Attached to The Capital Institute of Pediatrics, Beijing, China
| | - Chuan-Qing Wang
- Infection-control Department, Fudan University Pediatric Hospital, Shanghai, China
| | - Yue-Jie Zheng
- Department of Respiratory Medicine, Shenzhen Children's Hospital, Shenzhen, China
| | - Ji-Kui Deng
- Department of Infectious diseases, Shenzhen Children's Hospital, Shenzhen, China
| | - Mike Sharland
- Pediatric Infectious Diseases Research Group, St George's, University of London, London, UK
| | - Ying-Fen Hsia
- Pediatric Infectious Diseases Research Group, St George's, University of London, London, UK
| | - Kun-Ling Shen
- Department of Respiratory Medicine, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yong-Hong Yang
- Beijing Pediatric Research Institute, Beijing Children's Hospital Affiliated to Capital Medical University, 56 Nanlishi Road, Beijing, China.
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11
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Gandra S, Singh SK, Jinka DR, Kanithi R, Chikkappa AK, Sharma A, Dharmapalan D, Vasudevan AK, Tunga O, Akula A, Garg G, Hsia Y, Murki S, Alvarez-Uria G, Sharland M, Laxminarayan R. Point Prevalence Surveys of Antimicrobial Use among Hospitalized Children in Six Hospitals in India in 2016. Antibiotics (Basel) 2017; 6:E19. [PMID: 28902135 PMCID: PMC5617983 DOI: 10.3390/antibiotics6030019] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/22/2017] [Accepted: 09/07/2017] [Indexed: 01/15/2023] Open
Abstract
The prevalence of antimicrobial resistance in India is among the highest in the world. Antimicrobial use in inpatient settings is an important driver of resistance, but is poorly characterized, particularly in hospitalized children. In this study, conducted as part of the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children (GARPEC) project, we examined the prevalence of and indications of antimicrobial use, as well as antimicrobial agents used among hospitalized children by conducting four point prevalence surveys in six hospitals between February 2016 and February 2017. A total of 681 children were hospitalized in six hospitals across all survey days, and 419 (61.5%) were prescribed one or more antimicrobials (antibacterials, antivirals, antifungals). Antibacterial agents accounted for 90.8% (547/602) of the total antimicrobial prescriptions, of which third-generation cephalosporins (3GCs) accounted for 38.9% (213/547) and penicillin plus enzyme inhibitor combinations accounted for 14.4% (79/547). Lower respiratory tract infection (LRTI) was the most common indication for prescribing antimicrobials (149 prescriptions; 24.8%). Although national guidelines recommend the use of penicillin and combinations as first-line agents for LRTI, 3GCs were the most commonly prescribed antibacterial agents (55/149 LRTI prescriptions; 36.9%). In conclusion, 61.5% of hospitalized children were on at least one antimicrobial agent, with excessive use of 3GCs. Hence there is an opportunity to limit their inappropriate use.
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Affiliation(s)
- Sumanth Gandra
- Center for Disease Dynamics, Economics & Policy, New Delhi 110020, India.
| | - Sanjeev K Singh
- Department of Infection Control & Microbiology, Amrita Institute of Medical Sciences, Amrita University, Ponekkara, Kochi 682041, India.
| | - Dasaratha R Jinka
- Department of Infectious Diseases & Department of Paediatrics, Rural Development Trust Hospital, Bathalapalli 515661, India.
| | - Ravishankar Kanithi
- Department of Paediatrics, Sowmya Children's Hospital, Hyderabad 500038, India.
| | - Ashok K Chikkappa
- Department of Paediatrics, Rural Development Trust Hospital, Kalyanadurgam 515761, India.
| | - Anita Sharma
- Department of Microbiology & Department of Paediatric Intensive Care Unit, Fortis Hospital, Mohali 160062, India.
| | - Dhanya Dharmapalan
- Department of Paediatrics, Dr Yewale's Multispeciality Hospital for Children, Navi Mumbai 400703, India.
| | - Anil Kumar Vasudevan
- Department of Infection Control & Microbiology, Amrita Institute of Medical Sciences, Amrita University, Ponekkara, Kochi 682041, India.
| | - Onkaraiah Tunga
- Department of Paediatrics, Rural Development Trust Hospital, Kalyanadurgam 515761, India.
| | - Akhila Akula
- Department of Paediatrics, Sowmya Children's Hospital, Hyderabad 500038, India.
| | - Garima Garg
- Department of Microbiology & Department of Paediatric Intensive Care Unit, Fortis Hospital, Mohali 160062, India.
| | - Yingfen Hsia
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. Georges University, London SW17 0RE, UK.
| | - Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderabad 500029, India.
| | - Gerardo Alvarez-Uria
- Department of Infectious Diseases & Department of Paediatrics, Rural Development Trust Hospital, Bathalapalli 515661, India.
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. Georges University, London SW17 0RE, UK.
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, New Delhi 110020, India.
- Princeton Environmental Institute, Princeton University, Princeton, NJ 08544, USA.
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12
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Sviestina I, Usonis V, Gurksniene V, Burokiene S, Ivaskeviciene I, Mozgis D. Prescription of antibiotics in Riga and Vilnius tertiary children's hospitals. Eur J Hosp Pharm 2017; 25:189-194. [PMID: 31157017 DOI: 10.1136/ejhpharm-2016-001124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/01/2017] [Accepted: 02/27/2017] [Indexed: 11/04/2022] Open
Abstract
Objectives The aim of this study was to compare the use of antibiotics among hospitalised children in Riga (Latvia) and in Vilnius (Lithuania) at two tertiary paediatric centres. Methods A point prevalence survey (PPS) was conducted using validated and standardised Antibiotic Resistance and Prescribing in European Children (ARPEC) project methodology during November 2012. All inpatients less than 18 years old were included in the study. All data were recorded for patients with active antimicrobial prescriptions at 8 am on the day of the survey. Data were entered into the ARPEC-webPPS programme and were validated online for accuracy. Results The proportion of patients receiving antimicrobial therapy was statistically different: 128 (37.0%) patients in Riga and 83 (26.3%) in Vilnius. The most common age group in Riga and Vilnius was 1-5 years. The most commonly used antibiotic classes for the treatment and prophylaxis of infection were third-generation cephalosporins (38; 25.5% prescriptions) in Riga and second-generation cephalosporins (16; 19.8%) in Vilnius. Parenteral use of antimicrobials was higher in Riga than in Vilnius: 111 (74.5%) prescriptions to paediatric patients in Riga and 45 (55.6%) prescriptions in Vilnius. Conclusions The PPS identified differences in antibiotic use in both hospitals and problem areas for improvement: high use of third-generation cephalosporins for paediatric patients (in Riga) and predominant use of parenteral antibiotics. Further collaboration between both centres is needed because sharing audit data and antimicrobial stewardship initiatives may encourage further changes in practice at both institutions.
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Affiliation(s)
- Inese Sviestina
- University Children's Hospital, Riga, Latvia.,Faculty of Pharmacy, Riga Stradins University, Riga, Latvia.,Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Vytautas Usonis
- Vilnius University Faculty of Medicine, Clinic of Children's Diseases, Vilnius, Lithuania.,Vilnius University Children's Hospital, Affiliate of Vilnius University Hospital, Vilnius, Lithuania
| | - Vilija Gurksniene
- Vilnius University Children's Hospital, Affiliate of Vilnius University Hospital, Vilnius, Lithuania
| | - Sigita Burokiene
- Vilnius University Faculty of Medicine, Clinic of Children's Diseases, Vilnius, Lithuania.,Vilnius University Children's Hospital, Affiliate of Vilnius University Hospital, Vilnius, Lithuania
| | - Inga Ivaskeviciene
- Vilnius University Faculty of Medicine, Clinic of Children's Diseases, Vilnius, Lithuania.,Vilnius University Children's Hospital, Affiliate of Vilnius University Hospital, Vilnius, Lithuania
| | - Dzintars Mozgis
- Public Health and Epidemiology Department, Riga Stradins University, Riga, Latvia
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13
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Baidya S, Hazra A, Datta S, Das AK. A study of antimicrobial use in children admitted to pediatric medicine ward of a tertiary care hospital. Indian J Pharmacol 2017; 49:10-15. [PMID: 28458416 PMCID: PMC5351220 DOI: 10.4103/0253-7613.201034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 12/08/2016] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Antimicrobials are frequently used in tertiary care hospitals. We conducted an observational study on children admitted to a teaching hospital in Eastern India, to generate a profile of antimicrobial use and suspected adverse drug reactions (ADRs) attributable to them. MATERIALS AND METHODS Hospitalized children of either sex, aged between 1 month and 12 years, were studied. Baseline demographic and clinical features, duration of hospital stay, antimicrobials received in hospital along with dosing and indications and details of suspected ADRs attributable to their use were recorded. Every patient was followed up till discharge, admission to the Pediatric Intensive Care Unit, or death. RESULTS Over the 1 year study period, 332 admissions were screened. The prevalence of antimicrobial use was 79.82%. The majority of the 265 children who received antimicrobials were males (61.10%) and hailed from rural and low socioeconomic background. Median age was 36 months. Six children died, 43 were transferred out, and the rest discharged. In most instances, either 2 (40%) or a single antibiotic (39.6%) was used. Ceftriaxone, co-amoxiclav, amikacin, vancomycin, and ampicillin were predominantly used. Antivirals, antimalarials, and antiprotozoals were used occasionally. Average number of antimicrobials per patient was 2.0 ± 1.27; the majority (84.1%) were by parenteral route and initial choice was usually empirical. Prescriptions were usually in generic name. The antimicrobial treatment ranged between 1 and 34 days, with a median of 7 days. Six ADRs were noted of which half were skin rash and the rest loose stools. CONCLUSIONS The profile of antimicrobial use is broadly similar to earlier Indian studies. Apparent overuse of multiple antimicrobials per prescription and the parenteral route requires exploration. Antimicrobials are being used empirically in the absence of policy. ADRs to antimicrobials are occasional and usually mild. The baseline data can serve in situation analysis for antibiotic prescribing guidelines.
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Affiliation(s)
- Sandip Baidya
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Avijit Hazra
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Supratim Datta
- Department of Pediatrics, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Amal Kanti Das
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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