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Thaulow CM, Klingenberg C. [C.H. Thaulow and C. Klingenberg respond]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2023; 143:23-0535. [PMID: 37668122 DOI: 10.4045/tidsskr.23.0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
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Thaulow CM, Lindemann PC, Klingenberg C. Meticillinresistente gule stafylokokker i sårsekret hos barn. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2022; 142:22-0186. [DOI: 10.4045/tidsskr.22.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Thaulow CM, Blix HS, Nilsen RM, Eriksen BH, Wathne JS, Berild D, Harthug S. Antibiotic Use in Children Before, During and After Hospitalization. Pharmacoepidemiol Drug Saf 2022; 31:749-757. [PMID: 35384111 PMCID: PMC9320961 DOI: 10.1002/pds.5438] [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: 12/28/2021] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 11/05/2022]
Abstract
Purpose To investigate ambulatory antibiotic use in children during 1 year before and 1 year after in‐hospital antibiotic exposure compared to children from the general population that had not received antibiotics in‐hospital. Methods Explorative data‐linkage cohort study from Norway of children aged 3 months to 17 years. One group had received antibiotics in‐Hospital (H+), and one group had not received antibiotics in‐hospital (H‐). The H+ group was recruited during admission in 2017. Using the Norwegian Population Registry, 10 children from the H‐ group were matched with one child from the H+ group according to county of residence, age and sex. We used the Norwegian Prescription Database to register antibiotic use 1 year before and 1 year after the month of hospitalisation. Results Of 187 children in the H+ group, 83 (44%) received antibiotics before hospitalisation compared to 288/1870 (15%) in the H‐ group, relative risk (RR) 2.88 (95% confidence interval 2.38–3.49). After hospitalisation, 86 (46%) received antibiotics in the H+ group compared to 311 (17%) in the H‐ group, RR 2.77 (2.30–3.33). Comorbidity‐adjusted RR was 2.30 (1.84–2.86) before and 2.25 (1.81–2.79) after hospitalisation. RR after hospitalisation was 2.55 (1.99–3.26) in children 3 months‐2 years, 4.03 (2.84–5.71) in children 3–12 years and 2.07 (1.33–3.20) in children 13–17 years. Conclusions Children exposed to antibiotics in‐hospital had two to three times higher risk of receiving antibiotics in ambulatory care both before and after hospitalisation. The link between in‐hospital and ambulatory antibiotic exposure should be emphasised in future antibiotic stewardship programs.
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Affiliation(s)
- Christian Magnus Thaulow
- Department of Clinical Science, University of Bergen, Norway.,Department of Paediatrics and Adolscence Medicine, Haukeland University Hospital, Bergen, Norway
| | - Hege Salvesen Blix
- Department of Pharmacy, University of Oslo, Oslo, Norway.,Department of Drug Statistics, Norwegian Institute of Public Health, Oslo, Norway
| | - Roy Miodini Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Beate Horsberg Eriksen
- Department of Paediatrics and Adolscence Medicine, Ålesund hospital, Ålesund, Norway.,Clinical Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jannicke Slettli Wathne
- Department of Quality and Development, Hospital Pharmacies Enterprises in Western Norway, Bergen, Norway
| | - Dag Berild
- Department of Clinical Medicine, University of Oslo, Oslo
| | - Stig Harthug
- Department of Clinical Science, University of Bergen, Norway.,Department of Research and Development, Haukeland University Hospital, Bergen, Norway
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Mustafa ZU, Salman M, Yasir M, Godman B, Majeed HA, Kanwal M, Iqbal M, Riaz MB, Hayat K, Hasan SS. Antibiotic consumption among hospitalized neonates and children in Punjab province, Pakistan. Expert Rev Anti Infect Ther 2021; 20:931-939. [PMID: 34591720 DOI: 10.1080/14787210.2021.1986388] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Periodic surveillance of antibiotic consumption in the form of point prevalence studies is a quick and robust methodology to evaluate prescribing trends in hospitals. The current study was undertaken to document antibiotic consumption among neonates and children from hospitals in Pakistan. METHODS This large multicenter study using the World Health Organization standardized methodology and AWaRe (Access, Watch, and Reserve) classification examined antibiotic consumption for suspected bacterial infection among neonates and children admitted hospitals in Punjab, Pakistan. RESULTS A total of 708 beds of children wards of the 16 health facilities were examined. Almost all (97%) hospitalized children were prescribed antibiotics on the day of the assessment with 2.6 antibiotics per patient. The three most common indications were respiratory tract infections (31.58%), sepsis (26.52%), and prophylaxis for medical problems (10.30%). The three most frequently prescribed antibiotics were ceftriaxone (24.2%), amikacin (23.2%), and ampicillin (16.7%). Almost half of the antibiotics were prescribed from the 'Access' (49.5%) and 'Watch' (45.5%) categories under the AWaRe classification. However, no antimicrobial was prescribed from the 'Reserved' category. CONCLUSIONS Our findings indicate that empirical antimicrobials use among hospitalized children is highly prevalent in Pakistan. The utilization of 'Watch' category of antimicrobials is frequent, stressing immediate action.
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Affiliation(s)
- Zia Ul Mustafa
- Department of Pharmacy Services, District Headquarter (Dhq) Hospital, Pakpattan, Pakistan
| | - Muhammad Salman
- Department of Pharmacy, The University of the Lahore, Lahore, Pakistan
| | - Muhammad Yasir
- Department of Medicine, Quaid E Azam Medical College Bahawalpur, Bahawalpur, Pakistan
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde Glasgow, UK.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Hafiz Abdul Majeed
- Department of Pharmacy Services, District Headquarter (Dhq) Hospital, Pakpattan, Pakistan
| | - Mahpara Kanwal
- Department of Pharmacy Services, District Headquarter (Dhq) Hospital Okara South City, Okara, Pakistan
| | - Maryam Iqbal
- Department of Pharmacy Services, District Headquarter (Dhq) Hospital Hafiz Abad, Hafiz Abad, Pakistan
| | - Muhammad Bilal Riaz
- Department of Pharmacy Services, District Headquarter (Dhq) Hospital Chakwal, Chakwal, Pakistan
| | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
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Selvåg M, Thaulow CM. Half of all hospitalised children treated with antibiotics for pneumonia did not fulfil radiological, microbiological or laboratory criteria. Acta Paediatr 2021; 110:1924-1931. [PMID: 33576065 DOI: 10.1111/apa.15808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/21/2021] [Accepted: 02/10/2021] [Indexed: 12/11/2022]
Abstract
AIM Evaluating the management of paediatric pneumonia is important. We aimed to estimate the proportion of children receiving antibiotics for suspected community-acquired pneumonia (CAP) that were likely to have a bacterial infection. Furthermore, we described antibiotic use in relation to guidelines. METHODS We conducted a prospective observational study from a paediatric department in Norway. During 2017, all admitted children aged 0-17 years receiving antibiotics for CAP were enrolled in the study. We collected relevant data and defined likely CAP as one or more of the following: radiologically confirmed pneumonia, c-reactive protein of at least 100 mg/L, positive bacterial culture from blood or pleura, detection of bacteria from the nasopharynx associated with atypical pneumonia. RESULTS In total, 70 episodes of suspected CAP were included. Median age was 41.5 months, and 36 (51%) were girls. Of all treatments, 38 (54%) fulfilled our criteria for likely CAP. Median duration of treatment was 10 days. Of empirical treatments, 36 (57%) only involved penicillin. None of the children had neutropenia or complications, and only two needed intensive care. CONCLUSION Only half of children receiving antibiotics for suspected CAP were likely to have bacterial infection. Despite no obvious reason, antibiotic treatment was longer than currently recommended.
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Affiliation(s)
- Maren Selvåg
- Department of Clinical Science Faculty of Medicine University of Bergen Bergen Norway
| | - Christian Magnus Thaulow
- Department of Clinical Science Faculty of Medicine University of Bergen Bergen Norway
- Department of Paediatrics and Adolescence Medicine Haukeland University Hospital Bergen Norway
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Epidemiology and Antimicrobial Susceptibility of Invasive Bacterial Infections in Children-A Population-Based Study From Norway. Pediatr Infect Dis J 2021; 40:403-410. [PMID: 33298760 DOI: 10.1097/inf.0000000000003013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe epidemiology and antimicrobial susceptibility testing (AST) data of bacteria causing invasive infections in Norwegian children (0-18 years). METHODS Population-based observational study using prospectively collected AST data from the Norwegian Surveillance System of Antimicrobial Resistance from 2013 to 2017. We included all clinically relevant bacterial isolates (blood and cerebrospinal fluid), and compared incidence of invasive infections and AST data in isolates from children and adults. RESULTS We included 1173 isolates from children and 44,561 isolates from adults. Staphylococcus aureus accounted for 220/477 (46.2%, 95% CI: 41.6-50.7) of all isolates in schoolchildren (6-18 years). Compared with Streptococcus pneumonia isolates from adults (N = 2674), we observed higher nonsusceptibility rates to penicillin in isolates from children (N = 151), 11.9% versus 5.8%, P < 0.01; also higher resistance rates to erythromycin (11.3% vs. 4.9%, P < 0.01), clindamycin (9.3% vs. 3.6%, P < 0.001), and trimethoprim/sulfamethoxazole (17.9% vs. 6.4%, P < 0.001). Compared with Escherichia coli isolates in adults (N = 9073), we found lower rates of ESBL in isolates from children (N = 212), 2.4% versus 6.4%, P < 0.05. CONCLUSION The study indicates the importance of microbiologic surveillance strategies in children and highlights the need for pediatric AST data. The high rates of nonsusceptibility to commonly used antibiotics among S. pneumoniae in children and the high burden of invasive S. aureus infections in schoolchildren calls for modifications of Norwegian guidelines.
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Xu JJ, Gao J, Guo JH, Song LL. Analysis of antibiotic treatment of children in a Shanghai tertiary hospital based on point prevalence surveys. BMC Infect Dis 2020; 20:804. [PMID: 33121455 PMCID: PMC7597008 DOI: 10.1186/s12879-020-05542-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/23/2020] [Indexed: 01/10/2023] Open
Abstract
Background Misuse and overuse of antibiotics by physicians in the treatment of children is common in China. This study aimed to reveal the overall use of antibiotics to treat children hospitalized in four types of pediatric wards. Methods Seven independent point prevalence surveys (PPSs) were conducted in Shanghai Children’s Hospital of Shanghai Jiao Tong University over the period 2012 to 2018. Pediatric ward types were defined general pediatric medical, pediatric surgical, pediatric intensive care units (PICU), and neonatal. Results A total of 3975 pediatric patients were included in the study, of which 63.9% received at least one dose antibiotic. The top five classes of antibiotics administered were cephalosporins (43.8%, n = 1743), penicillins (13.2%, n = 526), carbapenems (8.7%, n = 347), nitroimidazoles (7.1%, n = 281) and macrolides (6.5%, n = 257). The five most commonly used generic antibiotics were cefuroxime (14.9%, n = 594), ceftriaxone (9.7%, n = 387), cefotaxime (9.0%, n = 358), meropenem (8.1%, n = 320) and ampicillin/sulbactam (6.0%, n = 239). Meropenem was among top five antibiotics prescribed in the general pediatric, PICU and neonatal wards and sixth in the pediatric surgical wards. Of all children on antibiotics, 23.4% received prophylactic treatment, and prophylaxis accounted for 68.1% of indications for treatment in the pediatric surgical wards. Conclusions Given that over-treatment with third-generation cephalosporins and carbapenems has been associated with treatment-resistant infections, the prescription of these drugs should be strictly controlled and monitored, and measures should be taken to improve the management of surgical prophylaxis in hospitalized children in China.
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Affiliation(s)
- Jiang-Jiang Xu
- Departments of Infection Control, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jie Gao
- Departments of Infection Control, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China.
| | - Jun-Hua Guo
- Departments of Infection Control, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Li-Li Song
- Departments of Infection Control, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
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Zeng S, Xu Z, Wang X, Liu W, Qian L, Chen X, Wei J, Zhu M, Gong Z, Yan Y. Time series analysis of antibacterial usage and bacterial resistance in China: observations from a tertiary hospital from 2014 to 2018. Infect Drug Resist 2019; 12:2683-2691. [PMID: 31695444 PMCID: PMC6717838 DOI: 10.2147/idr.s220183] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/15/2019] [Indexed: 02/05/2023] Open
Abstract
Purpose To describe trends and correlation between antibacterial exposure and bacterial resistance from hospitalized patients in a hospital in southern China. Patients and methods This study used hospital-wide data regarding antimicrobial resistance and consumption between January 1, 2014 and December 31, 2018. Antibacterial consumption was expressed as antimicrobial use density (AUD). The changes in trends and associations between antibacterial utilization and resistance were analyzed using linear regression and time series analysis. Results The total AUD of all antimicrobials decreased year by year (50.66 in 2014 vs 44.28 in 2018, P=0.03). The annual use of antimicrobials, such as penicillins, monobactams, aminoglycosides, macrolides, and lincosamides, significantly decreased (P<0.05), while the annual use of quinolones and tetracyclines significantly increased (P<0.05). Among the top ten isolated bacteria, antimicrobial resistance trends of Escherichia coli, Pseudomonas aeruginosa, Candida albicans, Staphylococcus aureus, and Staphylococcus epidermidis significantly decreased (P<0.05). Significant positive correlation was found between AUD of carbapenems and resistance rate of Acinetobacter baumannii to imipenem (β=32.87, P<0.01), as well as the correlation between AUD of quinolones and resistance rate of Enterococcus faecium to levofloxacin (β=104.40, P<0.01). Conclusion The consumption of antibiotics and antibiotic resistance has been significantly improved in this tertiary hospital. Additionally, the efforts of China’s antibiotic management may be suggested by the relationship between indicated antibiotic resistance and consumption. However, overall AUD levels and poor control of the use of antibiotics, such as quinolones and tetracyclines, still require strengthened management.
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Affiliation(s)
- Shuangshuang Zeng
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Zhijie Xu
- Department of Pathology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Xiang Wang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Wanli Liu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Long Qian
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Xi Chen
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Jie Wei
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Minwen Zhu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Zhicheng Gong
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Yuanliang Yan
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China.,Institute for Rational and Safe Medication Practices, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
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Thaulow CM, Blix HS, Eriksen BH, Ask I, Myklebust TÅ, Berild D. Using a period incidence survey to compare antibiotic use in children between a university hospital and a district hospital in a country with low antimicrobial resistance: a prospective observational study. BMJ Open 2019; 9:e027836. [PMID: 31138583 PMCID: PMC6549646 DOI: 10.1136/bmjopen-2018-027836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To describe and compare antibiotic use in relation to indications, doses, adherence rate to guidelines and rates of broad-spectrum antibiotics (BSA) in two different paediatric departments with different academic cultures, and identify areas with room for improvement. DESIGN Prospective observational survey of antibiotic use. SETTING Paediatric departments in a university hospital (UH) and a district hospital (DH) in Norway, 2017. The registration period was 1 year at the DH and 4 months at the UH. PARTICIPANTS 201 children at the DH (mean age 3.8: SD 5.1) and 137 children at the UH (mean age 2.0: SD 5.9) were treated with systemic antibiotics by a paediatrician in the study period and included in the study. OUTCOME MEASURES Main outcome variables were prescriptions of antibiotics, treatments with antibiotics, rates of BSA, median doses and adherence rate to national guidelines. RESULTS In total, 744 prescriptions of antibiotics were given at the UH and 638 at the DH. Total adherence rate to guidelines was 75% at the UH and 69% at the DH (p=0.244). The rate of treatments involving BSA did not differ significantly between the hospitals (p=0.263). Use of BSA was related to treatment of central nervous system (CNS) infections, patients with underlying medical conditions or targeted microbiological treatment in 92% and 86% of the treatments, at the UH and DH, respectively (p=0.217). A larger proportion of the children at the DH were treated for respiratory tract infections (p<0.01) compared with the UH. Children at the UH were treated with higher doses of ampicillin and cefotaxime (p<0.05) compared with the DH. CONCLUSION Our results indicate that Norwegian paediatricians have a common understanding of main aspects in rational antibiotic use independently of working in a UH or DH. Variations in treatment of respiratory tract infections and in doses of antibiotics should be further studied.
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Affiliation(s)
| | - Hege Salvesen Blix
- Faculty of Medicine, Department of Pharmacology, University of Oslo, Oslo, Norway
- Department of Drug Statistics, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Ingvild Ask
- Pediatric Department, Oslo University Hospital, Oslo, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Dag Berild
- Department of Infectious Diseases, University of Oslo, Oslo, Norway
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Thaulow CM, Berild D, Blix HS, Brigtsen AK, Myklebust TÅ, Eriksen BH. Can We Optimize Antibiotic Use in Norwegian Neonates? A Prospective Comparison Between a University Hospital and a District Hospital. Front Pediatr 2019; 7:440. [PMID: 31709209 PMCID: PMC6821648 DOI: 10.3389/fped.2019.00440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 10/10/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Worldwide, a large proportion of neonates are prescribed antibiotics without having infections leading to increased antimicrobial resistance, disturbance of the evolving microbiota, and increasing the risk of various chronical diseases. Comparing practice between different hospitals/settings is important in order to optimize antibiotic stewardship. Aim: To investigate and compare the potential for improved antibiotic stewardship in neonates in two Norwegian hospitals with different academic culture, with emphasis on antibiotic exposure in unconfirmed infections, treatment length/doses, CRP values and the use of broad-spectrum antibiotics (BSA). All types of infections were investigated, but the main focus was on early-onset sepsis (EOS). Methods: We conducted a prospective observational cohort study of antibiotic use in a Norwegian university hospital (UH) and a district hospital (DH), 2017. Unconfirmed infections were defined as culture negative infections that neither fulfilled the criteria for clinical infection (clinical symptoms, maximum CRP >30 mg/L, and treatment for at least 5 days). Results: Ninety-five neonates at the DH and 89 neonates at the UH treated with systemic antibiotics were included in the study. In total, 685 prescriptions (daily doses) of antibiotics were given at the DH and 903 at the UH. Among term and premature infants (≥ 28 weeks), 82% (75% at the UH and 86% at the DH, p = 0.172) of the treatments for suspected EOS were for unconfirmed infections, and average treatment length in unconfirmed infections was 3.1 days (both hospitals). Median dose for aminoglycoside was higher for term infants at the UH (5.96, 95% CI 5.02-6.89) compared to the DH (4.98, 95% CI 4.82-5.14; p < 0.001). At the UH, all prescriptions with aminoglycosides were gentamicin, while tobramycin accounted for 93% of all prescriptions with aminoglycosides at the DH. Conclusion: There is a potential for reduction in both antibiotic exposure and treatment length in these two neonatal units, and a systematic risk/observational algorithm of sepsis should be considered in both hospitals. We revealed no major differences between the UH and DH, but doses and choice of aminoglycosides varied significantly.
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Affiliation(s)
- Christian Magnus Thaulow
- Clinical Institute II, University of Bergen, Bergen, Norway.,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Dag Berild
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Pharmacology, University of Oslo, Oslo, Norway.,Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Hege Salvesen Blix
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Drug Statistics, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Alesund, Norway
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Sviestina I, Mozgis D. Observational Study of Antibiotic Usage at the Children's Clinical University Hospital in Riga, Latvia. MEDICINA (KAUNAS, LITHUANIA) 2018; 54:E74. [PMID: 30360478 PMCID: PMC6262611 DOI: 10.3390/medicina54050074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/15/2018] [Accepted: 10/19/2018] [Indexed: 11/16/2022]
Abstract
Background and objectives: Many pediatric patients have been treated with antibiotics during their hospitalization. There is a need to improve antibiotic prescribing for pediatric patients because many of these prescriptions are inappropriate. Antibiotic consumption analysis was conducted at the Children's Clinical University Hospital to identify targets for quality improvement. Materials and Methods: A one day cross-sectional point prevalence survey (PPS) was conducted in May and November 2011⁻2013 using a previously validated and standardized method. The survey included all inpatient pediatric and neonatal beds and identified all children receiving an antibiotic treatment on the day of survey. Total consumption of systemic antibiotics belonging to the ATC J01 class (except amphenicols (J01B) and a combination of antibacterials (J01R)) was also analyzed by using a defined daily dose (DDD) approach and antibiotic drug utilization (90%DU) for the period 2006⁻2015. Results were compared with results in 2017 using the DDD and 90%DU methodology. Results: The most commonly used antibiotic group in all PPS, except in May and November 2011, was other β-lactam antibiotics (J01D): 42 (40%) prescriptions in May 2013 and 66 (42%) and November 2011. In 2006⁻2015 and also in 2017, the most commonly used antibiotic groups were penicillins (J01C) and other β-lactam antibiotics (J01D)-76% (90%DU) of the total antibiotic consumption registered in 2006, 73% in 2015 and 70% in 2017. Starting in 2008, amoxicillin was the most commonly used antibiotic at the hospital. The usage of ceftriaxone increased from 3% in 2006 to 13% in 2015, but decreased in 2017 (7%). Conclusions: Study results from 2006⁻2015 showed that there was a need to establish a stronger antibiotic prescribing policy in the hospital reducing the use of broad-spectrum antibiotics (especially 3rd generation cephalosporins) and increasing the use of narrower spectrum antibiotics. It was partly achieved in 2017 with some reduction in ceftriaxone use.
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Affiliation(s)
- Inese Sviestina
- Faculty of Medicine, University of Latvia, Raiņa bulv., LV-1586 Riga, Latvia.
- Children's Clinical University Hospital, Vienibas avenue 45, LV-1004 Riga, Latvia.
| | - Dzintars Mozgis
- Public Health and Epidemiology Department, Riga Stradiņš University, Dzirciema street 16, LV-1007 Riga, Latvia.
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