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Ximenes G, Saha SK, Guterres H, Vieira A, Harris L, Mahony M, Dos Santos A, Toto L, Amaral E, Spargo JC, Tay SY, Amaral S, Champlin K, Draper ADK, Francis JR, Yan J, Lynar SA. Antimicrobial prescribing in referral hospitals in Timor-Leste: results of the first two national point prevalence surveys, 2020-21. JAC Antimicrob Resist 2024; 6:dlae123. [PMID: 39091690 PMCID: PMC11293431 DOI: 10.1093/jacamr/dlae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024] Open
Abstract
Objectives To describe antimicrobial use (AMU) in patients admitted to hospitals in Timor-Leste. Methods In 2020 and 2021, we undertook antimicrobial prescribing point prevalence surveys across all six hospitals in Timor-Leste (one national and five municipal) to describe AMU and appropriateness in admitted patients. Results In 2020, 291/394 (73.9%) surveyed patients had been prescribed antimicrobials, compared with 260/403 (64.5%) in 2021 (P = 0.004). Most (309/551; 56.1%) were prescribed one antimicrobial, and 179/551 (32.5%) were prescribed two. The most commonly prescribed antibiotics were ceftriaxone (38.5% in 2020, 41.5% in 2021) and ampicillin (35.7% in 2020, 32.3% in 2021), followed by gentamicin, metronidazole and cloxacillin. Reserve antibiotics like meropenem and vancomycin were minimally used. Of all antimicrobial prescriptions, 70.8% were deemed appropriate in 2020 and 69.1% in 2021. Antimicrobial prescriptions for surgical and post-partum prophylaxis were frequently deemed inappropriate [37/50 (74.0%) and 39/44 (88.6%) prescriptions, respectively]. Conclusions Most patients admitted to hospital in Timor-Leste are prescribed antimicrobials, and approximately one-third of these prescriptions are inappropriate. However, this was in the context of limited local guideline availability at the time of surveys and limited microbiological culture capacity outside of the capital, Dili. Improved microbiological guidance, iterative guideline revisions based on local antimicrobial resistance (AMR) surveillance data, and enhanced stewardship activities including further point prevalence studies, could improve antimicrobial use, optimize patient outcomes and reduce AMR in Timor-Leste.
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Affiliation(s)
- Guilherme Ximenes
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Pharmacy Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Sajal K Saha
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Infectious Diseases, Melbourne Medical School, National Centre for Antimicrobial Stewardship (NCAS), University of Melbourne, Melbourne, 3010 Victoria, Australia
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), IMPACT, Deakin University, Geelong 3220, VIC, Australia
| | - Helio Guterres
- Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Adriano Vieira
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Lisa Harris
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Michelle Mahony
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Paediatrics, Royal Darwin Hospital, Darwin 0810, Northern Territory, Australia
| | - Agata Dos Santos
- Pharmacy Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Lucia Toto
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Elfiana Amaral
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Jessie C Spargo
- Department of Paediatrics, Royal Darwin Hospital, Darwin 0810, Northern Territory, Australia
| | - Sze Yen Tay
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin 0810, Northern Territory, Australia
| | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Karen Champlin
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Anthony D K Draper
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Northern Territory Centre for Disease Control, Darwin 0810, Northern Territory, Australia
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra 0200, Australian Capital Territory, Australia
| | - Joshua R Francis
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Paediatrics, Royal Darwin Hospital, Darwin 0810, Northern Territory, Australia
| | - Jennifer Yan
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Paediatrics, Royal Darwin Hospital, Darwin 0810, Northern Territory, Australia
| | - Sarah A Lynar
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin 0810, Northern Territory, Australia
- Northern Territory Centre for Disease Control, Darwin 0810, Northern Territory, Australia
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Ximenes D, de Jesus G, de Sousa ASCFC, Soares C, Amaral LC, Oakley T, Alves L, Amaral S, Sarmento N, Guterres H, Cabral JADD, Boavida F, Yan J, Francis JR, Martins N, Arkell P. A pilot study investigating severe community-acquired febrile illness through implementation of an innovative microbiological and nucleic acid amplification testing strategy in Timor-Leste (ISIN-MANAS-TL). IJID REGIONS 2024; 11:100345. [PMID: 38596819 PMCID: PMC11002651 DOI: 10.1016/j.ijregi.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
Objectives Acute febrile illness (AFI) causes significant health-seeking, morbidity, and mortality in Southeast Asia. This pilot study aimed to describe presentation, etiology, treatment, and outcomes of patients with AFI at one hospital in Timor-Leste and assessing the feasibility of conducting larger studies in this setting. Methods Patients attending Hospital Nacional Guido Valadares with tympanic or axillary temperature ≥37.5°C in whom a blood culture was taken as part of routine clinical care were eligible. Participants were followed up daily for 10 days and again after 30 days. Whole blood was analyzed using a real-time quantitative polymerase chain reaction assay detecting dengue virus serotypes 1-4 and other arthropod-borne infections. Results A total of 82 participants were recruited. Polymerase chain reaction testing was positive for dengue in 14 of 82 (17.1%) participants and blood culture identified a bacterial pathogen in three of 82 (3.7%) participants. Follow-up was completed by 75 of 82 (91.5%) participants. High rates of hospital admission (58 of 82, 70.7%), broad-spectrum antimicrobial treatment (34 of 82, 41.5%), and mortality (9 of 82, 11.0%) were observed. Conclusions Patients with AFI experience poor clinical outcomes. Prospective observational and interventional studies assessing interventions, such as enhanced diagnostic testing, clinical decision support tools, or antimicrobial stewardship interventions, are required and would be feasible to conduct in this setting.
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Affiliation(s)
- Deolindo Ximenes
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Gustodio de Jesus
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Antonio SCFC de Sousa
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
- Molecular and Serology Department, Laboratorio Nacional da Saúde, Dili, Timor-Leste
| | - Caetano Soares
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Luciana C. Amaral
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Tessa Oakley
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Lucsendar Alves
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Salvador Amaral
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Nevio Sarmento
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Helio Guterres
- Internal Medicine Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | | | - Flavio Boavida
- Emergency Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Joshua R. Francis
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Nelson Martins
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
| | - Paul Arkell
- Global and Tropical Health Division, Menzies School of Health Research Timor-Leste Office, Charles Darwin University, Dili, Timor-Leste
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Salendo J, Ximenes J, Soares A, Guest G, Hagander L. Acute burn care and outcomes at the Hospital Nacional Guido Valadares (HNGV), Timor-Leste: A 7-year retrospective study. Medicine (Baltimore) 2022; 101:e32113. [PMID: 36550901 PMCID: PMC9771211 DOI: 10.1097/md.0000000000032113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The purpose of this study was to describe the epidemiology of patients presenting with acute burns and undergoing admission at Hospital Nacional Guido Valadares (HNGV) in Dili, Timor-Leste in the period 2013 to 2019. HNGV is the only tertiary referral hospital in Timor-Leste. This was a retrospective study involving all acute burn patients admitted to the surgical wards of HNGV from 2013 to 2019. The data was collected from patient charts and hospital medical archives. Data were reviewed and analyzed statistically in terms of age, gender, residence, cause, total body surface area (TBSA), burns depth, length of stay (LOS), and mortality. The outcomes were analyzed using logistic regression. Over the 7-year period, there were 288 acute burn patients admitted to the surgical wards of HNGV. Most patients were children (55%), male (65%) and from the capital city of Dili or surrounding areas (59%). The most common cause of burns in children was scalds and the most common cause among adults was flames. Of the admitted patients 59% had burns affecting >10% of the TBSA and 41% had full thickness burns. The median LOS was 17 days (1-143) and the average mortality for admitted burn patients in HNGV was 5.6% (annual mortality 0-17%). The odds ratio for extended LOS was 1.9 (95% confidence interval 1.1-3.2) in female compared with male patients. The odds ratio for mortality was 14.6 (95% confidence interval 2.7-80.6) in the older adults when compared with younger adults. Higher TBSA, full thickness burns, and flame burns were also significantly associated with longer LOS and higher mortality. Children and male patients were disproportionately overrepresented among patients admitted to HNGV, while female patients had longer LOS and older adults had more severe injury and a higher risk of mortality. Establishment of a national program for the prevention of burns is essential.
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Affiliation(s)
- Junius Salendo
- Institute of Tropical Medicine and International Health Charité, Universitätsmedizin Berlin, Berlin, Germany
- Global Health, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Joao Ximenes
- Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Alito Soares
- Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Glenn Guest
- Epworth Geelong Hospital and Department of Clinical and Biomedical Sciences, Deakin University, Geelong, Victoria, Australia
| | - Lars Hagander
- Department of Clinical Sciences in Lund, Pediatric Surgery, Skåne University Hospital in Lund, Faculty of Medicine, Lund University, Lund, Sweden
- * Correspondence: Lars Hagander, Department of Clinical Sciences in Lund, Pediatric Surgery, Skåne University Hospital in Lund, Faculty of Medicine, Lund University, Lund, Sweden (e-mail: )
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Jayaratnam S, Lucia de Fatima Godinho Soares M, Bucens I, Jennings B, Woods C, Shub A. A prospective review of perinatal mortality at Hospital Nacional Guido Valadares (HNGV). Aust N Z J Obstet Gynaecol 2019; 60:70-75. [PMID: 31134624 DOI: 10.1111/ajo.12991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 04/19/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Timor-Leste has one of the highest perinatal mortality rates in the Asia-Pacific region. Consistent and accurate data collection improves understanding of perinatal outcomes and facilitates the development of interventions to reduce stillbirths and early neonatal deaths. AIMS (1) To identify changes in the rates of stillbirth and early neonatal deaths from previous published data. (2) To determine if prospective data collection and the application of the simplified Causes Of Death and Associated Conditions (CODAC) classification allows better identification of perinatal deaths in Timor-Leste. METHODS A prospective audit of perinatal deaths of women delivering at Hospital Nacional Guido Valadares (HNGV) was undertaken from January to June 2016 inclusive. The hospital birth registry, maternal and neonatal records were reviewed to determine the most likely aetiology and classification of perinatal deaths using the simplified CODAC system. RESULTS One hundred and ten stillbirths and 28 early neonatal deaths were identified. Fifty-four percent of perinatal deaths occurred antepartum, 26% intrapartum and 20% were early neonatal deaths. Cause of death among stillbirths could not be ascertained in 40% of cases. Intrapartum asphyxia was the commonest identified aetiology of intrapartum and early neonatal deaths. CONCLUSION There has been limited improvement in the rate of stillbirths and early neonatal deaths at HNGV. Intrapartum hypoxia and maternal hypertensive conditions were the most common identified aetiologies highlighting areas where targeted interventions may help reduce high perinatal mortality rates. Aetiology of perinatal deaths, particularly antepartum stillbirths was difficult to discern even when well-tested classification systems are used.
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Affiliation(s)
- Skandarupan Jayaratnam
- Department of Obstetrics and Gynaecology, Cairns Hospital, Cairns, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | | | - Ingrid Bucens
- Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Belinda Jennings
- Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Cindy Woods
- School of Health, University of New England, Armidale, New South Wales, Australia
| | - Alexis Shub
- Perinatal Department, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics & Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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Zhu Y, Zhu X, Deng M, Wei H, Zhang M. Causes of death in hospitalized children younger than 12 years of age in a Chinese hospital: a 10 year study. BMC Pediatr 2018; 18:8. [PMID: 29347924 PMCID: PMC5773040 DOI: 10.1186/s12887-017-0981-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 12/29/2017] [Indexed: 11/15/2022] Open
Abstract
Background In China, the majority (77%) of urban children die in hospitals. Hospital-based review could provide insight leading to improvements in clinical practice and increase the survival of critically ill children. The aim of the present study is to identify the trends of immediate causes and chronic underlying diseases associated with deaths of children at one of the largest teaching hospitals in China over a period of 10 years (2006–2015). Methods A retrospective analysis of data of all children aged 1 month to 11 years who died at Xinhua Hospital between 2006 and 2015. Demographic details, main causes of deaths, and chronic underlying diseases were reviewed. Results Case fatality rate was 0.55% (510/93,443) and it represented 0.41–0.80% deaths per year. Overall, the most common immediate causes of deaths in hospitalized children were pneumonia (36.7%), sepsis (13.5%), tumour (11.4%), followed by nontraumatic intracranial or gastrointestinal hemorrhage (10.6%) and cardiac shock (9.6%). Over 70% of the deaths in children were complicated with chronic underlying diseases. Congenital abnormality was the most frequent chronic underlying disease observed in infants (60.3%) and tumour was the main chronic underlying disease in toddlers (31.1%) and older children (44%). Conclusions Infectious diseases, especially pneumonia, were the major immediate causes of deaths, and the mortality in the study population decreased with age. Tumour and other noninfectious disease accounted for more deaths in older children. Chronic underlying diseases were found in most deaths of children. Electronic supplementary material The online version of this article (10.1186/s12887-017-0981-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yueniu Zhu
- Department of Pediatric Critical Care Medicine, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Xiaodong Zhu
- Department of Pediatric Critical Care Medicine, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China.
| | - Mengyan Deng
- Department of Pediatric Critical Care Medicine, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Hongxia Wei
- Department of Pediatric Critical Care Medicine, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
| | - Mingjun Zhang
- Department of Pediatric Critical Care Medicine, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China
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Fallahzadeh MA, Abdehou ST, Hassanzadeh J, Fallhzadeh F, Fallahzadeh MH, Malekmakan L. Pattern of in-hospital pediatric mortality over a 3-year period at University teaching hospitals in Iran. Indian J Crit Care Med 2015. [PMID: 26195856 PMCID: PMC4478671 DOI: 10.4103/0972-5229.158257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction: Causes of death are different and very important for policy makers in different regions. This study was designed to analyze the data for our in-patient children mortality. Materials and Methods: In this cross-sectional study from March 2011 to March 2013, all patients from 2 months to 18 years who died in pediatric intensive care unit, emergency room or medical pediatric wards in the teaching hospitals were studied. Results: From a total of 18,915 admissions during a 2-year-period, 256 deaths occurred with a mean age of 4.3 ± 5 years and mortality 1.35%. An underlying disease was present in 70.7% of the patients and in 88.5% of them the leading causes of death were related to the underlying diseases. The most common underlying diseases were congenital heart disease and cardiomyopathy in 50 (27.6%). The four main causes of deaths were sepsis (14.8%), pneumonia (14.5%), congestive heart failure (9.8%), and hepatic encephalopathy (9.8%). Conclusion: We may conclude that after sepsis and pneumonia, congestive heart failure, and hepatic encephalopathy are the leading causes of death. Most patients who died had underlying diseases including malignancies, heart and liver diseases as the most common causes.
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Affiliation(s)
| | - Sophia T Abdehou
- Department of Pediatric, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jafar Hassanzadeh
- Department of Pediatric, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohammad Hossein Fallahzadeh
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, John C. McDonald Regional Transplant Center, Shreveport, Louisiana, USA
| | - Leila Malekmakan
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, John C. McDonald Regional Transplant Center, Shreveport, Louisiana, USA
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Gunasekera H, Tefuarani N, Kilalang C, Amini J, Sobi K, Vuvu J, Duke T. A day on the paediatric wards in Port Moresby, Papua New Guinea. J Paediatr Child Health 2014; 50:494-5. [PMID: 24888306 DOI: 10.1111/jpc.12594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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