1
|
Kenga DB, Sacarlal J, Sidat M, Amorim G, Myers HH, Chicamba V, Kampa KT, Moon TD. Evaluating empiric antibiotic prescribing for hospitalized children in Mozambique through the introduction of a quarterly syndromic antibiogram: An implementation science protocol. PLoS One 2024; 19:e0306511. [PMID: 39121076 PMCID: PMC11315278 DOI: 10.1371/journal.pone.0306511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 06/19/2024] [Indexed: 08/11/2024] Open
Abstract
Antimicrobials are the most frequently prescribed drug in pediatrics, with an estimated 37% of infants and 61% of hospitalized children having received them. Approximately 20-50% of prescriptions have been shown to be potentially unnecessary or inappropriate. The World Health Organization (WHO) estimates that the continued increase in antimicrobial resistance by the year 2050 will lead to the death of 10 million people per year. This paper describes a protocol to be used in a future study to evaluate the implementation of a quarterly syndromic antibiogram, aimed to improve the use of antibiotics for the treatment of pediatric bacterial infections at the Maputo Central Hospital, Mozambique. This study uses implementation science methods framed by the Dynamic Adaption Process (DAP) and RE-AIM conceptual frameworks to develop a multi-phase, mixed-methods evaluation utilizing qualitative and quantitative approaches. The pediatric inpatient services at HCM consist of approximately 18 physicians and 60 nurses. Additionally, the microbiology laboratory consists of eight laboratory technicians. We anticipate analyzing approximately 9,000 medical records. Qualitative methods include in-depth interviews with clinicians, laboratory technicians, and administrators to explore current knowledge and practices around antibiotic decision making, facilitators and barriers to intervention implementation, as well as acceptability and satisfaction with the intervention roll-out. Qualitative analysis will be performed with NVivo 12 software. Quantitative methods include extracting data from existing records from the pediatric ward of Hospital Central de Maputo (HCM) guided by the RE-AIM framework to explore intervention utilization and other factors influencing its implementation. Quantitative descriptive and inferential statistical analysis will be performed using R Studio statistical software. The findings from this evaluation will be shared with hospital administrators and relevant national policymakers and may be used by the Ministry of Health in deciding to expand this approach to other hospitals. The expected results of this research include the development of standard operating guidelines for the creation, distribution, and use of a quarterly syndromic antibiogram for antibiotic decision making that is informed by local epidemiology. Findings from this study will be used to develop a larger multi-site trial in Mozambique.
Collapse
Affiliation(s)
- Darlenne B. Kenga
- Department of Microbiology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Jahit Sacarlal
- Department of Microbiology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Mohsin Sidat
- Department of Community Health, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Gustavo Amorim
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Harriett H. Myers
- Department of Tropical Medicine and Infectious Diseases, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
| | - Valéria Chicamba
- Pediatric Intensive Care Unit, Hospital Central de Maputo, Maputo, Mozambique
| | - Kathryn T. Kampa
- Department of Tropical Medicine and Infectious Diseases, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
| | - Troy D. Moon
- Department of Tropical Medicine and Infectious Diseases, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States of America
| |
Collapse
|
2
|
Smolinski NE, Djabali EJ, Al-Bahou J, Pomputius A, Antonelli PJ, Winterstein AG. Antibiotic treatment to prevent pediatric acute otitis media infectious complications: A meta-analysis. PLoS One 2024; 19:e0304742. [PMID: 38885271 PMCID: PMC11182555 DOI: 10.1371/journal.pone.0304742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/16/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Most US children with acute otitis media [AOM] receive prompt antibiotic treatment, though guidelines encourage watchful waiting. Previous systematic reviews of antibiotics versus watchful waiting have focused on symptom resolution and RCTs, limiting the assessment of serious, rare complications. We sought to evaluate these complications by including observational studies. METHODS RCTs and observational studies that compared antibiotics to placebo or watchful waiting for pediatric clinician diagnosed AOM were identified [PubMed/MEDLINE, Embase, Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, and Web of Science] and reviewed for meta-analysis. Two reviewers independently extracted study characteristics, patient characteristics, and outcomes. We assessed publication bias, study bias with ROBINS-1 and RoB-2 and used random-effects models to assess treatment effects. RESULTS 24 studies were included. Antibiotics decreased the risk of acute mastoiditis [incidence 0.02%, RR 0.48, 95% CI 0.40-0.59; NNT 5,368]. This protective effect may be underestimated because of misclassification of non-suppurative conditions as AOM. Intracranial complications remained too rare to assess. Antibiotics markedly increased the risk of adverse effects [incidence 10.5%, RR 1.49, 1.27-1.73; NNH 23]. Studies used non-specific criteria for acute mastoiditis, potentially underestimating treatment effects. CONCLUSIONS Prompt antibiotic therapy reduces the risk for some AOM complications. The NNT to prevent serious, rare complications is high, while the NNH is relatively low. Large-scale population-based observational studies using real-world datasets with validated measures of severe complications are needed to improve understanding of risk factors for serious AOM complications, facilitate more selective antibiotic therapy, and optimize individual outcomes and public health.
Collapse
Affiliation(s)
- Nicole E. Smolinski
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States of America
- Center for Drug Evaluation and Safety [CoDES], University of Florida, Gainesville, FL, United States of America
| | - Emma J. Djabali
- College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Julie Al-Bahou
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States of America
- College of Pharmacy, University of Florida, Gainesville, FL, United States of America
| | - Ariel Pomputius
- Health Science Center Libraries, University of Florida, Gainesville, FL, United States of America
| | - Patrick J. Antonelli
- Center for Drug Evaluation and Safety [CoDES], University of Florida, Gainesville, FL, United States of America
- Department of Otolaryngology-Head & Neck Surgery, College of Medicine, University of Florida, Gainesville, FL, United States of America
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States of America
- Center for Drug Evaluation and Safety [CoDES], University of Florida, Gainesville, FL, United States of America
- Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States of America
| |
Collapse
|
3
|
Gisselsson-Solen M, Gunasekera H, Hall A, Homoe P, Kong K, Sih T, Rupa V, Morris P. Panel 1: Epidemiology and global health, including child development, sequelae and complications. Int J Pediatr Otorhinolaryngol 2024; 178:111861. [PMID: 38340606 DOI: 10.1016/j.ijporl.2024.111861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To summarise the published research evidence on the epidemiology of otitis media, including the risk factors and sequelae associated with this condition. DATA SOURCES Medline (PubMed), Embase, and the Cochrane Library covering the period from 2019 to June 1st, 2023. REVIEW METHODS We conducted a broad search strategy using otitis [Medical Subject Heading] combined with text words to identify relevant articles on the prevalence, incidence, risk factors, complications, and sequelae for acute otitis media, otitis media with effusion, and chronic suppurative otitis media. At least one review author independently screened titles and abstracts of the retrieved records for each condition to determine whether the research study was eligible for inclusion. Any discrepancies were resolved by reviewing the full text followed by discussion with a second review author. Studies with more than 100 participants were prioritised. RESULTS Over 2,000 papers on otitis media (OM) have been published since 2019. Our review has highlighted around 100 of these publications. While the amount of otitis media research on the Medline database published each year has not increased, there has been an increase in epidemiological studies using routinely collected data and systematic review methodology. Most of the large incidence studies have addressed acute otitis media (AOM) in children. Several studies have described a decrease in incidence of AOM after the introduction of conjugate PCV vaccines. Similarly, a decrease was noted when rates of coronavirus disease of 2019 (COVID-19) were high and there were major public health efforts to reduce the spread of infection. There have been new studies on OM in adults and OM prevalence in a broader range of countries and population subgroups. CONCLUSION Overall, the rates of severe and/or suppurative OM appeared to be decreasing. However, there is substantial heterogeneity between populations. While better use of available data is informative, it can be difficult to predict rates of severe disease without accurate examination findings. Most memorably, the COVID-19 pandemic had an enormous impact on the research and clinical services for otitis media for most of the period under review. IMPLICATIONS FOR PRACTICE The use of routinely collected data for epidemiological studies will lead to greater variability in the definitions and diagnostic criteria used. The impact of new vaccines will continue to be important. Some of the lessons learned during the COVID-19 pandemic concerning behaviours that reduce spread of respiratory viruses can hopefully be used to decrease the burden of otitis media in the future. There are still many countries in the world where the burden of otitis media is not well described. In countries where otitis media has been studied over many years, new potential risk factors continue to be identified. In addition, a better understanding of the disease in specific subgroups has been achieved.
Collapse
Affiliation(s)
- Marie Gisselsson-Solen
- Department of Otorhinolaryngology, Head and Neck Surgery, Lund University Hospital, Lund, Sweden.
| | - Hasantha Gunasekera
- Children's Hospital Westmead Clinical School, University of Sydney, Australia
| | | | - Preben Homoe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zeeland University Hospital, Koege, Denmark
| | - Kelvin Kong
- School of Medicine and Public Health, Newcastle, Australia
| | - Tania Sih
- Medical School University of Sao Paolo, Brazil
| | | | - Peter Morris
- Menzies School of Health Research Charles Darwin University Darwin, Australia
| |
Collapse
|
4
|
Lanera C, Lorenzoni G, Barbieri E, Piras G, Magge A, Weissenbacher D, Donà D, Cantarutti L, Gonzalez-Hernandez G, Giaquinto C, Gregori D. Monitoring the Epidemiology of Otitis Using Free-Text Pediatric Medical Notes: A Deep Learning Approach. J Pers Med 2023; 14:28. [PMID: 38248729 PMCID: PMC10817419 DOI: 10.3390/jpm14010028] [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: 11/30/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Free-text information represents a valuable resource for epidemiological surveillance. Its unstructured nature, however, presents significant challenges in the extraction of meaningful information. This study presents a deep learning model for classifying otitis using pediatric medical records. We analyzed the Pedianet database, which includes data from January 2004 to August 2017. The model categorizes narratives from clinical record diagnoses into six types: no otitis, non-media otitis, non-acute otitis media (OM), acute OM (AOM), AOM with perforation, and recurrent AOM. Utilizing deep learning architectures, including an ensemble model, this study addressed the challenges associated with the manual classification of extensive narrative data. The performance of the model was evaluated according to a gold standard classification made by three expert clinicians. The ensemble model achieved values of 97.03, 93.97, 96.59, and 95.48 for balanced precision, balanced recall, accuracy, and balanced F1 measure, respectively. These results underscore the efficacy of using automated systems for medical diagnoses, especially in pediatric care. Our findings demonstrate the potential of deep learning in interpreting complex medical records, enhancing epidemiological surveillance and research. This approach offers significant improvements in handling large-scale medical data, ensuring accuracy and minimizing human error. The methodology is adaptable to other medical contexts, promising a new horizon in healthcare analytics.
Collapse
Affiliation(s)
- Corrado Lanera
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (C.L.); (G.L.)
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (C.L.); (G.L.)
| | - Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padova, 35128 Padova, Italy; (E.B.); (D.D.); (C.G.)
| | - Gianluca Piras
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (C.L.); (G.L.)
| | - Arjun Magge
- Health Language Processing Center, Institute for Biomedical Informatics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.M.); (D.W.); (G.G.-H.)
| | - Davy Weissenbacher
- Health Language Processing Center, Institute for Biomedical Informatics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.M.); (D.W.); (G.G.-H.)
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padova, 35128 Padova, Italy; (E.B.); (D.D.); (C.G.)
| | | | - Graciela Gonzalez-Hernandez
- Health Language Processing Center, Institute for Biomedical Informatics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (A.M.); (D.W.); (G.G.-H.)
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padova, 35128 Padova, Italy; (E.B.); (D.D.); (C.G.)
- Società Servizi Telematici—Pedianet, 35100 Padova, Italy;
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (C.L.); (G.L.)
| |
Collapse
|
5
|
Jin Z, Ma F, Chen H, Guo S. Leveraging machine learning to distinguish between bacterial and viral induced pharyngitis using hematological markers: a retrospective cohort study. Sci Rep 2023; 13:22899. [PMID: 38129529 PMCID: PMC10739959 DOI: 10.1038/s41598-023-49925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
Accurate differentiation between bacterial and viral-induced pharyngitis is recognized as essential for personalized treatment and judicious antibiotic use. From a cohort of 693 patients with pharyngitis, data from 197 individuals clearly diagnosed with bacterial or viral infections were meticulously analyzed in this study. By integrating detailed hematological insights with several machine learning algorithms, including Random Forest, Neural Networks, Decision Trees, Support Vector Machine, Naive Bayes, and Lasso Regression, for potential biomarkers were identified, with an emphasis being placed on the diagnostic significance of the Monocyte-to-Lymphocyte Ratio. Distinct inflammatory signatures associated with bacterial infections were spotlighted in this study. An innovation introduced in this research was the adaptation of the high-accuracy Lasso Regression model for the TI-84 calculator, with an AUC (95% CI) of 0.94 (0.925-0.955) being achieved. Using this adaptation, pivotal laboratory parameters can be input on-the-spot and infection probabilities can be computed subsequently. This methodology embodies an improvement in diagnostics, facilitating more effective distinction between bacterial and viral infections while fostering judicious antibiotic use.
Collapse
Affiliation(s)
- Zhe Jin
- School of Medical Technology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Fengmei Ma
- Department of Otorhinolaryngology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, 050011, People's Republic of China
| | - Haoyang Chen
- Medicine-Education Coordination and Medical Education Research Center, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China
| | - Shufan Guo
- Department of Otorhinolaryngology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, 050011, People's Republic of China.
| |
Collapse
|
6
|
Miller KM, Barnett TC, Cadarette D, Bloom DE, Carapetis JR, Cannon JW. Antibiotic consumption for sore throat and the potential effect of a vaccine against group A Streptococcus: a systematic review and modelling study. EBioMedicine 2023; 98:104864. [PMID: 37950997 PMCID: PMC10663680 DOI: 10.1016/j.ebiom.2023.104864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/15/2023] [Accepted: 10/19/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Antibiotic consumption can lead to antimicrobial resistance and microbiome imbalance. We sought to estimate global antibiotic consumption for sore throat, and the potential reduction in consumption due to effective vaccination against group A Streptococcus (Strep A). METHODS We reviewed and analysed articles published between January 2000 and February 2022, identified though Clarivate Analytics' Web of Science search platform, with reference to antibiotic prescribing or consumption, sore throat, pharyngitis, or tonsillitis. We then used those analyses, combined with assumptions for the effectiveness, duration of protection, and coverage of a vaccine, to calculate the estimated reduction in antibiotic prescribing due to the introduction of Strep A vaccines. FINDINGS We identified 101 studies covering 38 countries. The mean prescribing rate for sore throat was approximately 5 courses per 100 population per year, accounting for approximately 5% of all antibiotic consumption. Based on 2020 population estimates for countries with empiric prescribing rates, antibiotic consumption for sore throat was estimated to exceed 37 million courses annually, of which half could be attributable to treatment for Strep A. A vaccine that reduces rates of Strep A infection by 80%, with 80% coverage and 10 year's duration of protection, could avert 2.8 million courses of antibiotics prescribed for sore throat treatment among 5-14 year-olds in countries with observed prescribing rates, increasing to an estimated 7.5 million averted if an effective vaccination program also reduced precautionary prescribing. INTERPRETATION A vaccine that prevents Strep A throat infections in children may reduce antibiotic prescribing for sore throat by 32-87% depending on changes to prescribing and consumption behaviours. FUNDING The Wellcome Trust, grant agreement number 215490/Z/19/Z.
Collapse
Affiliation(s)
- Kate M Miller
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; School of Population and Global Health, University of Western Australia, Nedlands, Western Australia, Australia
| | - Timothy C Barnett
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, Nedlands, Western Australia, Australia
| | - Daniel Cadarette
- Harvard Kennedy School, Harvard University, Cambridge, MA, United States
| | - David E Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Jonathan R Carapetis
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia; Centre for Child Health Research, Medical School, University of Western Australia, Nedlands, Western Australia, Australia.
| |
Collapse
|
7
|
Pellegrino R, Timitilli E, Verga MC, Guarino A, Iacono ID, Scotese I, Tezza G, Dinardo G, Riccio S, Pellizzari S, Iavarone S, Lorenzetti G, Simeone G, Bergamini M, Donà D, Pierantoni L, Garazzino S, Esposito S, Venturini E, Gattinara GC, Lo Vecchio A, Marseglia GL, Di Mauro G, Principi N, Galli L, Chiappini E. Acute pharyngitis in children and adults: descriptive comparison of current recommendations from national and international guidelines and future perspectives. Eur J Pediatr 2023; 182:5259-5273. [PMID: 37819417 PMCID: PMC10746578 DOI: 10.1007/s00431-023-05211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/13/2023]
Abstract
This study aims to provide a comparison of the current recommendations about the management of acute pharyngitis. A literature search was conducted from January 2009 to 2023. Documents reporting recommendations on the management of acute pharyngitis were included, pertinent data were extracted, and a descriptive comparison of the different recommendations was performed. The quality of guidelines was assessed through the AGREE II instrument. Nineteen guidelines were included, and an overall moderate quality was found. Three groups can be distinguished: one group supports the antibiotic treatment of group A β-hemolytic Streptococcus (GABHS) to prevent acute rheumatic fever (ARF); the second considers acute pharyngitis a self-resolving disease, recommending antibiotics only in selected cases; the third group recognizes a different strategy according to the ARF risk in each patient. An antibiotic course of 10 days is recommended if the prevention of ARF is the primary goal; conversely, some guidelines suggest a course of 5-7 days, assuming the symptomatic cure is the goal of treatment. Penicillin V and amoxicillin are the first-line options. In the case of penicillin allergy, first-generation cephalosporins are a suitable choice. In the case of beta-lactam allergy, clindamycin or macrolides could be considered according to local resistance rates. Conclusion: Several divergencies in the management of acute pharyngitis were raised among guidelines (GLs) from different countries, both in the diagnostic and therapeutic approach, allowing the distinction of 3 different strategies. Since GABHS pharyngitis could affect the global burden of GABHS disease, it is advisable to define a shared strategy worldwide. It could be interesting to investigate the following issues further: cost-effectiveness analysis of diagnostic strategies in different healthcare systems; local genomic epidemiology of GABHS infection and its complications; the impact of antibiotic treatment of GABHS pharyngitis on its complications and invasive GABHS infections; the role of GABHS vaccines as a prophylactic measure. The related results could aid the development of future recommendations. What is Known: • GABHS disease spectrum ranges from superficial to invasive infections and toxin-mediated diseases. • GABHS accounts for about 25% of sore throat in children and its management is a matter of debate. What is New: • Three strategies can be distinguished among current GLs: antibiotic therapy to prevent ARF, antibiotics only in complicated cases, and a tailored strategy according to the individual ARF risk. • The impact of antibiotic treatment of GABHS pharyngitis on its sequelae still is the main point of divergence; further studies are needed to achieve a global shared strategy.
Collapse
Affiliation(s)
- Roberta Pellegrino
- Department of Health Sciences, Postgraduate School of Pediatrics, University of Florence, Florence, Italy
| | - Edoardo Timitilli
- Department of Health Sciences, Postgraduate School of Pediatrics, University of Florence, Florence, Italy
| | | | - Alfredo Guarino
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Iride Dello Iacono
- Unit of Allergology, Division of Internal Medicine, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Giovanna Tezza
- Department of Pediatrics, Ospedale San Maurizio, Bolzano, Italy
| | - Giulio Dinardo
- Department of Woman, Child and of General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Simona Riccio
- Department of Woman, Child and of General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Sofia Pellizzari
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Sonia Iavarone
- Department of Maternal, Infantile, and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giulia Lorenzetti
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | | | | | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Luca Pierantoni
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy
| | - Silvia Garazzino
- Department of Paediatrics, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Susanna Esposito
- Paediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giuseppe Di Mauro
- Pediatric Primary Care, National Pediatric Health Care System, Caserta, Italy
| | - Nicola Principi
- Professor Emeritus of Pediatrics, University of Milan, Milan, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139, Firenze, Italy
| | - Elena Chiappini
- Infectious Diseases Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
- Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139, Firenze, Italy.
| |
Collapse
|
8
|
Milani GP, Rosa C, Tuzger N, Alberti I, Ghizzi C, Zampogna S, Amigoni A, Agostoni C, Peroni D, Marchisio P, Chiappini E. Nationwide survey on the management of pediatric pharyngitis in Italian emergency units. Ital J Pediatr 2023; 49:114. [PMID: 37670391 PMCID: PMC10481466 DOI: 10.1186/s13052-023-01514-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/19/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Acute pharyngitis is a frequent reason for primary care or emergency unit visits in children. Most available data on pharyngitis management come from primary care studies that demonstrate an underuse of microbiological tests, a tendency to over-prescribe antibiotics and a risk of antimicrobial resistance increase. However, a comprehensive understanding of acute pharyngitis management in emergency units is lacking. This study aimed to investigate the frequency of rapid antigen test use to diagnose acute pharyngitis, as well as other diagnostic approaches, the therapeutic attitude, and follow-up of children with this condition in the emergency units. METHODS A multicentric national study was conducted in Italian emergency departments between April and June 2022. RESULTS A total of 107 out of 131 invited units (response rate 82%), participated in the survey. The results showed that half of the units use a scoring system to diagnose pharyngitis, with the McIsaac score being the most commonly used. Most emergency units (56%) were not provided with a rapid antigen diagnostic test by their hospital, but the test was more frequently available in units visiting more than 10,000 children yearly (57% vs 33%, respectively, p = 0.02). Almost half (47%) of the units prescribe antibiotics in children with pharyngitis despite the lack of microbiologically confirmed cases of Group A β-hemolytic streptococcus. Finally, about 25% of units prescribe amoxicillin-clavulanic acid to treat Group A β-hemolytic streptococcus pharyngitis. CONCLUSIONS The study sheds light on the approach to pharyngitis in emergency units, providing valuable information to improve the appropriate management of acute pharyngitis in this setting. The routinary provision of rapid antigen tests in the hospitals could enhance the diagnostic and therapeutic approach to pharyngitis.
Collapse
Affiliation(s)
- Gregorio P Milani
- Pediatric Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 9, 20122, Milan, Italy.
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy.
| | - Claudio Rosa
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Naz Tuzger
- Pediatric Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 9, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Ilaria Alberti
- Pediatric Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 9, 20122, Milan, Italy
| | | | - Stefania Zampogna
- SOC Pediatria, Azienda Sanitaria Provinciale Di Crotone, Crotone, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, University Hospital of Padua, Padua, Italy
| | - Carlo Agostoni
- Pediatric Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 9, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Paola Marchisio
- Pediatric Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via Della Commenda 9, 20122, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Elena Chiappini
- Pediatric Infectious Disease Unit, Department of Health Sciences, Meyer Children's University Hospital, University of Florence, Florence, Italy
| |
Collapse
|
9
|
Najjar S, Sultan HO, Falana HH, Ata RO, Manasrah MA, Dreidi M, Abukhalil AD, Naseef H. Assessment of adherence to guidelines for testing and treatment of pharyngitis among children in Palestine: A retrospective review study. Germs 2023; 13:32-39. [PMID: 38023957 PMCID: PMC10659749 DOI: 10.18683/germs.2023.1364] [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: 09/30/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 12/01/2023]
Abstract
Introduction One of the most common reasons for pediatric outpatient visits is acute pharyngitis, an upper respiratory tract infection. Bacterial pharyngitis is caused by Group A beta-hemolytic Streptococcus (GABHS), also known as Streptococcus pyogenes. This research aimed to assess physicians' adherence to clinical guidelines for diagnosis, management, and selecting appropriate treatment for children suspected of bacterial pharyngitis. Methods A retrospective, observational study was conducted by reviewing patient charts for childred aged 3 to 13 years old diagnosed with pharyngitis from June 2019 until December 2019 at the Emergency Department of Palestine Medical Complex (PMC). The Modified Centor score, throat swab collections, and assessment of antimicrobial selection were used to assess the extent of physicians' adherence to clinical guidelines for appropriate diagnosis and management of pharyngitis. SPSS was used for data analysis. Results Out of 290 cases diagnosed with acute pharyngitis, 217 patients (74.8%) had a Modified Centor score of ≥2; 126 received antibiotics, and eight had their throat swabbed to confirm the diagnosis; furthermore, 73 patients (25.2%) had a Modified Centor score of <2; 34 of them received antibiotics. Azithromycin was the most commonly prescribed antibiotic (41.3%), followed by amoxicillin-clavulanic acid (38.1%). The frequency of empirical antibiotics prescribing was significantly higher among children with a Centor score >2, older children, and those presenting with fever. Conclusions Most cases were not appropriately tested to confirm the diagnosis of bacterial pharyngitis and were mostly treated with inappropriate antimicrobial agents such as azithromycin. Nonadherence to clinical guidelines is very evident in this study.
Collapse
Affiliation(s)
- Shahenaz Najjar
- PhD, Assistant Professor, Dean Faculty of Graduate Studies, Health Informatics Program, Health Sciences Department, Arab American University, Ramallah, P.O Box 240 Jenin, 13 Zababdeh, Palestine and Leuven Institute for Healthcare Policy, Pillar Quality and Safety, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Haya O Sultan
- MA, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, P.O. Box 14, Birzeit, West Bank, Palestine
| | - Hiba H Falana
- MA, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, P.O. Box 14, Birzeit, West Bank, Palestine
| | - Razan O Ata
- MA, Health Informatics Program, Health Sciences Department, Arab American University, Ramallah, P.O Box 240 Jenin, 13 Zababdeh, Palestine
| | - Maryam A Manasrah
- MA, Health Informatics Program, Health Sciences Department, Arab American University, Ramallah, P.O Box 240 Jenin, 13 Zababdeh, Palestine
| | - Mutaz Dreidi
- PhD, Assistant Professor, Department of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, P.O. Box 14, Birzeit, West Bank, Palestine
| | - Abdallah D. Abukhalil
- PhD, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, P.O. Box 14, Birzeit, West Bank, Palestine
| | - Hani Naseef
- PhD, Associate Professor, Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, P.O. Box 14, Birzeit, West Bank, Palestine
| |
Collapse
|
10
|
Vertillo Aluisio G, Spitale A, Bonifacio L, Privitera GF, Stivala A, Stefani S, Santagati M. Streptococcus salivarius 24SMBc Genome Analysis Reveals New Biosynthetic Gene Clusters Involved in Antimicrobial Effects on Streptococcus pneumoniae and Streptococcus pyogenes. Microorganisms 2022; 10:microorganisms10102042. [PMID: 36296318 PMCID: PMC9610097 DOI: 10.3390/microorganisms10102042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/29/2022] [Accepted: 10/14/2022] [Indexed: 12/03/2022] Open
Abstract
Streptococcus salivarius 24SMBc is an oral probiotic with antimicrobial activity against the otopathogens Streptococcus pyogenes and Streptococcus pneumoniae. Clinical studies have reinforced its role in reducing the recurrence of upper respiratory tract infections (URTIs) and rebalancing the nasal microbiota. In this study, for the first time, we characterized 24SMBc by whole genome sequencing and annotation; likewise, its antagonistic activity vs. Streptococcus pneumoniae and Streptococcus pyogenes was evaluated by in vitro co-aggregation and competitive adherence tests. The genome of 24SMBc comprises 2,131,204 bps with 1933 coding sequences (CDS), 44 tRNA, and six rRNA genes and it is categorized in 319 metabolic subsystems. Genome mining by BAGEL and antiSMASH tools predicted three novel biosynthetic gene clusters (BGCs): (i) a Blp class-IIc bacteriocin biosynthetic cluster, identifying two bacteriocins blpU and blpK; (ii) an ABC-type bacteriocin transporter; and (iii) a Type 3PKS (Polyketide synthase) involved in the mevalonate pathway for the isoprenoid biosynthetic process. Further analyses detected two additional genes for class-IIb bacteriocins and 24 putative adhesins and aggregation factors. Finally, in vitro assays of 24SMBc showed significant anti-adhesion and co-aggregation effects against Streptococcus pneumoniae strains, whereas it did not act as strongly against Streptococcus pyogenes. In conclusion, we identified a novel blpU-K bacteriocin-encoding BGC and two class-IIb bacteriocins involved in the activity against Streptococcus pneumoniae and Streptococcus pyogenes; likewise the type 3PKS pathway could have beneficial effects for the host including antimicrobial activity. Furthermore, the presence of adhesins and aggregation factors might be involved in the marked in vitro activity of co-aggregation with pathogens and competitive adherence, showing an additional antibacterial activity not solely related to metabolite production. These findings corroborate the antimicrobial activity of 24SMBc, especially against Streptococcus pneumoniae belonging to different serotypes, and further consolidate the use of this strain in URTIs in clinical settings.
Collapse
|
11
|
Barbieri E, Porcu G, Petigara T, Senese F, Prandi GM, Scamarcia A, Cantarutti L, Cantarutti A, Giaquinto C. The Economic Burden of Pneumococcal Disease in Children: A Population-Based Investigation in the Veneto Region of Italy. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9091347. [PMID: 36138656 PMCID: PMC9498138 DOI: 10.3390/children9091347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/27/2022] [Accepted: 08/28/2022] [Indexed: 12/03/2022]
Abstract
Despite widespread childhood immunization programs, pneumococcal disease (PD) continues to be associated with significant clinical and economic burden worldwide. This retrospective study assessed the PD-related economic burden in children from the Veneto region of Italy following the introduction of a 13-valent pneumococcal conjugate vaccine (PCV13) to the Italian immunization schedule in 2010. Between 2010 and 2017, the annual incidences of pneumonia, acute otitis media (AOM), and invasive pneumococcal disease (IPD), as well as syndromic-disease-related episodes, declined. In our analysis of data from regional expenditure and healthcare resource utilization (HCRU) databases related to children < 15 years of age, we found that regional expenditures decreased between 2010 and 2017 for pneumonia (EUR 8.88 to EUR 3.59 million), AOM (EUR 3.78 to EUR 2.76 million), and IPD (EUR 1.40 to EUR 1.00 million). Despite reductions in PD-related expenditure following the introduction of PCV13, there continues to be an economic burden associated with PD in Veneto, Italy.
Collapse
Affiliation(s)
- Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, 35131 Padova, Italy
- Correspondence:
| | - Gloria Porcu
- Unit of Biostatistics Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Tanaz Petigara
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ 07065, USA
| | | | | | | | | | - Anna Cantarutti
- Unit of Biostatistics Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, 35131 Padova, Italy
- Pedianet Project, 35138 Padova, Italy
| |
Collapse
|
12
|
Smolinski NE, Antonelli PJ, Winterstein AG. Watchful Waiting for Acute Otitis Media. Pediatrics 2022; 150:188303. [PMID: 35726560 DOI: 10.1542/peds.2021-055613] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Updated guidelines continue to support watchful waiting as an option for uncomplicated acute otitis media (AOM) and provide explicit diagnostic criteria. To determine treatment prevalence and associated determinants of watchful waiting for AOM in commercially insured pediatric patients. METHODS This was a retrospective cohort study using IBM Marketscan Commercial Claims Databases (2005 to 2019) of patients 1 to 12 years old with AOM, without otitis-related complications within 6 months prior, with no tympanostomy tubes, and no other infections around index diagnosis of AOM. We examined monthly antibiotic treatment prevalence (defined as pharmacy dispensing within 3 days of AOM diagnosis) and used multivariable logistic regression models to examine determinants of watchful waiting. RESULTS Among 2 176 617 AOM episodes, 77.8% were treated within 3 days. Whereas some clinical characteristics were moderate determinants for watchful waiting, clinician antibiotic prescribing volume and specialty were strong determinants. Low-volume antibiotic prescribers (≥80% of AOM episodes managed with watchful waiting) had 11.61 (95% confidence interval 10.66-12.64) higher odds of using watchful waiting for the index AOM episode than high-volume antibiotic prescribers (≥80% treated). Otolaryngologists were more likely to adopt watchful waiting (odds ratio 5.45, 95% CI 5.21-5.70) than pediatricians, whereas other specialties deferred more commonly to antibiotics. CONCLUSIONS Adoption of watchful waiting for management of uncomplicated, nonrecurrent AOM was limited and stagnant across the study period and driven by clinician rather than patient factors. Future work should assess motivators for prescribing and evaluate patient outcomes among clinicians who generally prefer versus reject watchful waiting approaches to guide clinical decision-making.
Collapse
Affiliation(s)
- Nicole E Smolinski
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy.,Center for Drug Evaluation and Safety (CoDES)
| | - Patrick J Antonelli
- Center for Drug Evaluation and Safety (CoDES).,Department of Otolaryngology, College of Medicine
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy.,Center for Drug Evaluation and Safety (CoDES).,Department of Epidemiology, Colleges of Medicine and Public Health and Health Professions, University of Florida, Gainesville, Florida
| |
Collapse
|
13
|
Antibiotic Prescription Patterns in the Paediatric Primary Care Setting before and after the COVID-19 Pandemic in Italy: An Analysis Using the AWaRe Metrics. Antibiotics (Basel) 2022; 11:antibiotics11040457. [PMID: 35453209 PMCID: PMC9025823 DOI: 10.3390/antibiotics11040457] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 01/15/2023] Open
Abstract
The containment measures following COVID-19 pandemic drastically reduced airway infections, but they also limited the access of patients to healthcare services. We aimed to assess the antibiotic prescription patterns in the Italian paediatric primary care setting before and after the containment measures implementation. For this retrospective analysis, we used a population database, Pedianet, collecting data of patients aged 0–14 years enrolled with family paediatricians (FP) from March 2019 to March 2021. Antibiotic prescriptions were classified according to WHO AWaRe classification. An interrupted time series evaluating the impact of the containment measures implementation on the monthly antibiotic index, on the access to watch index, and on the amoxicillin to co-amoxiclav index stratified by diagnosis was performed. Overall, 121,304 antibiotic prescriptions were retrieved from 134 FP, for a total of 162,260 children. From March 2020, the antibiotic index dropped by more than 80% for respiratory infections. The Access to Watch trend did not change after the containment measures, reflecting the propensity to prescribe more broad-spectrum antibiotics for respiratory infections even during the pandemic. Similarly, co-amoxiclav was prescribed more often than amoxicillin alone for all the diagnoses, with a significant variation in the trend slope for upper respiratory tract infections prescriptions.
Collapse
|
14
|
Barbieri E, Porcu G, Dona' D, Falsetto N, Biava M, Scamarcia A, Cantarutti L, Cantarutti A, Giaquinto C. Non-bullous Impetigo: Incidence, Prevalence, and Treatment in the Pediatric Primary Care Setting in Italy. Front Pediatr 2022; 10:753694. [PMID: 35433549 PMCID: PMC9008221 DOI: 10.3389/fped.2022.753694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED Impetigo is a common skin infection in children. The worldwide prevalence in children is estimated to be 12%, but this may be lower since high-income countries are under-represented. This research aims to evaluate the incidence, prevalence, and management of children with non-bullous impetigo (NBI) residing in Italy. This retrospective cohort study included children up to 14 years of age enrolled in the Pedianet database from January 2004 to June 2018. Events were identified searching ICD9-CM codes (684 and 694.3) and free text fields for a diagnosis of NBI reported during a primary care visit. Diagnoses were manually validated, and events registered within 30-days after the index date were considered follow-ups. Incidence (IR) and prevalence (PR) rates of NBI were stratified by sex, age group, and calendar year. Topical and systemic antibiotic treatments were grouped based on ATC codes. 15,136 NBI episodes occurred in a total cohort of 225,979 children. The overall IR of NBI was 9.5 per 1,000 person-years, and children aged 1-4 years had the highest IR (13.2 per 1,000 person-years). A significant decrease in NBI IR from 13 per 1,000 person-years in 2004 to 7.46 per 1,000 person-years in 2018 (p < 0.0001) was noted. Most of the episodes were treated; systemic antibiotics were preferred over topical. CONCLUSION The prevalence of NBI in children in Italy is less than one third than the global estimate and the trend in time is decreasing. Over prescriptions of systemic antibiotics pose a threat to the diffusion of antimicrobial resistance.
Collapse
Affiliation(s)
- Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Gloria Porcu
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Daniele Dona'
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | | | | | | | | | - Anna Cantarutti
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,Società Servizi Telematici - Pedianet, Padua, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy.,Società Servizi Telematici - Pedianet, Padua, Italy
| |
Collapse
|
15
|
Barbieri E, di Chiara C, Costenaro P, Cantarutti A, Giaquinto C, Hsia Y, Doná D. Antibiotic Prescribing Patterns in Paediatric Primary Care in Italy: Findings from 2012-2018. Antibiotics (Basel) 2021; 11:antibiotics11010018. [PMID: 35052895 PMCID: PMC8773435 DOI: 10.3390/antibiotics11010018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/09/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Comprehensive data are needed to monitor antibiotic prescribing and inform stewardship. We aimed to evaluate the current antibiotic prescribing patterns, including treatment switching and prolongation, in the paediatric primary care setting in Italy. This database study assessed antibiotic prescriptions retrieved from Pedianet, a paediatric primary care database, from 1 January 2012 to 31 December 2018. Descriptive analyses were stratified by diagnosis class, calendar year, and children's age. Generalized linear Poisson regression was used to assess variation in the prescriptions. In total, 505,927 antibiotic prescriptions were included. From 2012 to 2018, the number of antibiotics per child decreased significantly by 4% yearly from 0.79 in 2012 to 0.62 in 2018. Amoxicillin prescriptions decreased with increasing children's age, while macrolides and third-generation cephalosporins had the opposite trend. Prescriptions were associated with a diagnosis of upper respiratory infection in 23% of cases, followed by pharyngitis (21%), bronchitis and bronchiolitis (12%), and acute otitis media (12%). Eight percent of treatment episodes were prolonged or switched class, mostly represented by co-amoxiclav, macrolides, and third-generation cephalosporins. Our findings report an overall decrease in antibiotic prescriptions, but pre-schoolers are still receiving more than one antibiotic yearly, and broad-spectrum antibiotics prescription rates remain the highest.
Collapse
Affiliation(s)
- Elisa Barbieri
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy; (C.d.C.); (P.C.); (C.G.); (D.D.)
- Correspondence:
| | - Costanza di Chiara
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy; (C.d.C.); (P.C.); (C.G.); (D.D.)
| | - Paola Costenaro
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy; (C.d.C.); (P.C.); (C.G.); (D.D.)
| | - Anna Cantarutti
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy;
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- Società Servizi Telematici–Pedianet, 35121 Padua, Italy
| | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy; (C.d.C.); (P.C.); (C.G.); (D.D.)
- Società Servizi Telematici–Pedianet, 35121 Padua, Italy
| | - Yingfen Hsia
- School of Pharmacy, Queen’s University Belfast, Belfast BT9 7BL, UK;
- Paediatric Infectious Disease Research Group, St. George’s University of London, London SW17 0RE, UK
| | - Daniele Doná
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy; (C.d.C.); (P.C.); (C.G.); (D.D.)
- Paediatric Infectious Disease Research Group, St. George’s University of London, London SW17 0RE, UK
| |
Collapse
|
16
|
Bianco A, Licata F, Nobile CG, Napolitano F, Pavia M. Pattern and appropriateness of antibiotic prescriptions for upper respiratory tract infections in primary care paediatric patients. Int J Antimicrob Agents 2021; 59:106469. [PMID: 34757133 DOI: 10.1016/j.ijantimicag.2021.106469] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/12/2021] [Accepted: 10/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this cross-sectional study was to investigate the pattern of antibiotic prescriptions for upper respiratory tract infections (URTIs) in children seen by primary care paediatricians (PCPs). METHODS Data were collected from face-to-face interviews administered to a sample of parents of outpatient children aged 0-14 years in two regions in Southern Italy. To be eligible, children had to be diagnosed with sinusitis, pharyngotonsillitis, otitis media, bronchitis, influenza or a common cold. The presence of an indication of antibiotic therapy was evaluated according to national and international guidelines. RESULTS An antibiotic prescription was indicated in 57 (10.1%) of the sampled patients, of whom 33.3% did not receive an antibiotic prescription; among the 508 patients for whom an antibiotic prescription was not indicated, 27.4% received a prescription. Of all PCP consultations, 72% were appropriate (an antibiotic was prescribed when indicated and not prescribed when not indicated), whilst an antibiotic prescription not indicated by guidelines was given to 24.6% of the participants, and 3.4% of the sample did not receive an antibiotic prescription when indicated. The most frequently prescribed antibiotic was amoxicillin with clavulanic acid. A rapid microbiological examination was performed in two patients. CONCLUSIONS The study findings highlight a high rate of sub-optimal antibiotic therapeutic profile. Over-prescription of antibiotic therapy and the use of broad-spectrum molecules are widespread in children with URTIs. Antibiotic under-prescription, which may deprive paediatric patients of an effective treatment when indicated, also occurs.
Collapse
Affiliation(s)
- Aida Bianco
- Department of Health Sciences, School of Medicine, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Francesca Licata
- Department of Health Sciences, School of Medicine, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Carmelo Ga Nobile
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Cosenza, Italy
| | - Francesco Napolitano
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Pavia
- Department of Health Sciences, School of Medicine, University of Catanzaro "Magna Græcia", Catanzaro, Italy; Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
| |
Collapse
|
17
|
Pierantoni L, Lo Vecchio A, Lenzi J, Corsi V, Campana L, Luca Trobia G, Amendolea A, Di Felice B, Alighieri G, Fabrizio GC, Bisceglia M, Peia F, Chiale F, Bartolomei B, Siciliano C, Di Battista C, Passone E, di Giovanni C, Piergentili E, Donà D, Buonsenso D. Parents' Perspective of Antibiotic Usage in Children: A Nationwide Survey in Italy. Pediatr Infect Dis J 2021; 40:906-911. [PMID: 34437339 DOI: 10.1097/inf.0000000000003221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antibiotics represent the most widely prescribed drugs in children worldwide, both in hospital and community settings. A comprehensive approach to understanding the reasons and determinants of antibiotic prescription in the pediatric age is needed. This study aimed to assess parents' attitudes and perspectives about antibiotic use. METHODS Prospective observational study was conducted in all Italian Regions between February 1 and April 30, 2020, using a standardized questionnaire. RESULTS Six thousand six hundred twenty-five parents from all Italian regions completed the survey. Seventy-six percent of parents were aware that only bacteria are the target of antibiotics, but 92.9% knew that the antibiotic has no direct effect on fever. Antibiotic self-prescription (10.4%) or by remote consultation by phone call (19.9%) or message (9.6%) were relatively common. Ninety-three percent of parents were aware that excessive use of antibiotics could select resistant bacteria and 84.7% of them knew that they could actively fight antibiotic resistance. About two thirds of participants (66.1%) received information on antibiotic resistance from their family pediatrician. Parents born of Italy or those with lower income had a higher probability of having less information from pediatricians or knowledge of proper antibiotic use. DISCUSSION Our study suggests that parents' knowledge and attitudes toward antibiotic use and prescription are improving compared with previous studies, while there is still a gap regarding antibiotic resistance, particularly on practices that can reduce its burden. Our study's negative finding is that families from low-income settings or those born abroad have significantly more misconceptions about important antibiotic practices.
Collapse
Affiliation(s)
- Luca Pierantoni
- From the Pediatric Emergency Department, IRCSS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences-Section of Pediatrics, University of Naples Federico II, Napoli, Italy
| | - Jacopo Lenzi
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Vincenza Corsi
- Department of Pediatrics, PO San Francesco Nuoro, Nuoro, Italy
| | - Lara Campana
- Department of Pediatrics, A. Cardarelli Hospital, Campobasso, Italy
| | - Gian Luca Trobia
- Pediatric and Pediatric Emergency Room Unit, "Cannizzaro" Emergency Hospital Catania, Catania, Italy
| | | | | | - Giovanni Alighieri
- Family Pediatrician, Unità di Pediatria e TIN, Azienda Ospedaliera Cardinale Giovanni Panico, Tricase, Italy
| | - Giovanna Carmela Fabrizio
- Unità Operativa Complessa Pediatria e Neonatologia Ospedale Madonna delle Grazie, ASM Matera, Matera, Italy
| | - Massimo Bisceglia
- Neonatal Intensive Care Unit, San Giovanni di Dio Hospital, Crotone, Calabria
| | - Francesco Peia
- Neonatal Intensive Care Unit and Paediatric Department, ASST Lecco, Lecco, Italy
| | - Federica Chiale
- Regina Margherita Children's Hospital, Postgraduation School of Pediatrics, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | | | | | - Eva Passone
- Department of Pediatrics, Azienda Ospedaliero-Universitaria "Santa Maria della Misericordia" di Udine, Friuli Venezia Giulia, Italy
| | | | | | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Ge-melli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
18
|
Cantarutti A, Barbieri E, Scamarcia A, Cantarutti L, Canova C, Giaquinto C. Use of the Bacterial Lysate OM-85 in the Paediatric Population in Italy: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136871. [PMID: 34206831 PMCID: PMC8297025 DOI: 10.3390/ijerph18136871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 01/22/2023]
Abstract
Background: In Italy, the bacterial lysate OM-85 (Broncho-Vaxom®, Broncho-Munal®, Ommunal®, Paxoral®, Vaxoral®) is registered for the prophylaxis of recurrent respiratory tract infections (RTIs) in adults and children above one year of age, but there are limited data on its use in the paediatric population. We aim to estimate the impact of OM-85 treatment on RTIs and antibiotic prescriptions in children. Methods: This study included children aged 1 to 14 years enrolled in Pedianet, a paediatric general practice research database, from January 2007 to June 2017, having at least one prescription of OM-85. Children with less than 12 months of follow-up before (PRE period) and after (POST period) the OM-85 prescription were excluded. The frequency of antibiotic prescriptions and the frequency of RTI episodes in the PRE and POST periods were compared through the post-hoc test. Subgroup analysis was performed in children with recurrent RTIs. Results: 1091 children received 1382 OM-85 prescriptions for a total follow-up of 619,525.5 person-years. Overall, antibiotic prescriptions decreased from a mean of 2.8 (SD (standard deviation) 2.7) prescriptions in the PRE period to a mean of 2.2 (SD 2.6) prescriptions in the POST period (p < 0.0001). RTIs decreased from a mean of 3.4 (SD 2.9) episodes in the PRE period to a mean of 2.5 (SD 2.6) episodes in the POST period (p < 0.0001). No change in antibiotic class was noted, and co-amoxiclav remained the preferred therapy in 28% of cases, followed by amoxicillin. These results were confirmed among children with recurrent RTIs. Conclusions: OM-85 is effective in preventing both antibiotic prescriptions and RTIs in children.
Collapse
Affiliation(s)
- Anna Cantarutti
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- Società Servizi Telematici-Pedianet, 35121 Padua, Italy
| | - Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35128 Padua, Italy
| | | | | | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Carlo Giaquinto
- Società Servizi Telematici-Pedianet, 35121 Padua, Italy
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35128 Padua, Italy
| |
Collapse
|
19
|
Causality and avoidability of adverse drug reactions of antibiotics in hospitalized children: a cohort study. Int J Clin Pharm 2021; 43:1293-1301. [PMID: 33656658 DOI: 10.1007/s11096-021-01249-8] [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: 09/11/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Adverse drug reactions are a problem in healthcare systems worldwide. Children are more susceptible than adults, especially when exposed to specific drug classes, such as antibiotics. OBJECTIVE To assess the incidence, causality, severity, and avoidability of antibiotic-associated adverse drug reactions in hospitalized pediatric patients. SETTING Pediatric ward of a high-complexity public hospital in northeast Brazil. METHODS A prospective cohort study was conducted over six months, including children aged between 28 days and 12 years, hospitalized for more than 48 h, and receiving antibiotics. Liverpool's causality and avoidability assessment tools were used. Primary outcome measures: Incidence of adverse drug reactions, causality, severity, and avoidability, major antibiotics implicated, risk factors. RESULTS A total of 183 patients were followed, and 35 suspected adverse drug reactions were recorded overall incidence equal to 14.7%. Most adverse drug reactions were classified as moderate severity (76.7%), probable (57.1%) and defined (28.6%) causality, and unavoidable (66.7%). The affected organs were the gastrointestinal system (74.1%) and skin (25.9%). Major antibiotics implicated were ceftriaxone (40.7%), azithromycin (25.9%), and crystalline penicillin (11.1%). The number of antibiotics prescribed per patient during hospitalization and the length of stay were the risk factors identified. CONCLUSION Causality and severity assessment indicated that most adverse drug reactions were probable and moderate. Possibly avoidable reactions occurred due to inappropriate prescribing when preventive measures were not implemented. Monitoring the use of antibiotics in children is essential to ensure the safety of these patients.
Collapse
|
20
|
Costenaro P, Cantarutti A, Barbieri E, Scamarcia A, Oletto A, Sacerdoti P, Lundin R, Cantarutti L, Giaquinto C, Donà D. Antibiotic Prescriptions for Children With Community-acquired Pneumonia: Findings From Italy. Pediatr Infect Dis J 2021; 40:130-136. [PMID: 33055500 DOI: 10.1097/inf.0000000000002934] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND OBJECTIVE Community-acquired pneumonia (CAP) is one of the most common reasons of prescribing antibiotics for children, often with overuse of broad-spectrum antibiotics. The aim of this study is to describe the antibiotic prescriptions for Italian children with CAP, at the primary care level. STUDY DESIGN Retrospective cohort study conducted among children 3 months-14 years of age with CAP, enrolled in Pedianet (http://www.pedianet.it) from January 1, 2009 to December 31, 2018. Antibiotic treatment was defined as narrow-spectrum (NS-ABT) if amoxicillin and broad-spectrum (BS-ABT) if amoxicillin/clavulanic acid, cephalosporins or any combination. Crude and adjusted logistic regressions for the odds of receiving NS-ABT were conducted (all episodes of CAP and per patient). A P value <0.05 was considered statistically significant. RESULTS Among 9691 CAP, 7260 episodes from 6409 children followed by 147 pediatricians were analyzed. The 16.7% of CAP [1216/7260, 95% confidence interval (CI): 15.9%-17.6%] received an NS-ABT while 53.3% (3863/7260, 95% CI: 52%-54.4%) received BS-ABTs and 30% (2181/7260, 95% CI: 28.9%-31.1%) macrolides. Within 10 years, a slight but increasing trend of NS-ABT prescription was observed (P < 0.001). Factors independently associated with reduced odds of receiving an NS-ABT compared with BS-ABT including macrolides were being older than 5 years [odds ratio (OR) 0.45, 95% CI: 0.39-0.52], living in Central/Southern Italy (OR 0.13, 95% CI: 0.10-0.16) and being exposed to ABT 3 months before (OR 0.61, 95% CI: 0.53-0.70). These findings were confirmed comparing NS-ABT versus BS-ABT excluding macrolides (n = 5079) and when the analysis was limited to index CAP. CONCLUSION Our findings report a very limited prescription of narrow-spectrum antibiotics for Italian children with CAP.
Collapse
Affiliation(s)
- Paola Costenaro
- From the Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua
| | - Anna Cantarutti
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca
- Department of Statistics and Quantitative Methods, Unit of Biostatistics Epidemiology and Public Health, University of Milano-Bicocca, Milan
| | - Elisa Barbieri
- From the Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca
- Department of Statistics and Quantitative Methods, Unit of Biostatistics Epidemiology and Public Health, University of Milano-Bicocca, Milan
- Pedianet Project
- Paediatric Network for Treatment of AIDS or Penta Foundation, Padua, Italy
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Andrea Oletto
- Paediatric Network for Treatment of AIDS or Penta Foundation, Padua, Italy
| | - Paolo Sacerdoti
- Paediatric Network for Treatment of AIDS or Penta Foundation, Padua, Italy
| | - Rebecca Lundin
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Carlo Giaquinto
- From the Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University of Padua
- Pedianet Project
- Paediatric Network for Treatment of AIDS or Penta Foundation, Padua, Italy
| | - Daniele Donà
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca
- Paediatric Network for Treatment of AIDS or Penta Foundation, Padua, Italy
| |
Collapse
|
21
|
Barbieri E, De Luca M, Minute M, D’Amore C, Ciofi Degli Atti ML, Martelossi S, Giaquinto C, Da Dalt L, Zaoutis T, Dona D. Impact and Sustainability of Antibiotic Stewardship in Pediatric Emergency Departments: Why Persistence Is the Key to Success. Antibiotics (Basel) 2020; 9:antibiotics9120867. [PMID: 33291565 PMCID: PMC7761799 DOI: 10.3390/antibiotics9120867] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 02/06/2023] Open
Abstract
Antibiotic stewardship programs proved to be effective in improving prescribing appropriateness. This multicenter quasi-experimental study, aimed to assesses the stewardship impact on antibiotics prescribing in different semesters from 2014 to 2019 in three pediatric emergency departments (Center A, B, and C) in Italy. All consecutive patients diagnosed with acute otitis media or pharyngitis were evaluated for inclusion. Two different stewardship were adopted: for Center A and B, clinical pathways were implemented and disseminated, and yearly lectures were held, for Center C, only pathways were implemented. Broad-spectrum prescription rates decreased significantly by 80% for pharyngitis and 29.5 to 55.2% for otitis after the implementation. In Center C, rates gradually increased from the year after the implementation. Amoxicillin dosage adjusted to pharyngitis recommendations in Center C (53.7 vs. 51.6 mg/kg/die; p = 0.011) and otitis recommendations in Center A increasing from 50.0 to 75.0 mg/kg/die (p < 0.001). Days of therapy in children < 24 months with otitis increased from 8.0 to 10.0 in Center A, while in older children decreased in Center A (8.0 vs. 7.0; p < 0.001) and Center B (10.0 vs. 8.0; p < 0.001). Clinical pathways combined with educational lectures is a feasible and sustainable program in reducing broad-spectrum antibiotic prescribing with stable rates over time.
Collapse
Affiliation(s)
- Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, 35131 Padova, Italy; (C.G.); (D.D.)
- Correspondence:
| | - Maia De Luca
- Unit of Immune and Infectious Diseases, Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Marta Minute
- Pediatric Unit, Ca’ Foncello’s Hospital, 31100 Treviso, Italy; (M.M.); (S.M.)
| | - Carmen D’Amore
- Unit of Clinical Epidemiology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (C.D.); (M.L.C.D.A.)
| | | | - Stefano Martelossi
- Pediatric Unit, Ca’ Foncello’s Hospital, 31100 Treviso, Italy; (M.M.); (S.M.)
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, 35131 Padova, Italy; (C.G.); (D.D.)
| | - Liviana Da Dalt
- Pediatric Emergency Department, Department of Women’s and Children’s Health, University Hospital of Padua, 2-35128 Padova, Italy;
| | - Theoklis Zaoutis
- Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Daniele Dona
- Division of Pediatric Infectious Diseases, Department of Women’s and Children’s Health, University of Padova, 35131 Padova, Italy; (C.G.); (D.D.)
| |
Collapse
|
22
|
Caffarelli C, Santamaria F, Santoro A, Procaccianti M, Castellano F, Nastro FF, Villani A, Bernasconi S, Corsello G. Best practices, challenges and innovations in pediatrics in 2019. Ital J Pediatr 2020; 46:176. [PMID: 33256810 PMCID: PMC7703504 DOI: 10.1186/s13052-020-00941-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/21/2020] [Indexed: 12/22/2022] Open
Abstract
This paper runs through key progresses in epidemiology, pathomechanisms and therapy of various diseases in children that were issued in the Italian Journal of Pediatrics at the end of last year. Novel research and documents that explore areas such as allergy, critical care, endocrinology, gastroenterology, infectious diseases, neonatology, neurology, nutrition, and respiratory tract illnesses in children have been reported. These observations will help to control childhood illnesses.
Collapse
Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Angelica Santoro
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy
| | - Michela Procaccianti
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci 14, Parma, Italy
| | - Fabio Castellano
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Alberto Villani
- UOC di Pediatria Generale e Malattie Infettive, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| |
Collapse
|
23
|
Whitby PW, Morton DJ, Mussa HJ, Mirea L, Stull TL. A bacterial vaccine polypeptide protective against nontypable Haemophilus influenzae. Vaccine 2020; 38:2960-2970. [PMID: 32111525 DOI: 10.1016/j.vaccine.2020.02.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/07/2020] [Accepted: 02/18/2020] [Indexed: 02/08/2023]
Abstract
Nontypeable strains of Haemophilus influenzae (NTHi) are one of the most common cause of otitis media and the most frequent infection associated with exacerbations of chronic obstructive pulmonary disease; there is currently no vaccine in the U.S. to prevent NTHi. Using bioinformatics and structural vaccinology, we previously identified several NTHi species-conserved and sequence-conserved peptides that mediate passive protection in the rat model of infection. Using these, and similar peptides, we designed Hi Poly 1, a Bacterial Vaccine Polypeptide, comprising 9 unique peptides from 6 different surface proteins. Recombinant Hi Poly 1 was purified by affinity chromatography. Forty chinchillas were immunized three times with 200 µg of Hi Poly 1 with alum adjuvant; similarly, 41 controls were immunized with adjuvant alone. The average Log2 IgG titer among immunized animals was 17.04, and IgG antibodies against each component peptide were detected. In the infant rat model, antisera from immunized chinchillas provided significant passive protection compared to PBS (p = 0.01) and pre-immune sera (p = 0.03). In the established chinchilla model of NTHi otitis media, the vaccinated group cleared infection faster than the control group as indicated by significantly decreased positive findings on video-otoscopy (p < 0.0001) and tympanometry (p = 0.0002) on day 7, and for middle ear fluid obtained by aspiration (p = 0.0001) on day 10 post-infection. Using 12 representative NTHi strains in a Live-Cell ELISA, greater antibody binding to each strain was detected with post Hi Poly 1 than the pre-immune chinchilla antisera. The data from this proof-of-principle study demonstrate the effectiveness of Hi Poly 1 against the NTHi in two relevant preclinical models of bacteremia and otitis media as well as surface antibody binding across the species. The Bacterial Vaccine Polypeptide approach to a vaccine against NTHi also serves as a paradigm for development of similar vaccines to protect against other bacteria.
Collapse
Affiliation(s)
- Paul W Whitby
- Department of Child Health, University of Arizona College of Medicine-Phoenix, United States; Phoenix Childrens Hospital, Phoenix, United States.
| | - Daniel J Morton
- Department of Child Health, University of Arizona College of Medicine-Phoenix, United States; Phoenix Childrens Hospital, Phoenix, United States
| | - Huda J Mussa
- Department of Child Health, University of Arizona College of Medicine-Phoenix, United States; Phoenix Childrens Hospital, Phoenix, United States
| | - Lucia Mirea
- Department of Child Health, University of Arizona College of Medicine-Phoenix, United States; Phoenix Childrens Hospital, Phoenix, United States
| | - Terrence L Stull
- Department of Child Health, University of Arizona College of Medicine-Phoenix, United States; Phoenix Childrens Hospital, Phoenix, United States
| |
Collapse
|
24
|
Varricchio A, La Mantia I, Brunese FP, Ciprandi G. Inflammation, infection, and allergy of upper airways: new insights from national and real-world studies. Ital J Pediatr 2020; 46:18. [PMID: 32039733 PMCID: PMC7008537 DOI: 10.1186/s13052-020-0782-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 01/29/2020] [Indexed: 12/24/2022] Open
Abstract
The upper airways (UA) should be considered as a functional unit. Current functional anatomy divides URT in three, mutually dependent, "junction boxes": i) the ostio-meatal complex (OMC), ii) the spheno-ethmoidal recess (SER), and iii) the rhinopharynx (RP). Correct ventilation and effective mucociliary clearance of these sites significantly affect the healthy physiology of the entire respiratory system. The OMC, SER, and RP obstruction is the first pathogenic step in the inflammatory/infectious cascade of UA disorders. The inflammation of the respiratory mucosa is the main pathogenic factor for airway obstruction. Moreover, bacterial biofilm (a strategy modality of bacterial survival) is an important local cause of systemic antibiotic ineffectiveness, recurrent infections, and antibiotic resistance. Health microbiota guarantees UA wellness; on the contrary, dysbiosis promotes and worsens UA infections. Allergy, namely type 2 inflammation, is a common cause of UA obstruction such as promoting in turn infections. Fiberoptic endoscopy is a mandatory diagnostic tool in clinical practice. Nasal cytology, mainly concerning flow cytometry, allows defining rhinitis phenotypes so allowing a precision medicine approach. Several conventional therapeutic approaches are available, but efficacy and safety should be ever properly considered before the prescription. Also, complementary medicine plays a fruitful role in the management of UA diseases. National and real-world studies are reported and discussed as they may be useful in daily clinical practice.
Collapse
Affiliation(s)
- Attilio Varricchio
- UOSD Video-Endoscopia delle VAS, P.O. San Gennaro - ASL Napoli 1-centro, Naples, Italy
| | | | | | - Giorgio Ciprandi
- Allergy Clinic, Casa di Cura Villa Montallegro, Via Boselli 5, 16146, Genoa, Italy.
| |
Collapse
|
25
|
Donà D, Barbieri E, Daverio M, Lundin R, Giaquinto C, Zaoutis T, Sharland M. Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review. Antimicrob Resist Infect Control 2020; 9:3. [PMID: 31911831 PMCID: PMC6942341 DOI: 10.1186/s13756-019-0659-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.
Collapse
Affiliation(s)
- D. Donà
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
- Fondazione Penta ONLUS, Padua, Italy
| | - E. Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
| | - M. Daverio
- Pediatric intensive care unit, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - R. Lundin
- Fondazione Penta ONLUS, Padua, Italy
| | - C. Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141 Padua, Italy
- Fondazione Penta ONLUS, Padua, Italy
| | - T. Zaoutis
- Fondazione Penta ONLUS, Padua, Italy
- Division of Infectious Diseases and the Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - M. Sharland
- Pediatric Infectious Disease Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
- Fondazione Penta ONLUS, Padua, Italy
| |
Collapse
|