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Akintan P, Oshun P, Osuagwu C, Ola-Bello O, Fajolu I, Roberts A, Temiye E, Oduyebo O. Point prevalence surveys of antibiotic prescribing in children at a tertiary hospital in a resource constraint, low-income sub-Saharan African country-the impact of an antimicrobial stewardship program. BMC Pediatr 2024; 24:383. [PMID: 38834956 DOI: 10.1186/s12887-024-04847-3] [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: 11/07/2022] [Accepted: 05/22/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Resistance to multiple antibiotics by several pathogens has been widely described in children and has become a global health emergency. This is due to increased use by parents, caregivers, and healthcare providers. This study aims to describe the prevalence rates of antibiotic prescribing, ascertain the impact of antimicrobial stewardship programs, and target improving the quality of antibiotic prescribing in the paediatric population over time in a hospital. METHOD A point prevalence survey of antibiotic use was performed yearly for 4 years to monitor trends in antibiotic prescribing. Data from all patients admitted before 8 a.m. on the day of the PPS were included. A web-based application designed by the University of Antwerp was used for data entry, validation, and analysis ( http://www.global-pps.com ). RESULTS A total of 260 children, including 90 (34.6%) neonates and 170 (65.4%) older children, were admitted during the four surveys. Overall, 179 (68.8%) patients received at least one antibiotic. In neonates, the prevalence of antibiotic use increased from 78.9 to 89.5% but decreased from 100 to 58.8% in older children. There was a reduction in the use of antibiotics for prophylaxis from 45.7 to 24.6%. The most frequently prescribed antibiotic groups were third generation cephalosporins and aminoglycosides. The most common indications for antibiotic prescription were sepsis in neonates and central nervous system infection in older children. The documentation of reason in notes increased from 33 to 100%, while the stop-review date also increased from 19.4 to 70%. CONCLUSION The indicators for appropriate antibiotic prescription improved over time with the introduction of antibiotic stewardship program in the department.
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Affiliation(s)
- Patricia Akintan
- Department of Paediatric College of Medicine, University of Lagos, Lagos, Nigeria.
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
| | - Philip Oshun
- Department of Medical Microbiology and Parasitology College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Chioma Osuagwu
- Department of Medical Microbiology and Parasitology College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Olafoyekemi Ola-Bello
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Iretiola Fajolu
- Department of Paediatric College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Alero Roberts
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Community Health and Primary Care, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Edamisan Temiye
- Department of Paediatric College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Oyinlola Oduyebo
- Department of Medical Microbiology and Parasitology College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Medical Microbiology and Parasitology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
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Liu BT, Nagarajan D, Kaliyamoorthy S, Rathinam B. Citrate Functionalized Zirconium-Based Metal Organic Framework for the Fluorescent Detection of Ciprofloxacin in Aqueous Media. MICROMACHINES 2022; 13:2097. [PMID: 36557396 PMCID: PMC9782501 DOI: 10.3390/mi13122097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 06/17/2023]
Abstract
Ciprofloxacin (CIP) is a commonly used antibiotic for the treatment of infectious diseases in humans and as a prophylactic agent in the livestock industry, leading to the environmental discharge of significant amounts of CIP. CIP is stable in aquatic systems leading to its pseudo-persistence. Constant exposure to these antibiotics results in the generation of antibiotic-resistant pathogens and potential toxicity/hypersensitivity in humans. Therefore, it is necessary to develop a convenient, rapid, and cost-effective method for the monitoring of ciprofloxacin in environmental samples. Rhodamine-based fluorescent receptors have the limitation of aqueous solubility. Therefore, in order to overcome this drawback, we designed a novel fluorescent receptor based on a zirconium-based metal organic framework (MOF-808). The precursor, MOF-808, was synthesized and functionalized by using sodium citrate to obtain a receptor called C-MOF-808. The C-MOF-808 was structurally characterized by XRD and spectroscopic analyses. Thus, this synthesized receptor can be used for the fluorescent detection of CIP in aqueous media with a detection limit of 9.4 µM. The detection phenomena of the receptor were studied by absorption as well as fluorescent spectra. The binding behavior of CIP with the receptor was studied by FT-IR and 1H-NMR analyses, and a binding mechanism is proposed.
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Affiliation(s)
- Bo-Tau Liu
- Department of Chemical and Materials, Engineering National Yunlin University of Science and Technology, Yunlin 64002, Taiwan
| | - Dillirani Nagarajan
- Department of Chemical Engineering, National Cheng Kung University, Tainan 70101, Taiwan
| | - Selvam Kaliyamoorthy
- The Noyori Laboratory, Graduate School of Science and Research Center for Materials Science Nagoya University, Furo-Cho, Chikusa-ku, Nagoya 464-8602, Japan
| | - Balamurugan Rathinam
- Department of Chemical and Materials, Engineering National Yunlin University of Science and Technology, Yunlin 64002, Taiwan
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Majalekar PP, Shirote PJ. Fluoroquinolones: Blessings Or Curses. Curr Drug Targets 2021; 21:1354-1370. [PMID: 32564750 DOI: 10.2174/1389450121666200621193355] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 11/22/2022]
Abstract
Fluoroquinolones are one of the world's most valuable and popularly used categories of antimicrobial agents. This paper attempts to review the substantial progress of fluoroquinolones from their discovery to black box warning. Antibiotic drug choice will remain difficult in the presence of increasing resistance, but the introduction of fluoroquinolones has created a new and exciting era in antimicrobial treatment. These are a synthetic heterogeneous group of compounds used in both hospital and community practices to treat numerous severe infections. The era of quinolone antibiotics began with the serendipitous discovery of the quinolone prototype in 1962. The chronological development of fluoroquinolone reported that nalidixic acid was the first quinolone that gained popular choice for the treatment of urinary tract infection. The subsequent agents like levofloxacin, ofloxacin, norfloxacin, gatifloxacin, moxifloxacin, clinafloxacin, sparfloxacin, and ciprofloxacin were derived through side chain and nuclear manipulation from basic pharmacophore. The fluoroquinolone motifs have been found as a milestone, effective in certain infections that are respiratory tract infection, urinary tract infection, bone disorders, meningococcal and mycobacterial infections, sexually transmitted diseases, skin infections, etc. Fluoroquinolones are first entirely man-made antibiotics that exhibit antibacterial activity through the inhibition of topoisomerase II, topoisomerase IV and deoxyribonucleic acid gyrase, which is vital for chromosome replication and function. The post-marketing surveillance pointed out the favorable side effects associated with fluoroquinolones such as phototoxicity, QT interval prolongation and anaphylaxis. The discovery, development and clinical use of fluoroquinolone antibiotics in the last century contributed to a decline in morbidity and mortality rates.
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Affiliation(s)
- Priyanka P Majalekar
- Department of Pharmaceutical Chemistry, Appasaheb Birnale College of Pharmacy, Sangli. Shivaji University, Sangli - 416416, India
| | - Pramodkumar J Shirote
- Department of Pharmaceutical Chemistry, Arvind Gavali College of Pharmacy, Satara Shivaji University, Satara- 415015, India
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Rheumatologic Manifestations of CF. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_18] [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: 10/24/2022]
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Yuphintharakun N, Nurerk P, Chullasat K, Kanatharana P, Davis F, Sooksawat D, Bunkoed O. A nanocomposite optosensor containing carboxylic functionalized multiwall carbon nanotubes and quantum dots incorporated into a molecularly imprinted polymer for highly selective and sensitive detection of ciprofloxacin. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2018; 201:382-391. [PMID: 29775931 DOI: 10.1016/j.saa.2018.05.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 06/08/2023]
Abstract
A nanocomposite optosensor consisting of carboxylic acid functionalized multiwall carbon nanotubes and CdTe quantum dots embedded inside a molecularly imprinted polymer (COOH@MWCNT-MIP-QDs) was developed for trace ciprofloxacin detection. The COOH@MWCNT-MIP-QDs were synthesized through a facile sol-gel process using ciprofloxacin as a template molecule, 3-aminopropylethoxysilane as a functional monomer and tetraethoxysilane as a cross-linker at a molar ratio of 1:8:20. The synthesized nanocomposite optosensor had high sensitivity, excellent specificity and high binding affinity to ciprofloxacin. Under optimal conditions, the fluorescence intensity of the optosensor decreased in a linear fashion with the concentration of ciprofloxacin and two linear dynamic ranges were obtained, 0.10-1.0 μg L-1 and 1.0-100.0 μg L-1 with a very low limit of detection of 0.066 μg L-1. The imprinting factors of the two linear range were 17.67 and 4.28, respectively. The developed nanocomposite fluorescence probe was applied towards the determination of ciprofloxacin levels in chicken muscle and milk samples with satisfactory recoveries being obtained in the range of 82.6 to 98.4%. The results were also in good agreement with a HPLC method which indicates that the optosensor can be used as a sensitive, selective and rapid method to detect ciprofloxacin in chicken and milk samples.
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Affiliation(s)
- Naphat Yuphintharakun
- Trace Analysis and Biosensor Research Center, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Center of Excellence for Innovation in Chemistry, Department of Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Piyaluk Nurerk
- Trace Analysis and Biosensor Research Center, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Center of Excellence for Innovation in Chemistry, Department of Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Kochaporn Chullasat
- Trace Analysis and Biosensor Research Center, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Center of Excellence for Innovation in Chemistry, Department of Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Proespichaya Kanatharana
- Trace Analysis and Biosensor Research Center, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Center of Excellence for Innovation in Chemistry, Department of Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Frank Davis
- University of Chichester, College Lane, Chichester, West Sussex P019 6PE, UK
| | - Dhassida Sooksawat
- Trace Analysis and Biosensor Research Center, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Center of Excellence for Innovation in Chemistry, Department of Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand
| | - Opas Bunkoed
- Trace Analysis and Biosensor Research Center, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand; Center of Excellence for Innovation in Chemistry, Department of Chemistry, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla 90112, Thailand.
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Mendes MD, Cavallo RR, Carvalhães CHVFG, Ferrarini MAG. Septic arthritis by Sphingobacterium multivorum in immunocompromised pediatric patient. REVISTA PAULISTA DE PEDIATRIA (ENGLISH EDITION) 2016. [PMID: 26915918 PMCID: PMC5178126 DOI: 10.1016/j.rppede.2016.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective: To report a case septic arthritis with a rare pathogen in a immunosuppressed child. Case description: Male patient, 6 years old, had liver transplant five and half years ago due to biliary atresia. Patient was using tacrolimus 1mg q.12h. This patient started to have pain in left foot and ankle and had one episode of fever 3 days before hospital admission. Physical examination showed weight 17kg, height 109cm, temperature 36.4°C, with pain, swelling and heat in the left ankle, without other clinical signs. Initial tests: hemoglobin 11.7g/dL hematocrit 36.4%, leukocyte count 17,600µL-1 (7% banded neutrophils, 70% segmented neutrophils, 2% eosinophils, basophils 1%, 13% lymphocytes, 7% monocytes) C-reactive protein 170.88mg/L. Joint ultrasound showed moderate effusion in the site. Patient was submitted to surgical procedure and Sphingobacterium multivorum was isolated from the effusion. The germ was susceptible to broad spectrum cephalosporins (ceftriaxone and cefepime) and fluoroquinolones (ciprofloxacin and levofloxacin), and it was resistant to carbapenemic antibiotics and aminoglycosides. He was treated intravenously with oxacillin for 15 days and ceftriaxone for 13 days, and orally with ciprofloxacin for 15 days, with good outcome. Comments: The S. multivorum is a gram negative bacillus that belongs to Flavobacteriaceae family and it is considered non-pathogenic. It has rarely been described as a cause of infections in humans, especially in hospital environment and in immunosuppressed patients. This case report is relevant for its unusual etiology and for the site affected, which may be the first case of septic arthritis described.
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Affiliation(s)
- Maiana Darwich Mendes
- Escola Paulista de Medicina da Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil.
| | - Rafael Ruiz Cavallo
- Escola Paulista de Medicina da Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
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Mendes MD, Cavallo RR, Carvalhães CHVFG, Ferrarini MAG. Septic arthritis by Sphingobacterium multivorum in imunocompromised pediatric patient. REVISTA PAULISTA DE PEDIATRIA 2016; 34:379-83. [PMID: 26915918 DOI: 10.1016/j.rpped.2015.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/12/2015] [Accepted: 12/01/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report a case septic arthritis with a rare pathogen in a immunosuppressed child. CASE DESCRIPTION Male patient, 6 years old, had liver transplant 5 and half years ago due to biliary atresia. Patient was using tacrolimus 1mg q.12hours. This patient started to have pain in left foot and ankle and had one episode of fever 3 days before hospital admission. Physical Examination showed weight 17kg, height 109cm, temperature 36,4°C, with pain, swelling and heat in the left ankle, without other clinical signs. Initial tests: hemoglobin 11,7g/dL hematocrit 36.4%, leukocyte count 17600/uL (7% banded neutrophils, 70% segmented neutrophils, 2% eosinophils, basophils 1%, 13% lymphocytes, 7% monocytes) C-reactive protein 170,88mg/L. Joint ultrasound showed moderate effusion in the site. Patient was submitted to surgical procedure and S. multivorum was isolated from the effusion. The germ was susceptible to broad spectrum cephalosporins (ceftriaxone and cefepime) and fluoroquinolones (ciprofloxacin and levofloxacin), and it was resistant to carbapenemic antibiotics and aminoglycosides. He was treated intravenously with oxacillin for 15 days and ceftriaxone for 13 days, and orally with ciprofloxacin for 15 days, with good outcome. COMMENTS The Sphingobacterium multivorum is a gram negative bacillus that belongs to Flavobacteriaceae family and it is considered non-pathogenic. It has rarely been described as a cause of infections in humans, especially in hospital environment and in immunosuppressed patients. This case report is relevant for its unusual etiology and for the site affected, which may be the first case of septic arthritis described.
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Affiliation(s)
- Maiana Darwich Mendes
- Escola Paulista de Medicina da Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil.
| | - Rafael Ruiz Cavallo
- Escola Paulista de Medicina da Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
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Er B, Onurdağ FK, Demirhan B, Özgacar SÖ, Öktem AB, Abbasoğlu U. Screening of quinolone antibiotic residues in chicken meat and beef sold in the markets of Ankara, Turkey. Poult Sci 2013; 92:2212-5. [DOI: 10.3382/ps.2013-03072] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Choi SH, Kim EY, Kim YJ. Systemic use of fluoroquinolone in children. KOREAN JOURNAL OF PEDIATRICS 2013; 56:196-201. [PMID: 23741232 PMCID: PMC3668199 DOI: 10.3345/kjp.2013.56.5.196] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/13/2013] [Indexed: 11/27/2022]
Abstract
Fluoroquinolones are an important class of antibiotics that are widely used in adult patients because of their broad spectrum of activity, good tissue penetration, and oral bioavailability. However, fluoroquinolone use in children is limited because juvenile animals developed arthropathy in previous experiments on fluoroquinolone use. Indications for fluoroquinolone use in patients younger than 18 years, as stated by the U.S. Food and Drug Administration, include treatment of complicated urinary tract infections and postexposure treatment for inhalation anthrax. In Korea, the systemic use of fluoroquinolones has not been approved in children younger than 18 years. Although concerns remain regarding the adverse musculoskeletal effects of fluoroquinolones in children, their use in the pediatric population has increased in many circumstances. While pediatricians should be aware of the indications and adverse effects of fluoroquinolones, recent studies have shown that the risk for musculoskeletal complications in children did not significantly increase following fluoroquinolone treatment. In addition, fluoroquinolones may be particularly helpful in treating multidrug-resistant infections that have not responded to standard antibiotic therapy in immunocompromised patients. In the present article, we provide an updated review on the safety and current recommendations for using fluoroquinolones in children.
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Affiliation(s)
- Soo-Han Choi
- Department of Pediatrics, KEPCO Medical Foundation KEPCO Medical Center, Seoul, Korea
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Adverse effects of antimicrobials via predictable or idiosyncratic inhibition of host mitochondrial components. Antimicrob Agents Chemother 2012; 56:4046-51. [PMID: 22615289 DOI: 10.1128/aac.00678-12] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This minireview explores mitochondria as a site for antibiotic-host interactions that lead to pathophysiologic responses manifested as nonantibacterial side effects. Mitochondrion-based side effects are possibly related to the notion that these organelles are archaic bacterial ancestors or commandeered remnants that have co-evolved in eukaryotic cells; thus, this minireview focuses on mitochondrial damage that may be analogous to the antibacterial effects of the drugs. Special attention is devoted to aminoglycosides, chloramphenicol, and fluoroquinolones and their respective single side effects related to mitochondrial disturbances. Linezolid/oxazolidinone multisystemic toxicity is also discussed. Aminoglycosides and oxazolidinones are inhibitors of bacterial ribosomes, and some of their side effects appear to be based on direct inhibition of mitochondrial ribosomes. Chloramphenicol and fluoroquinolones target bacterial ribosomes and gyrases/topoisomerases, respectively, both of which are present in mitochondria. However, the side effects of chloramphenicol and the fluoroquinolones appear to be based on idiosyncratic damage to host mitochondria. Nonetheless, it appears that mitochondrion-associated side effects are a potential aspect of antibiotics whose targets are shared by prokaryotes and mitochondria-an important consideration for future drug design.
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Abstract
Drug-resistant Mycobacterium tuberculosis (TB) infection represents a serious and growing problem. For patients infected or suspected of being infected with multidrug or extensively drug-resistant TB, several medications have to be given simultaneously for prolonged periods. Here, we review the literature on treatment and monitoring of adverse effects of pediatric drug-resistant TB therapy in a high resource, low TB burden setting.
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Cinti SK, Barnosky AR, Gay SE, Goold SD, Lozon MM, Kim K, Rodgers PE, Baum NM, Cadwallender BA, Collins CD, Wright CM, Winfield RA. Bacterial pneumonias during an influenza pandemic: how will we allocate antibiotics? Biosecur Bioterror 2010; 7:311-6. [PMID: 19821750 DOI: 10.1089/bsp.2009.0019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We are currently in the midst of the 2009 H1N1 pandemic, and a second wave of flu in the fall and winter could lead to more hospitalizations for pneumonia. Recent pathologic and historic data from the 1918 influenza pandemic confirms that many, if not most, of the deaths in that pandemic were a result of secondary bacterial pneumonias. This means that a second wave of 2009 H1N1 pandemic influenza could result in a widespread shortage of antibiotics, making these medications a scarce resource. Recently, our University of Michigan Health System (UMHS) Scarce Resource Allocation Committee (SRAC) added antibiotics to a list of resources (including ventilators, antivirals, vaccines) that might become scarce during an influenza pandemic. In this article, we summarize the data on bacterial pneumonias during the 1918 influenza pandemic, discuss the possible impact of a pandemic on the University of Michigan Health System, and summarize our committee's guiding principles for allocating antibiotics during a pandemic.
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Affiliation(s)
- Sandro K Cinti
- Infectious Diseases, University of Michigan Hospitals/VA Ann Arbor Health Systems, Ann Arbor, Michigan 48105, USA.
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Transmission risk factors and treatment of pediatric shigellosis during a large daycare center-associated outbreak of multidrug resistant Shigella sonnei: implications for the management of shigellosis outbreaks among children. Pediatr Infect Dis J 2009; 28:976-80. [PMID: 19738503 DOI: 10.1097/inf.0b013e3181a76eab] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Shigellosis outbreaks in daycare centers result in substantial disease and economic burdens in the United States. The emergence of multidrug resistant Shigella strains raises questions regarding control of transmission within daycare centers and treatment for children. From May to October 2005, 639 Shigella sonnei cases were reported in northwest Missouri, mostly among persons exposed to daycare centers. METHODS We conducted a case-control investigation among licensed daycare centers (LDCs) in northwest Missouri to determine transmission risk factors, tested isolates for antimicrobial resistance, and described treatment practices. Case LDCs had secondary attack rates of shigellosis>or=2% (range, 2%-25%) and control LDCs<or=2% (range, 0%-1.3%). We interviewed LDC staff and performed on-site inspections. Thirty-one outbreak isolates were tested for antimicrobial resistance. We interviewed physicians and reviewed health department outbreak-related treatment data. RESULTS We enrolled 18 case and 21 control LDCs. LDCs with >or=1 sink in every room (odds ratio [OR]: 0.1; 95% confidence interval [CI]: 0.02-0.5) or a diapering station in every room (OR: 0.1; 95% CI: 0.01-0.6) were less likely to be case-LDCs. Resistance to ampicillin and trimethoprim-sulfamethoxazole was found in 90% of the outbreak strains. Among 210 children treated with antimicrobial agents, azithromycin was used in 92 (44%) while a fluoroquinolone was used in 11 (5%) children. CONCLUSIONS During a large daycare center-associated shigellosis outbreak, strains were highly resistant to ampicillin and trimethoprim-sulfamethoxazole. Children were frequently treated with azithromycin and occasionally fluoroquinolones. Appropriate handwashing and diapering infrastructure are necessary to minimize spread of shigellosis within daycare centers, and could reduce use of antimicrobial agents.
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