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Alzard S, Wen J, Huynh NPQ, Shirkhanzadeh S, Tso JY, Rabino M, Vanevski M, Bryant PA, Buttery J, Haeusler GM, Lim AS. Opportunities and barriers to pediatric antimicrobial stewardship by community pharmacists. J Pediatric Infect Dis Soc 2024:piae039. [PMID: 38686824 DOI: 10.1093/jpids/piae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Indexed: 05/02/2024]
Abstract
Community Pharmacists (CPs) are easily accessible and can advocate for appropriate use of antibiotics in children. Semi-structured interviews were conducted with 47 CPs and 46 parents/caregivers. Both groups expressed challenges to intervening when antibiotics have already been prescribed and highlighted the need for more support for CPs to make informed decisions.
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Affiliation(s)
- Shahd Alzard
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jane Wen
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | | | - Shahrzad Shirkhanzadeh
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jocelyn Y Tso
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Meynard Rabino
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | | | - Penelope A Bryant
- Royal Childrens Hospital, Melbourne, Australia
- University of Melbourne Department of Paediatrics
| | - Jim Buttery
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Gabrielle M Haeusler
- Murdoch Childrens Research Institute, Melbourne, Australia
- Royal Childrens Hospital, Melbourne, Australia
| | - Angelina S Lim
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Australia
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2
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Bryant PA. The role of public engagement in the journey to ALARA. Radiat Prot Dosimetry 2023; 199:705-709. [PMID: 37225228 DOI: 10.1093/rpd/ncad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The 'As Low As Reasonably Achievable' (ALARA) principle is one of the three fundamental elements of radiation protection. Noting that ionising radiation is both encountered naturally in the environment as part of everyday life, and artificially as part of a range of practices, the ALARA principle aims to provide a means of optimising radiation exposures. Historically, the stakeholders involved in the application of the ALARA process have primarily been assumed to be internal to an organisation, except for regulatory 'buy in'. However, could there be instances when the public should be a key stakeholder? This paper explores the area of perceived risk with reference to a particular case study in which the dredging of non-hazardous sediment in the UK near a now decommissioned nuclear power station raised substantial public concern about radiological exposure. This turned what was a straightforward construction activity into a complex public engagement and reassurance task, at a significant cost disproportionate to the level of radiological risk. Learning from this case study is used to highlight the key lessons learnt and the importance of public engagement, and how perceived risk and the associated societal stress could be incorporated into the ALARA process. The paper also highlights the ongoing work and guidance produced by the Society for Radiological Protection in the UK on the development of Guidance for Practitioners to support the Communication of Radiation Risk.
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Affiliation(s)
- P A Bryant
- The Society for Radiological Protection, DS009 Dartington Hall, Devon TQ9 6EN, United Kingdom
- EDF Energy, 90 Whitfield Street, London W1T 4EZ, United Kingdom
- Department of Physics, University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom
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3
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Bryant PA, Lawrence J, Boyce S, Simpson CM, Sinclair G, Chong C, Lewis P, Lee S, Hughes R, Dalton S, Lacey C, Nisbet LC, Smith TE, Chapman S, Lakshminarayanan S, Hurd K, Smith K, Savill B, Ibrahim LF. Hospital bed replacement for acute care of children at home during the COVID-19 pandemic through a Hospital-in-the-Home programme. Arch Dis Child 2023:archdischild-2022-325004. [PMID: 36828574 DOI: 10.1136/archdischild-2022-325004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/08/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVES During the COVID-19 pandemic, we expanded our Hospital-in-the-Home (HITH) programme to increase capacity and manage COVID-19-positive children. We aimed to assess impact on overall HITH activity and COVID-19-positive outcomes. DESIGN Prospective comparative cohort study. SETTING The largest paediatric HITH in Australasia, at The Royal Children's Hospital Melbourne. PATIENTS Children 0-18 years admitted to HITH during the pandemic. INTERVENTION We developed a COVID-19 responsive service, and a guideline for COVID-19-positive patients. We compared overall activity prior to and during the pandemic, and COVID-19-positive admissions with different variants. MAIN OUTCOMES We compared outcomes for all HITH patients before and during the pandemic, and for COVID-19-positive patients admitted first to hospital versus directly to HITH. RESULTS HITH managed 7319 patients from March 2020 to March 2022, a 21% increase to previously, with a 132% telehealth increase. 421 COVID-19-positive patients (3 days-18.9 years) were admitted to HITH, predominantly high risk (63%) or moderately unwell (33%). Rates of childhood infection in Victoria, with proportion admitted to HITH were: original/alpha variant-3/100 000/month, 0.7%; delta-92/100 000/month, 0.8%; omicron-593/100 000/month, 0.3%. Eligible parents of only 29 of 71 (41%) high-risk children were vaccinated. COVID-19-positive children admitted directly to HITH were less likely to receive COVID-19-specific treatment than those admitted to hospital first (14 of 113 (12%) vs 33 of 46 (72%), p<0.001), reflecting more severe respiratory, but not other features in inpatients. 15 of 159 (10%) were readmitted to hospital, but none deteriorated rapidly. CONCLUSIONS COVID-19-positive children at high risk or with moderate symptoms can be managed safely via HITH at home, the ideal place for children during the pandemic.
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Affiliation(s)
- Penelope A Bryant
- Infectious Diseases, The Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia .,Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia.,Murdoch Children's Research Institute, Parkville, VIC 3052, Australia.,Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Joanna Lawrence
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia.,Murdoch Children's Research Institute, Parkville, VIC 3052, Australia.,Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,School of Population Health, University of New South Wales, Kensington, NSW 2033, Australia
| | - Suzanne Boyce
- Murdoch Children's Research Institute, Parkville, VIC 3052, Australia.,Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,General Medicine, The Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia
| | - Catherine M Simpson
- Murdoch Children's Research Institute, Parkville, VIC 3052, Australia.,Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - Gemma Sinclair
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Candie Chong
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Phillipa Lewis
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Stephanie Lee
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Rebecca Hughes
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Samuel Dalton
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Cara Lacey
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Lauren C Nisbet
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Tessa E Smith
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Sarah Chapman
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Swathi Lakshminarayanan
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Kahlia Hurd
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Katie Smith
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Brenda Savill
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Laila F Ibrahim
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia.,Murdoch Children's Research Institute, Parkville, VIC 3052, Australia.,Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,General Medicine, The Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia
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McMullan B, Bryant PA, Duffy E, Bielicki J, De Cock P, Science M, Zembles T, Timberlake K, Monsees E, Hamdy RF, Tribble AC, Newland J, Patel S. Multinational consensus antimicrobial stewardship recommendations for children managed in hospital settings. Lancet Infect Dis 2022; 23:e199-e207. [PMID: 36566768 DOI: 10.1016/s1473-3099(22)00726-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 12/24/2022]
Abstract
Children are entitled to receive antibiotic therapy that is based on evidence and best practice, but might be overlooked in hospital programmes designed to achieve antimicrobial stewardship [AMS]. This failure to include children could be because children make up small proportion of patients in most hospitals, and are cared for by specialised paediatric staff. We reviewed the evidence and consulted experts in three global regions to develop ten recommendations for good-practice in hospital AMS programmes for children. We performed a review of scientific research, published between Jan 1, 2007, and Oct 17, 2019, concerning AMS, and formed a multinational expert group comprising members from the USA, Canada, the UK, Belgium, Switzerland, Australia, and Aotearoa New Zealand to develop the recommendations. These recommendations aim to help health-care workers who care for children in these regions to deliver best-practice care. We surveyed health-care workers with expertise in antibiotic therapy for children across these regions, and found that the recommendations were considered both very important and generally feasible. These recommendations should be implemented in hospitals to improve antibiotic therapy for children and to stimulate research into future improvements in care.
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Affiliation(s)
- Brendan McMullan
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Immunology, Sydney Children's Hospital Randwick, Sydney, NSW, Australia; Department of Infectious Diseases, Sydney Children's Hospital Randwick, Sydney, NSW, Australia.
| | - Penelope A Bryant
- Departments of Hospital-in-the-Home, The Royal Children's Hospital, Melbourne, VIC, Australia; Department of Infectious Diseases, The Royal Children's Hospital, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Eamon Duffy
- Departments of Infectious Disease, Te Whatu Ora Health New Zealand, Auckland, New Zealand; Department of Pharmacy, Te Whatu Ora Health New Zealand, Auckland, New Zealand; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Julia Bielicki
- Department of Paediatric Infectious Diseases and Infection Prevention and Control, University of Basel Children's Hospital, Basel, Switzerland; Centre for Neonatal and Paediatric Infection, St George's University, London, UK
| | - Pieter De Cock
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium; Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium; Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Michelle Science
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Tracy Zembles
- Department of Enterprise Safety, Children's Wisconsin, WI, Milwaukee, USA
| | - Kathryn Timberlake
- Department of Pharmacy, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Monsees
- Children's Mercy Hospital, Kansas City, MO, USA; Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Rana F Hamdy
- Division of Infectious Diseases, Children's National Hospital, Washington DC, USA; Department of Pediatrics, George Washington School of Medicine and Health Sciences, Washington DC, USA
| | - Alison C Tribble
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Jason Newland
- Department of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Sanjay Patel
- Department of Paediatric Infectious Diseases and Immunology, Southampton Children's Hospital, Southampton, UK
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Abstract
CONTEXT Bronchiolitis is the leading cause of pediatric hospital admissions. Hospital-at-Home (HAH) delivers hospital-level care at home, relieving pressure on the hospital system. OBJECTIVES We aimed to review the feasibility, acceptability, and safety of HAH for bronchiolitis, and assess the cost-impact to hospitals and society. DATA SOURCES Ovid Medline, Embase, Pubmed, Cochrane Library, CINAHL, and Web of Science. STUDY SELECTION Studies (randomized control trials, retrospective audits, prospective observational trials) of infants with bronchiolitis receiving HAH (oxygen, nasogastric feeding, remote monitoring). Studies were limited to English language since 2000. DATA EXTRACTION We reviewed all studies in duplicate for inclusion, data extraction, and risk of bias. RESULTS Ten studies met inclusion criteria, all for home oxygen therapy (HOT). One abstract on nasogastric feeding did not meet full inclusion criteria. No studies on remote monitoring were found. HOT appears feasible in terms of uptake (70%-82%) and successful completion, both at altitude and sea-level. Caregiver acceptability was reported in 2 qualitative studies. There were 7 reported adverse events (0.6%) with 0 mortality in 1257 patients. Cost studies showed evidence of savings, although included costs to hospitals only. LIMITATIONS Small number of studies with heterogenous study design and quality. No adequately powered randomized control studies. CONCLUSIONS Evidence exists to support HOT as feasible, acceptable, and safe. Evidence of cost-effectiveness remains limited. Further research is needed to understand the relevant impact of HAH versus alternative interventions to reduce oxygen prescribing. Other models of care looking at nasogastric feeding support and remote monitoring should be explored.
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Affiliation(s)
- Joanna Lawrence
- Hospital in the Home.,Health Services Research Unit.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ramesh Walpola
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Suzanne L Boyce
- Hospital in the Home.,Department of General Paediatrics.,Clinical Paediatrics Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Penelope A Bryant
- Hospital in the Home.,Infectious Disease Unit, Royal Children's Hospital, Melbourne, Australia.,Clinical Paediatrics Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Anurag Sharma
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Harriet Hiscock
- Health Services Research Unit.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Lawrence J, Lewis P, Bryant PA. Mock Scenarios Add Value to Recruitment Processes. J Paediatr Child Health 2022; 58:1494-1495. [PMID: 35792144 DOI: 10.1111/jpc.16105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Joanna Lawrence
- Hospital in the Home, Royal Children's Hospital, Melbourne, Victoria, Australia.,Health Services Research Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Philippa Lewis
- Hospital in the Home, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Hospital in the Home, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infectious Disease Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Paediatrics Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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7
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Tew M, De Abreu Lourenco R, Gordon JR, Thursky KA, Slavin MA, Babl FA, Orme L, Bryant PA, Teh BW, Dalziel K, Haeusler GM. Cost-effectiveness of home-based care of febrile neutropenia in children with cancer. Pediatr Blood Cancer 2022; 69:e29469. [PMID: 34854550 DOI: 10.1002/pbc.29469] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/10/2021] [Accepted: 11/01/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Home-based treatment of febrile neutropenia (FN) in children with cancer with oral or intravenous antibiotics is safe and effective. There are limited data on the economic impact of this model of care. We evaluated the cost-effectiveness of implementing an FN programme, incorporating home-based intravenous antibiotics for carefully selected patients, in a tertiary paediatric hospital. METHODS A decision analytic model was constructed to compare costs and outcomes of the home-based FN programme, with usual in-hospital treatment with intravenous antibiotics. The programme included a clinical decision rule to stratify patients by risk for severe infection and home-based eligibility criteria using disease, chemotherapy and patient-level factors. Health outcomes (quality of life) and probabilities of FN risk classification and home-based eligibility were based on prospectively collected data between 2017 and 2019. Patient-level costs were extracted from hospital administrative records. Cost-effectiveness was expressed as the incremental cost per quality-adjusted life year (QALY). FINDINGS The mean health care cost of home-based FN treatment in low-risk patients was Australian dollars (A$) 7765 per patient compared to A$20,396 for in-hospital treatment (mean difference A$12,632 [95% CI: 12,496-12,767]). Overall, the home-based FN programme was the dominant strategy, being more effective (0.0011 QALY [95% CI: 0.0011-0.0012]) and less costly. Results of the model were most sensitive to proportion of children eligible for home-based care programme. CONCLUSION Compared to in-hospital FN care, the home-based FN programme is cost-effective, with savings arising from cheaper cost of caring for children at home. These savings could increase as more patients eligible for home-based care are included in the programme.
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Affiliation(s)
- Michelle Tew
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Joshua Robert Gordon
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Karin A Thursky
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,NHMRC National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Monica A Slavin
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Franz A Babl
- Department of Emergency Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics and Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Orme
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Penelope A Bryant
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics and Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Benjamin W Teh
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Dalziel
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gabrielle M Haeusler
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics and Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Royal Children's Hospital, Parkville, Victoria, Australia
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Hodgson KA, Lim R, Huynh J, Nind B, Katz N, Marlow R, Hensey CC, Scanlan B, Ibrahim LF, Bryant PA. Outpatient parenteral antimicrobial therapy: how young is too young? Arch Dis Child 2022; 107:archdischild-2022-324143. [PMID: 35537826 DOI: 10.1136/archdischild-2022-324143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/27/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report the use, and assess the efficacy and outcomes of outpatient parenteral antimicrobial therapy (OPAT) in neonates (≤28 days of age), compared with older infants (1-12 months of age). DESIGN A prospective 8-year observational study from September 2012 to September 2020. SETTING The Hospital-in-the-Home (HITH) programme of the Royal Children's Hospital Melbourne. PATIENTS Neonatal patients (≤28 days of age) were compared with older infants (1-12 months of age) receiving OPAT. INTERVENTIONS Data were collected including demographics, diagnosis, type of venous access and antibiotic choice. MAIN OUTCOME MEASURES Success of OPAT, antibiotic appropriateness, complications and readmission rate. RESULTS There were 76 episodes for which neonates were admitted to HITH for OPAT, and 405 episodes for older infants. Meningitis was the most common diagnosis in both groups (59% and 35%, respectively); the most frequently prescribed antibiotic was ceftriaxone for both groups (61% and 49%). A positive bacterial culture was less frequent in neonates (38% vs 53%, p=0.02). Vascular access complication rate was 19% in neonates compared with 13% in older infants (p=0.2) with no central line-associated bloodstream infection in either group. Rates of appropriate antibiotic prescribing were similarly high between groups (93% vs 90%, p=0.3). The OPAT course was successfully completed in 74 of 74 (100%) neonates and 380 of 396 (96%) older infants (p=0.09). The unplanned readmission rate was low: 4 of 76 (5%) neonates and 27 of 405 (7%) older infants. CONCLUSIONS OPAT is a safe and effective way of providing antibiotics to selected clinically stable neonatal patients. While appropriate antibiotic use was common, improvements can still be made.
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Affiliation(s)
- Kate Alison Hodgson
- Hospital in the Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Ruth Lim
- Newborn Research Centre, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Julie Huynh
- Hospital in the Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Ben Nind
- Hospital in the Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Naomi Katz
- Hospital in the Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Robin Marlow
- Bristol Royal Hospital for Children, Bristol, UK
| | - Conor C Hensey
- Department of General Paediatrics, National Maternity Hospital, Dublin, Ireland
| | - Barry Scanlan
- Hospital in the Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Laila F Ibrahim
- Hospital in the Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Penelope A Bryant
- General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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9
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Tosif S, Ibrahim LF, Hughes R, R Cheng D, Wurzel D, Overmars I, Steer AC, Bryant PA, Duke T, Lewena S, Babl FE, McNab S, Crawford N. Characteristics and outcomes of SARS-CoV-2 infection in Victorian children at a tertiary paediatric hospital. J Paediatr Child Health 2022; 58:618-623. [PMID: 34693586 PMCID: PMC8662161 DOI: 10.1111/jpc.15786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/10/2021] [Accepted: 09/17/2021] [Indexed: 12/24/2022]
Abstract
AIM Victoria experienced two 'waves' of COVID-19 between March and September 2020 and more cases than any other jurisdiction in Australia. Although world-wide reports of COVID-19 reflect that children are less likely to experience severe disease compared with adults, hospitalisations and deaths have been reported. We report testing and outcomes of children with SARS-CoV-2 infection presenting to a tertiary paediatric hospital in Melbourne. METHODS We conducted a prospective cohort study at The Royal Children's Hospital (RCH), including all children and adolescents (aged 0-18 years) who presented and were tested for SARS-CoV-2 over a 6-month period, between 21 March 2020, up to the 21 September 2020. Detailed epidemiological and clinical data were recorded. RESULTS A total of 19 708 tests for SARS-CoV-2 were performed in 14 419 patients. One hundred and eighty patients tested positive for SARS-CoV-2 (1.2%). 110 (61%) were symptomatic, 60 (33%) were asymptomatic and 10 (6%) were pre-symptomatic. Close contacts of a positive case were associated with a higher risk of a testing positive for SARS-CoV-2 (120/2027 (6%) vs. 60/14589 (0.4%), RD 5.5 (95% CI 4.5 to 6.5), P < 0.001). Eighteen (10%) SARS-CoV-2-positive patients were admitted to hospital with one patient requiring intensive care. All patients recovered fully with no deaths. CONCLUSION In Victorian children presenting to a tertiary hospital, SARS-CoV-2 infection caused predominantly mild or asymptomatic infection, with most children not requiring hospitalisation.
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Affiliation(s)
- Shidan Tosif
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Laila F Ibrahim
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia,Hospital‐in‐the‐Home DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Rebecca Hughes
- Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Daryl R Cheng
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Danielle Wurzel
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia,Department of Respiratory MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Isabella Overmars
- Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia
| | - Andrew C Steer
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Infectious Diseases Unit, Department of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Penelope A Bryant
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Hospital‐in‐the‐Home DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Infectious Diseases Unit, Department of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Trevor Duke
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Intensive Care UnitThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Stuart Lewena
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Emergency Research, Clinical SciencesMurdoch Children 's Research InstituteMelbourneVictoriaAustralia
| | - Franz E Babl
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia,Emergency Research, Clinical SciencesMurdoch Children 's Research InstituteMelbourneVictoriaAustralia
| | - Sarah McNab
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Nigel Crawford
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Infection and ImmunityMurdoch Children 's Research InstituteMelbourneVictoriaAustralia,Departments of General MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
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10
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Campbell AJ, Mowlaboccus S, Coombs GW, Daley DA, Al Yazidi LS, Phuong LK, Leung C, Best EJ, Webb RH, Voss L, Athan E, Britton PN, Bryant PA, Butters CT, Carapetis JR, Ching NS, Francis J, Hung TY, Nourse C, Ojaimi S, Tai A, Vasilunas N, McMullan B, Bowen AC, Blyth CC. Whole genome sequencing and molecular epidemiology of pediatric Staphylococcus aureus bacteremia. J Glob Antimicrob Resist 2022; 29:197-206. [PMID: 35342022 DOI: 10.1016/j.jgar.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/25/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The role Staphylococcus aureus antimicrobial resistance genes and toxins play in disease severity, management and outcome in childhood is an emerging field requiring further exploration. METHODS A prospective multi-site study of Australian and New Zealand children hospitalized with S. aureus bacteremia (SAB), occurred over 24-months (2017-2018). Whole genome sequencing (WGS) data was paired with clinical information from the ISAIAH cohort. RESULTS 353 SAB isolates were sequenced; 85% methicillin-susceptible S. aureus ([MSSA], 301/353); 15% methicillin-resistant S. aureus ([MRSA], 52/353). There were 92 sequence types (STs), most commonly; ST5 (18%) and ST30 (8%), grouped into 23 clonal complexes (CCs), most frequently CC5 (21%) and CC30 (12%). MSSA comprised the majority of healthcare-associated SAB (87%, 109/125), with principal clones CC15 (48%, 11/21) and CC8 (33%, 7/21). Panton Valentine Leukocidin (PVL)-positive SAB occurred in 22% (76/353); predominantly MSSA (59%, 45/76), community-onset (92%, 70/76) infections. For community-onset SAB, the only microbiological independent predictor of poor outcomes was PVL-positivity (aOR 2.6 [CI 1.0-6.2]). CONCLUSION From this WGS pediatric SAB data, we demonstrate the previously under-recognized role MSSA has in harboring genetic virulence and causing healthcare-associated infections. PVL-positivity was the only molecular independent predictor of poor outcomes in children. These findings underscore the need for further research to define the potential implications PVL-producing strains may have on approaches to S. aureus clinical management.
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Affiliation(s)
- Anita J Campbell
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute. Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia.
| | - Shakeel Mowlaboccus
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch; Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Western Australia; School of Biomedical Sciences, University of Western Australia, Nedlands
| | - Geoffrey W Coombs
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch; Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Western Australia
| | - Denise A Daley
- Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Western Australia; The Australian Group on Antimicrobial Resistance (AGAR)
| | - Laila S Al Yazidi
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman; Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia; The Children's Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, NSW, Australia
| | - Linny K Phuong
- Department of General Medicine, Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia; Infection and Immunity Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Clare Leung
- Department of Paediatrics, Wagga Wagga Base Hospital, New South Wales, Australia
| | - Emma J Best
- Department of Paediatrics; Child and Youth Health, The University of Auckland; The National Immunisation Advisory Centre, The University of Auckland; Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Rachel H Webb
- Department of Paediatrics, Child and Youth Health, The University of Auckland; Department of Infectious Diseases Starship Children's Hospital, Auckland, New Zealand; Department of Paediatrics, Kidz First Hospital, Auckland, New Zealand
| | - Lesley Voss
- Department of Paediatrics, Child and Youth Health, The University of Auckland; Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Eugene Athan
- Department of Infectious Disease, Barwon Health, Geelong, Australia; School of Medicine, Deakin University, Geelong, Australia
| | - Philip N Britton
- Sydney Medical School and Marie Bashir Institute, University of Sydney, NSW, Australia; Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, Sydney, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Coen T Butters
- Department of General Medicine, Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia; Infection and Immunity Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jonathan R Carapetis
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia; University of Western Australia. School of Medicine, Perth, Western Australia
| | - Natasha S Ching
- Infection and Immunity, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia; Department of General Paediatrics, Monash Children's Hospital, Monash Health, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Australia
| | - Joshua Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - Te-Yu Hung
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - Clare Nourse
- Queensland Children's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Australia
| | - Samar Ojaimi
- Infection & Immunity, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Australia; Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
| | - Alex Tai
- Department of Infectious Disease, Barwon Health, Geelong, Australia
| | - Nan Vasilunas
- Infectious Diseases Department, Women's and Children's Hospital, Adelaide
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia; National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute; School of Medicine, University of Western Australia, Subiaco; Menzies School of Health Research, Charles Darwin Hospital, Darwin, NT
| | - Christopher C Blyth
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia; Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia
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11
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Villanueva P, Coffin SE, Mekasha A, McMullan B, Cotton MF, Bryant PA. Comparison of Antimicrobial Stewardship and Infection Prevention and Control Activities and Resources Between Low-/Middle- and High-income Countries. Pediatr Infect Dis J 2022; 41:S3-S9. [PMID: 35134034 PMCID: PMC8815833 DOI: 10.1097/inf.0000000000003318] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND The growth of antimicrobial resistance worldwide has led to increased focus on antimicrobial stewardship (AMS) and infection prevention and control (IPC) measures, although primarily in high-income countries (HIC). We aimed to compare pediatric AMS and IPC resources/activities between low- and middle-income countries (LMIC) and HIC and to determine the barriers and priorities for AMS and IPC in LMIC as assessed by clinicians in those settings. METHODS An online questionnaire was distributed to clinicians working in HIC and LMIC healthcare facilities in 2020. RESULTS Participants were from 135 healthcare settings in 39 LMIC and 27 HIC. Formal AMS and IPC programs were less frequent in LMIC than HIC settings (AMS 42% versus 76% and IPC 58% versus 89%). Only 47% of LMIC facilities conducted audits of antibiotic use for pediatric patients, with less reliable availability of World Health Organization Access list antibiotics (29% of LMIC facilities). Hand hygiene promotion was the most common IPC intervention in both LMIC and HIC settings (82% versus 91%), although LMIC hospitals had more limited access to reliable water supply for handwashing and antiseptic hand rub. The greatest perceived barrier to pediatric AMS and IPC in both LMIC and HIC was lack of education: only 17% of LMIC settings had regular/required education on antimicrobial prescribing and only 25% on IPC. CONCLUSIONS Marked differences exist in availability of AMS and IPC resources in LMIC as compared with HIC. A collaborative international approach is urgently needed to combat antimicrobial resistance, using targeted strategies that address the imbalance in global AMS and IPC resource availability and activities.
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Affiliation(s)
- Paola Villanueva
- From the Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Medicine, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
| | - Susan E. Coffin
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, PA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Amha Mekasha
- Department of Paediatrics and Child Health, Tikur Anbesa Specialized Hospital, Ethiopia
- College of Health Sciences, Addis Ababa University, Ethiopia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Randwick, Sydney, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia
- National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - Mark F. Cotton
- Tygerberg Children’s Hospital, Tygerberg, South Africa
- Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - Penelope A. Bryant
- Infectious Diseases and Hospital-in-the-Home Departments, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
- Clinical Paediatrics Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
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12
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Basu S, Copana R, Morales R, Anugulruengkitt S, Puthanakit T, Maramba-Lazarte C, Williams P, Musembi J, Boga M, Issack M, Hokororo A, Falade AG, Trehan I, Molyneux E, Arscott-Mills T, Alemayehu T, Bryant PA. Keeping It Real: Antibiotic Use Problems and Stewardship Solutions in Low- and Middle-income Countries. Pediatr Infect Dis J 2022; 41:S18-S25. [PMID: 35134036 PMCID: PMC8815843 DOI: 10.1097/inf.0000000000003321] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 12/28/2022]
Abstract
Antimicrobial resistance is a global health threat and there is an urgent need to manage antibiotic use to slow its development. However, antimicrobial stewardship interventions in low- and middle-income countries (LMIC) have been limited in terms of their resourcing, feasibility and effectiveness in the face of greater challenges in child mortality. We sought to gather together examples of antibiotic use problems faced by clinicians in LMIC, many of which are unique to these settings, and real-world antimicrobial stewardship solutions identified, with the goal of learning broader lessons that might be applicable across LMIC.
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Affiliation(s)
- Saurav Basu
- From the Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Raul Copana
- Department of Pediatrics, Faculty of Medicine, San Simon University, Cochabamba, Bolivia
- Intensive Care Unit, Manuel A. Villarroel Childrens Hospotal, Cochabamba, Bolivia
| | - Ronaldo Morales
- Clinical Pharmacokinetics Center, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Suvaporn Anugulruengkitt
- Department of Pediatrics and
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanyawee Puthanakit
- Department of Pediatrics and
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Cecilia Maramba-Lazarte
- Division of Infectious and Tropical Diseases (INTROP), Department of Pediatrics, University of the Philippines College of Medicine-Philippine General Hospital, Manila, Philippines
- Department of Pharmacology and Toxicology, University of the Philippines, College of Medicine, Manila, Philippines
| | - Phoebe Williams
- Kenya Medical Research Institute (KEMRI/Wellcome Trust Research Programme), Department of Paediatrics, Kilifi, Kenya
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - John Musembi
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Mwanamvua Boga
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Mohammad Issack
- Bacteriology Department, Central Health Laboratory, Victoria Hospital, Quatre-Bornes, Mauritius
| | - Adolfine Hokororo
- Department of Paediatrics and Child Health, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Adegoke G. Falade
- Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Indi Trehan
- Departments of Pediatrics, Global Health, and Epidemiology, University of Washington, Seattle, Washington
| | - Elizabeth Molyneux
- Paediatric and Child Health Department, College of Medicine, Blantyre, Malawi
| | | | - Tinsae Alemayehu
- American Medical Center, and St. Paul’s Hospital Millennium Medical College, Department of Infectious Diseases and Travel Medicine, Addis Ababa, Ethiopia
| | - Penelope A. Bryant
- Consultant in Paediatric Infectious Diseases and Medical Lead, Hospital-in-the-Home, The Royal Children’s Hospital
- Group Leader and Clinician-Scientist Fellow, Clinical Paediatrics, Murdoch Children's Research Institute and
- Department of Paediatrics, University of Melbourne Parkville, Victoria, Australia
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13
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Abstract
BACKGROUND Antimicrobial stewardship (AMS) is central to the World Health Organisation Global Action Plan against antimicrobial resistance (AMR). If antibiotics are used without restraint, morbidity and mortality from AMR will continue to increase. In resource-rich settings, AMS can safely reduce antibiotic consumption. However, for children in low- and middle-income countries (LMIC), the impact of different AMS interventions is unknown. AIM To determine the impact of different AMS interventions on antibiotic use and clinical and microbiologic outcomes in children in LMIC. METHODS MEDLINE, Embase and PubMed were searched for studies of AMS interventions in pediatric population in LMIC settings. Controlled trials, controlled before-and-after studies and interrupted time series studies were included. Outcomes assessed were antibiotic use, multidrug-resistant organism (MDRO) rates, clinical outcomes and cost. RESULTS Of 1462 studies, 34 met inclusion criteria including a total population of >5,000,000 in 17 countries. Twenty were in inpatients, 2 in ED, 10 in OPD and 2 in both. Seven studies were randomized controlled trials. All types of interventions reported a positive impact on antibiotic prescribing. AMS bundles with education, and clinical decision tools appeared more effective than guidelines alone. AMS interventions resulted in significantly decreased clinical infections (4/4 studies) and clinical failure (2/2) and reduced MDRO colonization rate (4/4). There was no concomitant increase in mortality (4/4 studies) or length of stay (2/2). CONCLUSION Multiple effective strategies exist to reduce antibiotic consumption in LMIC. However, marked heterogeneity limit conclusions regarding the most effective approach, particularly regarding clinical outcomes. Overall, AMS strategies are important tools in the reduction of MDRO-related morbidity in children in LMIC.
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Affiliation(s)
- Yara-Natalie Abo
- From the Infectious Diseases Unit, Royal Children’s Hospital, Melbourne, Victoria, Australia, Blantyre, Malawi
| | - Bridget Freyne
- Malawi-Liverpool Wellcome Trust Research Programme
- Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, Merseyside, UK
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Diana Kululanga
- Malawi-Liverpool Wellcome Trust Research Programme
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Penelope A. Bryant
- From the Infectious Diseases Unit, Royal Children’s Hospital, Melbourne, Victoria, Australia, Blantyre, Malawi
- Clinical Paediatrics, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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14
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Ibrahim LF, Babl FE, Hopper SM, Bryant PA. What is the risk of missing orbital cellulitis in children? Arch Dis Child 2021; 106:896-899. [PMID: 33419726 DOI: 10.1136/archdischild-2020-320590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Preseptal cellulitis can be difficult to distinguish from orbital cellulitis in children. The majority of patients with periorbital infections are admitted for intravenous antibiotics. This study aimed to investigate the risk of missing orbital cellulitis and the outcomes of missed patients. METHODS A prospective cohort study of children aged 3 months to 18 years diagnosed with preseptal cellulitis over 5 years. Data were collected prospectively, including demographics, clinical features and outcomes. RESULTS There were 216 children diagnosed with preseptal cellulitis. 75 (35%) were treated with oral antibiotics and 141 (65%) with intravenous antibiotics. 5 (2%) children who were hospitalised were subsequently determined to have orbital cellulitis. All 5 children were either a young infant with difficult eye examination, or had headache or vomiting. CONCLUSION The risk of missing orbital cellulitis is low. Young infants with difficult eye examination or the presence of headache or vomiting should increase suspicion of orbital cellulitis.
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Affiliation(s)
- Laila F Ibrahim
- General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Franz E Babl
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Penelope A Bryant
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia .,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Infectious Diseases Unit, General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.,Hospital-in-the-Home, The Royal Children's Hospital, Parkville, Victoria, Australia
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15
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Villanueva P, Freyne B, Hickey L, Carr J, Bryant PA. Impact of an antimicrobial stewardship intervention in neonatal intensive care: Recommendations and implementation. J Paediatr Child Health 2021; 57:1208-1214. [PMID: 33729615 DOI: 10.1111/jpc.15427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/10/2021] [Accepted: 02/17/2021] [Indexed: 12/18/2022]
Abstract
AIM To (i) determine the appropriateness of antimicrobial prescribing in the neonatal intensive care unit (NICU) and (ii) assess the impact of a collaborative antimicrobial stewardship (AMS) intervention on prescribing practices. METHODS The intervention was a weekly AMS audit-feedback joint ward round (6-month period) of Neonatology and Infectious Diseases clinicians in a tertiary neonatal intensive care unit in Melbourne, Australia. Antibiotic prescriptions were audited and recommendations delivered in real time. The proportion of recommendations implemented was used to assess acceptability of the intervention. RESULTS During the study period, there were 23 AMS rounds, during which 249 patients were reviewed at 627 separate episodes. Of these, 233 (37%) episodes were for patients receiving antimicrobials. Of these, 147 (63%) received empirical antimicrobial treatment, 43 (18%) targeted antimicrobial treatment and 43 (18%) antimicrobial prophylaxis. There were 58 (25%) of 233 episodes of inappropriate antibiotic use, and 62 recommendations for improvement. Most common recommendations were to narrow (33/62, 53%) or stop (12/62, 19%) antimicrobials. The majority (45, 73%) of recommendations were accepted, resulting in significant improvement in the proportion of the 233 episodes that had completely appropriate antibiotic prescribing: 175 (75%) to 217 (93%) (relative risk 1.2, 95% confidence intervals 1.1-1.3, P < 0.001). CONCLUSIONS A collaborative audit-feedback AMS intervention was effective in identifying inappropriate antimicrobial prescriptions and impacted positively on treatment plans. Ancillary benefits were improved communication between departments and the revision of antimicrobial prescribing guidelines.
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Affiliation(s)
- Paola Villanueva
- Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Bridget Freyne
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Leah Hickey
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neonatal Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jeremy Carr
- Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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16
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Olijve L, Amarasena L, Best E, Blyth C, van den Boom M, Bowen A, Bryant PA, Buttery J, Dobinson HC, Davis J, Francis J, Goldsmith H, Griffiths E, Hung TY, Huynh J, Kesson A, Meehan A, McMullan B, Nourse C, Palasanthiran P, Penumarthy R, Pilkington K, Searle J, Stephenson A, Webb R, Williman J, Walls T. The role of Kingella kingae in pre-school aged children with bone and joint infections. J Infect 2021; 83:321-331. [PMID: 34265316 DOI: 10.1016/j.jinf.2021.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/20/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The Pre-school Osteoarticular Infection (POI) study aimed to describe the burden of disease, epidemiology, microbiology and treatment of acute osteoarticular infections (OAI) and the role of Kingella kingae in these infections. METHODS Information about children 3-60 months of age who were hospitalized with an OAI to 11 different hospitals across Australia and New Zealand between January 2012 and December 2016 was collected retrospectively. RESULTS A total of 907 cases (73%) were included. Blood cultures grew a likely pathogen in only 18% (140/781). The peak age of presentation was 12 to 24 months (466/907, 51%) and Kingella kingae was the most frequently detected microorganism in this age group (60/466, 13%). In the majority of cases, no microorganism was detected (517/907, 57%). Addition of PCR to culture increased detection rates of K. kingae. However, PCR was performed infrequently (63/907, 7%). CONCLUSIONS This large multi-national study highlights the need for more widespread use of molecular diagnostic techniques for accurate microbiological diagnosis of OAI in pre-school aged children. The data from this study supports the hypothesis that a substantial proportion of pre-school aged children with OAI and no organism identified may in fact have undiagnosed K. kingae infection. Improved detection of Kingella cases is likely to reduce the average length of antimicrobial treatment.
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Affiliation(s)
- Laudi Olijve
- Department of Paediatrics, University of Otago, Christchurch School of Medicine, New Zealand; Sheffield Teaching Hospitals, UK; Sydney Children's Hospital Randwick, 61 High Street, Randwick, NSW 2031, Australia
| | - Lahiru Amarasena
- Department of Paediatrics; Child and Youth Health, National Immunisation Advisory Centre, The University of Auckland, New Zealand
| | - Emma Best
- Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand; Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Grafton, Auckland, New Zealand; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Australia
| | - Christopher Blyth
- School of Medicine, University of Western Australia, Australia; School of Medicine, University of Western Australia, Australia; Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; Department of Microbiology, Pathwest Laboratory Medicine, QEII Medical Centre, Australia; Department of Paediatrics, Christchurch Hospital, Canterbury District Health Board, University of Otago, PO Box 4345, Christchurch Mail Centre, Christchurch 8140, New Zealand
| | - Mirjam van den Boom
- Starship Children's Hospital, Auckland, New Zealand; Starship Children's Hospital, Auckland, New Zealand; Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Avenue, Nedlands WA 6009, Locked Bag 2010, Nedlands WA 6909, Australia
| | - Asha Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Australia; National Health and Medical Research Council, Australia; Division of Paediatrics, School of Medicine, University of Western Australia, Australia; Menzies School of Health Research, Charles Darwin University, Australia; Institute for Health Research, The University of Notre Dame Australia, Australia; Dept of General Medicine, The Royal Children's Hospital Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Infectious Diseases and Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Australia; Infectious Diseases and Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Australia; Infection, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; Department of Infection and Immunity, Monash Children's Hospital, Australia
| | - Jim Buttery
- Monash Centre for Health Care Research and Implementation, Department of Paediatrics, Monash University, Melbourne, 246 Clayton Rd, Clayton 3168, Victoria, Australia; Monash Centre for Health Care Research and Implementation, Department of Paediatrics, Monash University, Melbourne, 246 Clayton Rd, Clayton 3168, Victoria, Australia; Wellington Regional Hospital, Capital and Coast District Health Board, Department of Paediatrics and Child Health, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Hazel C Dobinson
- Global Health Division, Menzies School of Health Research, Darwin, Australia
| | - Joshua Davis
- Infectious Diseases, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2300, Australia; Infectious Diseases, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2300, Australia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Joshua Francis
- Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Dr Tiwi NT 0810, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Dr Tiwi NT 0810, Darwin, Australia; John Hunter Children's Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
| | - Heidi Goldsmith
- Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Australia
| | - Elle Griffiths
- Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi 0810, Northern Territory, Australia
| | - Te-Yu Hung
- Departments of Infectious Disease and Microbiology, The Children's Hospital at Westmead, Westmead New South Wales, Australia
| | - Julie Huynh
- Discipline of Child and Adolescent health, University of Sydney, Australia; Discipline of Child and Adolescent health, University of Sydney, Australia; Centre for tropical medicine, 764 Vo Van Kiet, District 5 Ho Chi Minh City, Viet Nam; Departments of Infectious Disease and Microbiology, The Children's Hospital at Westmead, Westmead New South Wales, Locked Bag 4001, Westmead 2145, Australia
| | - Alison Kesson
- Discipline of Child and Adolescent health, University of Sydney, Australia; Discipline of Child and Adolescent health, University of Sydney, Australia; The Marie Bashir Institute of Infectious Diseases and Biosecurrity, University of Sydney, Australia; Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Locked Bag 2010, Nedlands WA 6909, Australia
| | - Andrea Meehan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, Randwick, NSW 2031, Australia
| | - Brendan McMullan
- National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia; National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia; Queensland Children's Hospital, Children's Health Queensland, Level 12, South Brisbane, QLD 4101, Australia
| | - Clare Nourse
- Faculty of Medicine, University of Queensland, Australia; Faculty of Medicine, University of Queensland, Australia; Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Randwick, High Street, Randwick, NSW 2031, Australia
| | - Pamela Palasanthiran
- University of New South Wales, UNSW, Kensington, NSW, Australia; University of New South Wales, UNSW, Kensington, NSW, Australia; Counties manukau district health board, Middlemore Hospital, 100 hospital road, Otahuhu 2025, Auckland, New Zealand
| | - Rushi Penumarthy
- Monash Children's Hospital, Monash Health, 101/71 Abinger Street, Richmond, VIC 3121, Australia
| | - Katie Pilkington
- Department of Paediatrics, the University of Melbourne, Australia; Department of Paediatrics, the University of Melbourne, Australia; Department of General Medicine, The Royal Children's Hospital Melbourne, 50 Flemington Road, Melbourne 3052, Australia
| | - Janine Searle
- Starship Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Anya Stephenson
- University of Auckland, Middlemore Hospital, 100 hospital road, Otahuhu, 2025 Auckland, New Zealand
| | - Rachel Webb
- Starship Children's Hospital and KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand; Starship Children's Hospital and KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand; Biostatistics and Computation Biology Unit, University of Otago, 2 Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Jonathan Williman
- Department of Paediatrics, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch School of Medicine, New Zealand.
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17
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Campbell AJ, Al Yazidi LS, Phuong LK, Leung C, Best EJ, Webb RH, Voss L, Athan E, Britton PN, Bryant PA, Butters CT, Carapetis JR, Ching NS, Coombs GW, Daley D, Francis J, Hung TY, Mowlaboccus S, Nourse C, Ojaimi S, Tai A, Vasilunas N, McMullan B, Blyth CC, Bowen AC. Pediatric Staphylococcus aureus bacteremia: clinical spectrum and predictors of poor outcome. Clin Infect Dis 2021; 74:604-613. [PMID: 34089594 DOI: 10.1093/cid/ciab510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Staphylococcus aureus is a common cause of bacteremia, yet the epidemiology, and predictors of poor outcome remain inadequately defined in childhood. METHODS ISAIAH is a prospective, cross-sectional study of S. aureus bacteremia (SAB), in children hospitalized in Australia and New Zealand, over 24-months (2017-2018). RESULTS Overall, 552 SABs were identified, (incidence 4.4/100,000/yr [95% confidence interval (CI) 2.2-8.8]), with methicillin-susceptible (84%), community onset (78%) infection predominating. Indigenous children (8.1/100,000/yr [CI 4.8-14.4]), those from lower-socioeconomic areas (5.5/100,000/yr [CI 2.8-10.2]) and neonates (6.6/100,000/yr (CI 3.4-11.7) were over-represented. Although 90-day mortality was infrequent, one-third experienced the composite of: length of stay >30 days (26%), ICU admission (20%), relapse (4%), or death (3%).Predictors of mortality included prematurity (aOR 16.8 [CI 1.6-296.9]), multifocal infection (aOR 22.6 [CI 1.4-498.5]), necrotizing pneumonia (aOR 38.9 [CI 1.7 - 1754.6]), multiorgan dysfunction (aOR 26.5 [CI 4.1-268.8]) and empiric-vancomycin (aOR 15.7 [CI 1.6-434.4]); whilst Infectious Diseases (ID) consultation (aOR 0.07 [CI 0.004-0.9]) was protective. Neither MRSA nor vancomycin trough-targets impacted survival; however, empiric-vancomycin was associated with significant nephrotoxicity (OR 3.1 [CI 1.3-8.1]). CONCLUSIONS High SAB incidence was demonstrated, with at-risk populations identified for future prioritized care. For the first time in a pediatric setting, necrotizing pneumonia and multifocal infection were predictors of mortality, whilst ID consultation was protective. The need to re-evaluate pediatric vancomycin trough-targets and limit unnecessary empiric-vancomycin exposure, to reduce poor outcomes and nephrotoxicity is highlighted. One in three children experienced considerable SAB morbidity, therefore pediatric inclusion in future SAB comparator trials is paramount to improve outcomes.
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Affiliation(s)
- Anita J Campbell
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.,School of Medicine, University of Western Australia, Perth, Australia
| | - Laila S Al Yazidi
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.,Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia.,The Children's Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, NSW, Australia
| | - Linny K Phuong
- Department of General Medicine, Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia.,Infection and Immunity Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Clare Leung
- Department of Paediatrics, Wagga Wagga Base Hospital, New South Wales, Australia
| | - Emma J Best
- Department of Paediatrics; Child and Youth Health, The University of Auckland.,The National Immunisation Advisory Centre, The University of Auckland.,Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Rachel H Webb
- Department of Paediatrics; Child and Youth Health, The University of Auckland.,Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand.,Department of Paediatrics, Kidz First Hospital, Auckland, New Zealand
| | - Lesley Voss
- Department of Paediatrics; Child and Youth Health, The University of Auckland.,Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Eugene Athan
- Department of Infectious Disease, Barwon Health, Geelong, Australia.,School of Medicine, Deakin University, Geelong, Australia
| | - Philip N Britton
- Sydney Medical School and Marie Bashir Institute, University of Sydney, NSW, Australia.,Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, Sydney, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Coen T Butters
- Infectious Diseases Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jonathan R Carapetis
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia.,University of Western Australia. School of Medicine, Perth, Western, Australia
| | - Natasha S Ching
- Department of General Paediatrics, Monash Children's Hospital, Monash Health, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Australia
| | - Geoffrey W Coombs
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Royal Perth Hospital and Fiona Stanley Hospital, Western Australia.,Antimicrobial Resistance and Infectious Diseases Research (AMRID) Laboratory, Murdoch University, Perth, Western Australia
| | - Denise Daley
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Royal Perth Hospital and Fiona Stanley Hospital, Western Australia.,The Australian Group on Antimicrobial Resistance (AGAR)
| | - Joshua Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Te-Yu Hung
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.,Doherty Institute of Infection and Immunity, The Royal Melbourne Hospital, The University of Melbourne
| | - Shakeel Mowlaboccus
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch.,School of Biomedical Sciences, University of Western Australia, Nedlands
| | - Clare Nourse
- Queensland Children's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Australia
| | - Samar Ojaimi
- Infection & Immunity, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia.,Department of Pediatrics, Monash University, Clayton, Australia
| | - Alex Tai
- Department of Infectious Disease, Barwon Health, Geelong, Australia
| | - Nan Vasilunas
- Infectious Diseases Department, Women's and Children's Hospital, Adelaide
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia.,National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia.,Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute.,School of Medicine, University of Western Australia, Subiaco.,Menzies School of Health Research, Charles Darwin Hospital, Darwin, NT
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18
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Abstract
The ALARA (an acronym for 'as low as reasonably achievable') principle, keeping the likelihood of incurring exposure, the number of people exposed and the magnitude of their individual doses 'as low as reasonably achievable, taking into account economic and societal factors', is at the core of radiation protection. For many decades the principle has been an area of continuous development, with recent work highlighting the importance of engaging not only with the decision-makers in the ALARA process but all stakeholders who may incur an exposure. This paper considers a particular case study in which the dredging of non-hazardous sediment in the United Kingdom near a now decommissioned nuclear power station raised substantial public concern about radiological exposure. This turned what was a straightforward construction activity into a complex public engagement and reassurance task, at a significant cost disproportionate to the level of radiological risk. This paper highlights the key lessons learnt from the case study, including not only the importance of engaging the public as part of the ALARA process but also of considering the societal impact arising from stress and concerns if misinformation is allowed to promulgate. A discussion is included on the need to underpin any engagement with a clear plan, including pre-engagement, implementation and reinforcement of messages. In addition, the role of the radiation protection professional is considered in ensuring that all stakeholders are informed, so that ultimately they can come to their own decision on what is safe.
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Affiliation(s)
- P A Bryant
- The Society for Radiological Protection, DS009 Dartington Hall, Devon TQ9 6EN, United Kingdom
- EDF Energy, Bridgewater House, Bristol BS1 6BX, United Kingdom
- Department of Physics, University of Surrey, Guildford, Surrey GU2 7XH, United Kingdom
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19
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Silvester EJ, Watanabe MMY, Pittet LF, Boast A, Bryant PA, Haeusler GM, Daley AJ, Curtis N, Gwee A. Candidemia in Children: A 16-year Longitudinal Epidemiologic Study. Pediatr Infect Dis J 2021; 40:537-543. [PMID: 33591077 DOI: 10.1097/inf.0000000000003082] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Candida species are the most common cause of systemic fungal infections in children. Risk factors for candidemia vary in different patient populations, posing challenges for clinical prediction of infection. We describe the epidemiology and clinical disease of candidemia in children admitted to a tertiary pediatric hospital. METHODS Retrospective audit of children ≤18 years of age with candidemia at a tertiary pediatric hospital over a 16-year period. RESULTS There were 139 episodes of candidemia in 124 children. A central venous catheter was present in 94% of episodes, prior antibiotic exposure in 86% and parenteral nutrition in 43%. During the study period, the proportion of candidemia due to non-albicans Candida spp. increased primarily due to a rise in C. krusei. Colonization with Candida spp. in the 30 days before developing candidemia was identified in 40% of episodes and the species was concordant in 60%. Infection at other sites was rare, including pulmonary dissemination (9/38, 24%), renal fungal disease (9/114, 8%), fungal endophthalmitis (8/102, 8%) and hepatosplenic nodules (5/92, 5%). Overall, 8/127 (6%) isolates were fluconazole-resistant (7 C. krusei and 1 C. glabrata) and 7/127 (6%) had intermediate susceptibility to fluconazole. The overall 30-day mortality was 12% and significant risk factors for mortality on multivariate analysis were male sex, liver disease and mucositis. CONCLUSIONS Our study outlines low rates of disseminated candidiasis and low mortality associated with candidemia at our institution. Additionally, it suggests that prior colonization may be an important risk factor, however, this should be validated in large prospective controlled studies.
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Affiliation(s)
- Eloise J Silvester
- From the Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Melissa M Y Watanabe
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Laure F Pittet
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Alison Boast
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Penelope A Bryant
- From the Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Infection and Immunity Theme, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Hospital-in-the-Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Gabrielle M Haeusler
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Infection and Immunity Theme, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
- The Paediatric Integrated Cancer Service, Victoria, Australia
| | - Andrew J Daley
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Laboratory Services, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Nigel Curtis
- From the Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Infection and Immunity Theme, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Amanda Gwee
- From the Department of Pediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Infection and Immunity Theme, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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20
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Yeoh DK, Saunders T, Butters C, Burgner D, Bryant PA, Cain TM, Ng J, Gwee A, Daley AJ, Cole T, Curtis N, Harrison J, Osowicki J. Refractory thoracic conidiobolomycosis treated with mepolizumab immunotherapy. J Allergy Clin Immunol Pract 2021; 9:2527-2530.e6. [PMID: 33601049 DOI: 10.1016/j.jaip.2021.01.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/12/2021] [Accepted: 01/27/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Daniel K Yeoh
- Infectious Diseases Department, Perth Children's Hospital, Perth, Western Australia, Australia; Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Thomas Saunders
- Department of Respiratory Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Coen Butters
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - David Burgner
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy M Cain
- Department of Medical Imaging, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Jessica Ng
- Department of Anatomical Pathology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Amanda Gwee
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew J Daley
- Microbiology Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Theresa Cole
- Department of Allergy and Immunology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Nigel Curtis
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Joanne Harrison
- Department of Respiratory Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Joshua Osowicki
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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21
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Shepherd K, Giles M, Blyth K, O'Keeffe F, Bordun L, Connell TG, Bryant PA. Follow-up and Clinical Outcomes of Human Immunodeficiency Virus (HIV)-Exposed Infants in A Low-Prevalence Setting in A Multidisciplinary Model of Care in Australia: The Children's HIV Exposure Study 1. J Pediatric Infect Dis Soc 2021; 10:14-21. [PMID: 32067032 DOI: 10.1093/jpids/piaa010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/16/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) is effective, but outcome information beyond the postnatal period in low-prevalence settings is scarce. A multidisciplinary model of care (MOC) was developed to ensure PMTCT. Our aims in this study were to assess how well HIV-exposed infants are followed up through this MOC and to determine infant outcomes to age 18 months. METHODS This was a multicenter, prospective study of infants exposed to HIV during pregnancy, born 1 September 2009-31 August 2016 in Victoria, Australia. RESULTS There were 129 live births from 127 pregnancies. There were no episodes of HIV transmission. Sixteen (13%) infants were born prematurely, 15 (12%) had low birthweight, and 6 (5%) had a congenital anomaly. There were 122 (95%) infants with an HIV polymerase chain reaction (PCR) within 2 weeks of birth. The proportion in the MOC reduced from 95% at 2 weeks postnatally to 75% by 18 months. Eighty-eight percent cared for within the MOC had 2 viral PCR tests completed after stopping antiretroviral prophylaxis compared with 22% of those outside of the MOC. By 18 months, 84/126 (67%) children attended follow-up, with higher rates within the MOC than outside (76% vs 6%; odds ratio, 46; 95% confidence interval, 6 to 365; P < .001). CONCLUSIONS HIV-exposed, uninfected infants in this low-prevalence setting had good prospective follow-up through this MOC to 3 months. The decrease in follow-up by 18 months could be addressed in several ways, including expanding the MOC and providing better links to regional/rural services.
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Affiliation(s)
- Kathryn Shepherd
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Michelle Giles
- Monash Infectious Diseases, Monash Medical Centre, Melbourne, Australia.,Department of Infectious Diseases, Royal Women's Hospital, Melbourne, Australia.,Infectious Diseases Unit, Alfred Hospital, Melbourne, Australia
| | - Karen Blyth
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Australia.,Monash Infectious Diseases, Monash Medical Centre, Melbourne, Australia.,Department of Infectious Diseases, Royal Women's Hospital, Melbourne, Australia.,Infectious Diseases Unit, Alfred Hospital, Melbourne, Australia
| | - Fiona O'Keeffe
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Australia.,Monash Infectious Diseases, Monash Medical Centre, Melbourne, Australia.,Department of Infectious Diseases, Royal Women's Hospital, Melbourne, Australia.,Infectious Diseases Unit, Alfred Hospital, Melbourne, Australia
| | - Louise Bordun
- Pharmacy Department, The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Tom G Connell
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Australia.,Clinical Paediatrics, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Melbourne, Australia.,Clinical Paediatrics, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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22
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Huynh J, Hodgson KA, Boyce S, Ibrahim LF, Bryant PA. Impact of expanding a paediatric OPAT programme with an antimicrobial stewardship intervention. Arch Dis Child 2020; 105:1220-1228. [PMID: 32381516 DOI: 10.1136/archdischild-2019-318091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND As treatment out of hospital with outpatient parenteral antimicrobial therapy (OPAT) increases, so too does the risk for patients of being less visible, with potential for suboptimal care. OBJECTIVES We aimed to compare pre-expansion and post-expansion (1) successful completion, complications and (2) the impact of an OPAT-specific antimicrobial stewardship (AMS) intervention to mitigate inappropriate antibiotic prescribing. DESIGN A prospective longitudinal study during two consecutive 12-month periods: period A (1 August 2012 to 31 July 2013) and period B (1 August 2013 to 31 July 2014). SETTING The Hospital-in-the-Home (HITH) programme at The Royal Children's Hospital Melbourne. PARTICIPANTS All patients who received OPAT during the study period. INTERVENTIONS Between the two periods, the programme expanded from 16 to 32 patients/day. To coincide with this, a combined AMS intervention was introduced: (1) OPAT-specific guidelines and (2) active review of OPAT prescriptions and input by Paediatric Infectious Diseases. MAIN OUTCOMES Successful completion of OPAT, OPAT-related complications, readmission, length of stay and antibiotic appropriateness. RESULTS Over 2 years, 646 patients (47% female, median age 7 years) were treated via OPAT for 754 episodes. Patient episodes increased from 254 in period A to 500 in period B, with proportional increases in infants under 1 month and immunocompromised patients. OPAT was successfully completed in 245/251 (98%) versus 473/482 (98%) (OR 1.8, 95% CI 0.7 to 4.5, p=0.3). OPAT-related complications remained low: intravenous catheter-associated complications 16/138 (12%) versus 41/414 (10%), and antibiotic-associated complications 0/254 (0%) versus 2/500 (0.4%). Despite the increase in activity, with the AMS intervention, overall appropriate antibiotic prescribing remained high: 71% versus 76%. Inappropriately long durations reduced from 30/312 (10%) to 37/617 (6%) (OR 0.6, 95% CI 0.4 to 0.99, p=0.04), and median number of days on broad-spectrum antibiotics from 11 (IQR 8-24.5) to 8 (IQR 5-11). CONCLUSION During a period of substantial expansion, we maintained clinical outcomes. A modest AMS intervention reduced some but not all aspects of inappropriate antibiotic prescribing.
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Affiliation(s)
- Julie Huynh
- Hospital-in-the-Home Department, The Royal Children's Hospital, Parkville, Victoria, Australia.,Discipline of Child and Adolescent Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Kate A Hodgson
- Hospital-in-the-Home Department, The Royal Children's Hospital, Parkville, Victoria, Australia.,Perinatal Infant and Paediatric Emergency Retrieval, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Newborn Research, Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Suzanne Boyce
- Hospital-in-the-Home Department, The Royal Children's Hospital, Parkville, Victoria, Australia.,Clinical Paediatrics Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Laila F Ibrahim
- Hospital-in-the-Home Department, The Royal Children's Hospital, Parkville, Victoria, Australia.,Clinical Paediatrics Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Penelope A Bryant
- Hospital-in-the-Home Department, The Royal Children's Hospital, Parkville, Victoria, Australia .,Clinical Paediatrics Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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23
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Abstract
BACKGROUND Influenza is a vaccine-preventable infection that causes serious illness. The mandate to prevent an influenza epidemic has increased with the COVID-19 pandemic. However, isolation restrictions have reduced interactions with healthcare professionals. We aimed to determine whether these barriers could be overcome by offering vaccination via an ambulatory setting for the first time. METHODS During a 12-week period, patients receiving care through the Hospital-in-the-Home programme were offered immunisation during their home visit. Logistical cold chain barriers were addressed, and patient acceptance was measured. RESULTS Cooler boxes with temperature loggers were designed to monitor the cold chain. 157 eligible patients were contacted, of whom 96 (61%) consented and received in-home injectable influenza vaccine, with no major adverse events. 52/96 (54%) were first-time influenza vaccine recipients. Most refusals (28/41, 68%) were for immunisation concerns, not home administration. CONCLUSION This pilot shows ambulatory influenza vaccination is feasible, safe and overcomes some barriers.
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Affiliation(s)
- Lauren Claire Nisbet
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Annie M Cobbledick
- Immunisation Clinic, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Pharmacy, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Tessa E Smith
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Penelope A Bryant
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Joanna Lawrence
- Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Fay MJ, Bryant PA. Antimicrobial stewardship in children: Where to from here? J Paediatr Child Health 2020; 56:1504-1507. [PMID: 33099822 DOI: 10.1111/jpc.15209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/24/2020] [Accepted: 09/11/2020] [Indexed: 12/26/2022]
Abstract
Antimicrobial resistance (AMR) is an ever-developing global threat and children are becoming increasingly affected. In addition to established antimicrobial stewardship (AMS) measures, it is important to recognise the need for a paediatric focus to manage the physiological and pathological differences unique to children. Most studies on paediatric AMS are drawn from resource-rich, hospital settings. They support interventions including AMS programmes, bundled groups of interventions, guidelines and education initiatives. These must be tailored to specific institutions, populations and resources as translating interventions between these may not be effective. There are knowledge gaps in paediatric AMS, which pose challenges to designing both interventions and research in this area. These include quantifying antimicrobial consumption, defining AMS outcomes and understanding the development of AMR. Finding answers to fill these gaps needs urgent attention. There is also a need to think outside the box to improve AMS in children. Potential opportunities include intravenous antibiotics at home via hospital-in-the-home programmes, earlier switching to oral antibiotics, repurposing old antibiotics and re-evaluating children labelled as having antibiotic allergy. Using all of the possibilities available gives us the best chance of staying ahead of the relentless march of AMR in children.
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Affiliation(s)
- Michael-John Fay
- Department of Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Penelope A Bryant
- Infectious Diseases and Hospital-in-the-Home Departments, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Paediatrics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Ibrahim LF, Cheng DR, Babl FE, Bryant PA, Crawford NW, Daley AJ, Lewena S, McNab S, Noakes K, Steer AC, Tosif S. COVID-19 in health-care workers: Testing and outcomes at a Victorian tertiary children's hospital. J Paediatr Child Health 2020; 56:1642-1644. [PMID: 32870575 DOI: 10.1111/jpc.15143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Laila F Ibrahim
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Hospital-In-The-Home Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Daryl R Cheng
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Franz E Babl
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Hospital-In-The-Home Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Nigel W Crawford
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Immunisation Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andrew J Daley
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Microbiology, Laboratory Services, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stuart Lewena
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sarah McNab
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kirsten Noakes
- Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andrew C Steer
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Shidan Tosif
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Immunisation Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
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Bryant PA, Rogers BA, Cowan R, Bowen AC, Pollard J. Planning and clinical role of acute medical home care services for COVID-19: consensus position statement by the Hospital-in-the-Home Society Australasia. Intern Med J 2020; 50:1267-1271. [PMID: 32945570 PMCID: PMC7536903 DOI: 10.1111/imj.15011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 01/24/2023]
Abstract
During a pandemic when hospitals are stretched and patients need isolation, the role of hospital‐in‐the‐home (HITH) providing acute medical care at home has never been more relevant. We aimed to define and address the challenges to acute home care services posed by the COVID‐19 pandemic. Planning for service operation involves staffing, equipment availability and cleaning, upskilling in telehealth and communication. Planning for clinical care involves maximising cohorts of patients without COVID‐19 and new clinical pathways for patients with COVID‐19. The risk of SARS‐CoV‐2 transmission, specific COVID‐19 clinical pathways and the well‐being of patients and staff should be addressed in advance.
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Affiliation(s)
- Penelope A Bryant
- Hospital-in-the-Home and Infectious Diseases Departments, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Paediatrics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Benjamin A Rogers
- Centre for Inflammatory Diseases, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
| | - Raquel Cowan
- Infectious Disease Department, Ballarat Hospital, Ballarat, Victoria, Australia.,Infectious Diseases Department, Barwon Health, Geelong, Victoria, Australia.,School of Medicine, Deakin University, Melbourne, Victoria, Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,Skin Health, Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - James Pollard
- Community Care, Cabrini Health, Melbourne, Victoria, Australia
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Haeusler GM, Gaynor L, Teh B, Babl FE, Orme LM, Segal A, Mechinaud F, Bryant PA, Phillips B, Lourenco RDA, Slavin MA, Thursky KA. Home-based care of low-risk febrile neutropenia in children-an implementation study in a tertiary paediatric hospital. Support Care Cancer 2020; 29:1609-1617. [PMID: 32740894 DOI: 10.1007/s00520-020-05654-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/24/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Home-based management of low-risk febrile neutropenia (FN) is safe, improves quality of life and reduces healthcare expenditure. A formal low-risk paediatric program has not been implemented in Australia. We aimed to describe the implementation process and evaluate the clinical impact. METHOD This prospective study incorporated three phases: implementation, intervention and evaluation. A low-risk FN implementation toolkit was developed, including a care-pathway, patient information, home-based assessment and educational resources. The program had executive-level endorsement, a multidisciplinary committee and a nurse specialist. Children with cancer and low-risk FN were eligible to be transferred home with a nurse visiting daily after an overnight period of observation for intravenous antibiotics. Low-risk patients were identified using a validated decision rule, and suitability for home-based care was determined using disease, chemotherapy and patient-level criteria. Plan-Do-Study-Act methodology was used to evaluate clinical impact and safety. RESULTS Over 18 months, 292 children with FN were screened: 132 (45%) were low-risk and 63 (22%) were transferred to home-based care. Compared with pre-implementation there was a significant reduction in in-hospital median LOS (4.0 to 1.5 days, p < 0.001) and 291 in-hospital bed days were saved. Eight (13%) patients needed readmission and there were no adverse outcomes. A key barrier was timely screening of all patients and program improvements, including utilising the electronic medical record for patient identification, are planned. CONCLUSION This program significantly reduces in-hospital LOS for children with low-risk FN. Ongoing evaluation will inform sustainability, identify areas for improvement and support national scale-up of the program.
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Affiliation(s)
- Gabrielle M Haeusler
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,University of Melbourne, Parkville, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia. .,The Paediatric Integrated Cancer Service, Parkville, Victoria, Australia. .,Infection Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia. .,Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Lynda Gaynor
- The Paediatric Integrated Cancer Service, Parkville, Victoria, Australia.,Hospital In The Home Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Benjamin Teh
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Emergency Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lisa M Orme
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Ahuva Segal
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Francoise Mechinaud
- Unité d'hématologie immunologie pédiatrique, Hopital Robert Debré, APHP Nord Université de Paris, Paris, France
| | - Penelope A Bryant
- Infection Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Hospital In The Home Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, New South Wales, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, 3010, Australia.,Victorian Infectious Diseases Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Karin A Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,University of Melbourne, Parkville, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, 3010, Australia.,Victorian Infectious Diseases Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,NHMRC National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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Ibrahim LF, Tosif S, McNab S, Hall S, Lee HJ, Lewena S, Daley AJ, Crawford NW, Steer AC, Bryant PA, Babl FE. SARS-CoV-2 testing and outcomes in the first 30 days after the first case of COVID-19 at an Australian children's hospital. Emerg Med Australas 2020; 32:801-808. [PMID: 32390285 PMCID: PMC7273066 DOI: 10.1111/1742-6723.13550] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 12/24/2022]
Abstract
Objective International studies describing COVID‐19 in children have shown low proportions of paediatric cases and generally a mild clinical course. We aimed to present early data on children tested for SARS‐CoV‐2 at a large Australian tertiary children's hospital according to the state health department guidelines, which varied over time. Methods We conducted a retrospective cohort study at The Royal Children's Hospital, Melbourne, Australia. It included all paediatric patients (aged 0–18 years) who presented to the ED or the Respiratory Infection Clinic (RIC) and were tested for SARS‐CoV‐2. The 30‐day study period commenced after the first confirmed positive case was detected at the hospital on 21 March 2020, until 19 April 2020. We recorded epidemiological and clinical data. Results There were 433 patients in whom SARS‐CoV‐2 testing was performed in ED (331 [76%]) or RIC (102 [24%]). There were four (0.9%) who had positive SARS‐CoV‐2 detected, none of whom were admitted to hospital or developed severe disease. Of these SARS‐CoV‐2 positive patients, 1/4 (25%) had a comorbidity, which was asthma. Of the SARS‐CoV‐2 negative patients, 196/429 (46%) had comorbidities. Risk factors for COVID‐19 were identified in 4/4 SARS‐CoV‐2 positive patients and 47/429 (11%) SARS‐CoV‐2 negative patients. Conclusion Our study identified a very low rate of SARS‐CoV‐2 positive cases in children presenting to a tertiary ED or RIC, none of whom were admitted to hospital. A high proportion of patients who were SARS‐CoV‐2 negative had comorbidities.
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Affiliation(s)
- Laila F Ibrahim
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Hospital-In-The-Home Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Shidan Tosif
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sarah McNab
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Samantha Hall
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Hyun Jung Lee
- Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Stuart Lewena
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andrew J Daley
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Microbiology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Nigel W Crawford
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andrew C Steer
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Hospital-In-The-Home Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Franz E Babl
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia
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Affiliation(s)
- Laila F Ibrahim
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Paediatrics Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Hospital-In-The-Home, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Franz E Babl
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sandy M Hopper
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Paediatrics Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Hospital-In-The-Home, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
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Kaufman J, Knight AJ, Bryant PA, Babl FE, Dalziel K. Liquid gold: the cost-effectiveness of urine sample collection methods for young precontinent children. Arch Dis Child 2020; 105:253-259. [PMID: 31444211 DOI: 10.1136/archdischild-2019-317561] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/03/2019] [Accepted: 08/08/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Urinary tract infection (UTI) is a common childhood infection. Many febrile children require a urine sample to diagnose or exclude UTI. Collecting urine from young children can be time-consuming, unsuccessful or contaminated. Cost-effectiveness of each collection method in the emergency department is unknown. OBJECTIVE To determine the cost-effectiveness of urine collection methods for precontinent children. METHODS A cost-effectiveness analysis was conducted comparing non-invasive (urine bag, clean catch and 5 min voiding stimulation for clean catch) and invasive (catheterisation and suprapubic aspirate (SPA)) collection methods, for children aged 0-24 months in the emergency department. Costs included equipment, staff time and hospital bed occupancy. If initial collection attempts were unsuccessful subsequent collection using catheterisation was assumed. The final outcome was a definitive sample incorporating progressive dipstick, culture and contamination results. Average costs and outcomes were calculated for initial collection attempts and obtaining a definitive sample. One-way and probabilistic sensitivity analyses were performed. RESULTS For initial collection attempts, catheterisation had the lowest cost per successful collection (GBP£25.98) compared with SPA (£37.80), voiding stimulation (£41.32), clean catch (£52.84) and urine bag (£92.60). For definitive collection, catheterisation had the lowest cost per definitive sample (£49.39) compared with SPA (£51.84), voiding stimulation (£52.25), clean catch (£64.82) and urine bag (£112.28). Time occupying a hospital bed was the most significant determinant of cost. CONCLUSION Catheterisation is the most cost-effective urine collection method, and voiding stimulation is the most cost-effective non-invasive method. Urine bags are the most expensive method. Although clinical factors influence choice of method, considering cost-effectiveness for this common procedure has potential for significant aggregate savings.
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Affiliation(s)
- Jonathan Kaufman
- Royal Children's Hospital Melbourne, Parkville, Victoria, Australia .,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Andrew Joshua Knight
- Health Economics Unit, The University of Melbourne School of Population Health, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Franz E Babl
- Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Kim Dalziel
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Health Economics Unit, The University of Melbourne School of Population Health, Melbourne, Victoria, Australia
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Bryant PA, Yoshida H, Butlin M, Wood MD, Raines K, Bannon A, Hunak S. SRP workshop on 'communication of radiation risk in the modern world'. J Radiol Prot 2020; 40:319-326. [PMID: 31550693 DOI: 10.1088/1361-6498/ab4773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Communicating radiation risk is an important part of radiation protection. However, achieving effective risk communication is challenging given the negative public perception of radiation and conflicting views presented by both the media and social media. Noting the importance of building capacity amongst radiation protection professionals to communicate radiation risk effectively, the Society for Radiological Protection (SRP) ran a half-day workshop at its Annual Conference on the 22nd May 2019 in Scarborough Spa, UK. A number of key factors were identified that should be considered when communicating with the public, post a nuclear or radiological incident, communicating with government and local authorities, and communicating with the public as part of public outreach. The following memorandum provides a summary of the points presented and discussed. It also outlines proposed future activities of the SRP, focused on further developing the communications aspect of radiation professionals' practice.
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Affiliation(s)
- P A Bryant
- The Society for Radiological Protection, DS009, Dartington Hall, Devon, TQ9 6EN, United Kingdom. University of Surrey, Department of Physics, Stag Hill, Guildford, GU2 7XH United Kingdom
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Bryant PA. Ethical dilemmas in providing acute medical care at home for children: a survey of health professionals. BMJ Paediatr Open 2020; 4:e000590. [PMID: 32099907 PMCID: PMC7015051 DOI: 10.1136/bmjpo-2019-000590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Acute care at home is increasing. We aimed to determine the views of healthcare professionals on the ethics of providing home care and compare the impact of situational changes on their opinions. DESIGN An analysis of opinions of home healthcare professionals. SETTING The Australasian Hospital-in-the-Home Annual Conference, November 2017. PARTICIPANTS Eighty physicians, nurses and allied health staff who provide acute care for children and adults at home. METHODS Clinical scenarios were presented about a 14 years old receiving intravenous antibiotics at home via an established home care pathway, and participants were asked to vote manually on whether providing home care was ethical. MAIN OUTCOMES The proportions of healthcare professionals who believed that provision of home care was ethical in different situations. RESULTS For each question the response rate ranged from 71% to 100%. While the provision of acute home care was deemed ethical by the majority (77/80, 96%), this decreased when other factors were involved such as domestic violence (37/63 (59%) OR 0.06, 95% CI 0.02 to 0.20, p<0.001) and parental reluctance (28/67 (42%) OR 0.02, 95% CI 0.008 to 0.09, p<0.001). The age of consent affected the proportion who considered home care ethical against parental wishes: 16 years (48/58, 83%) versus 14 years (33/53, 52%) OR 4.4, 95% CI 1.9 to 10.1, p<0.001. The lowest proportion to consider home care ethical (16%) was when home care was deemed less than hospital care. CONCLUSIONS Home healthcare providers are supportive of the ethics of providing acute care at home for children, although differ among themselves with situational complexities. Applying the tenets of medical ethics (autonomy, non-maleficence, beneficence and justice) can provide insights into the factors that may influence opinions.
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Affiliation(s)
- Penelope A Bryant
- Hospital-in-the-Home Department & Infectious Diseases Unit, General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Infection, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Lenko D, Purcell R, Starr M, Bryant PA, South M, Gwee A. Does discharging asthma patients after one hour of treatment if clinically well affect emergency department length of stay. J Paediatr Child Health 2019; 55:1445-1450. [PMID: 30895667 DOI: 10.1111/jpc.14437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 02/06/2019] [Accepted: 02/25/2019] [Indexed: 11/29/2022]
Abstract
AIM Asthma is a major contributor to direct and indirect health-care costs and resource use. In May 2015, the Royal Children's Hospital (RCH) amended its clinical practice guideline for acute asthma management from discharging patients if the anticipated salbutamol requirement was every 3-4 h to discharging patients who were clinically well at 1 h after initial treatment. Our objective was to examine the impact of the new discharge recommendation on emergency department (ED) length of stay (LOS), rates of admission and representation. METHODS We retrospectively audited the case notes of children presenting with mild or moderate asthma to the RCH ED over the equivalent 2-week periods in winter 2014 (pre-implementation of the new guideline) and 2015 (post-implementation). RESULTS A total of 105 patients in 2014 and 92 patients in 2015 were included. In both years, all patients who initially presented with mild or moderate asthma either improved or stayed within the same severity classification at the 1-h assessment. For patients who were clinically well by the 1-h assessment, there was a significant reduction in admissions between 2014 and 2015 (40 vs. 10%, P = 0.001). There was also a reduction for these patients in median LOS from 3 h 13 min in 2014 to 2 h 31 min in 2015 (P = 0.03). In both years, all patients who were moderate at 1 h were admitted. There was no difference in the rate of representation or subsequent deterioration in those patients who were discharged at 1 h between the 2 years. CONCLUSION Early discharge of patients who are clinically well 1 h after initial therapy may be associated with a reduction in LOS and admission rate without an apparent compromise in patient safety. Further evaluation of this intervention is required to determine whether this is a true causal relationship.
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Affiliation(s)
- Debbie Lenko
- Department of General Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachael Purcell
- Department of General Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Mike Starr
- Department of General Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Department of General Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael South
- Department of General Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Amanda Gwee
- Department of General Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Wang SS, Kotecha RS, Bernard A, Blyth CC, McMullan BJ, Cann MP, Yeoh DK, Bartlett AW, Ryan AL, Moore AS, Bryant PA, Clark J, Haeusler GM. Invasive fungal infections in children with acute lymphoblastic leukaemia: Results from four Australian centres, 2003-2013. Pediatr Blood Cancer 2019; 66:e27915. [PMID: 31309711 DOI: 10.1002/pbc.27915] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 05/29/2019] [Accepted: 06/24/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Invasive fungal infections (IFI) are an important complication of acute lymphoblastic leukaemia (ALL) treatment. Our study describes the prevalence and outcomes of IFI in children with ALL. METHODS IFI episodes in children with primary or relapsed ALL, identified for The Epidemiology and Risk Factors for Invasive Fungal Infections in Immunocompromised Children study, were analysed. IFI were classified according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group criteria with a 'modified-possible' category included. RESULTS A total of 123 IFI episodes in 119 patients with ALL were included. A proven, probable, possible and modified-possible IFI was diagnosed in 56 (45.5%), 22 (17.9%), 39 (31.7%) and six (4.9%) episodes, respectively. The prevalence was 9.7% (95% confidence interval [CI] 8-11.4%) overall and 23.5% (95% CI 14.5-32.5%) for relapsed/refractory ALL. For non-relapsed ALL, the IFI prevalence was significantly higher for children with high-risk compared to standard-risk ALL (14.5% vs 7.3%, P = .009), and IFI were more common during induction, consolidation and delayed intensification phases. Mould infections occurred more frequently than non-mould infections. Thirteen children (10.9%) died within 6 months of IFI diagnosis with five deaths (4.2%) attributable to an IFI. CONCLUSIONS IFI is more common in children with high-risk ALL and in relapsed disease. Overall survival was encouraging, with IFI contributing to very few deaths.
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Affiliation(s)
- Stacie S Wang
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Rishi S Kotecha
- Department of Haematology and Oncology, Perth Children's Hospital, Perth, Western Australia, Australia.,Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Western Australia, Australia
| | - Anne Bernard
- QFAB Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Christopher C Blyth
- School of Medicine and Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Brendan J McMullan
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Megan P Cann
- Infection Management Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Daniel K Yeoh
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Adam W Bartlett
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Biostatistics and Databases Program, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Anne L Ryan
- Department of Haematology and Oncology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Andrew S Moore
- Oncology Services Group, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Diamantina Institute & Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Paediatrics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Julia Clark
- Infection Management Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia.,Centre for Children's Health Research, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Gabrielle M Haeusler
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Paediatrics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,The Paediatric Integrated Cancer Service, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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Andrew EC, Connell T, Robinson P, Curtis N, Massie J, Robertson C, Harrison J, Shanthikumar S, Bryant PA, Starr M, Steer A, Ranganathan S, Gwee A. Pulmonary Mycobacterium abscessus complex in children with cystic fibrosis: A practical management guideline. J Paediatr Child Health 2019; 55:502-511. [PMID: 30884016 DOI: 10.1111/jpc.14427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/05/2019] [Accepted: 02/10/2019] [Indexed: 11/28/2022]
Abstract
The treatment of Mycobacterium abscessus complex (MABSC) pulmonary infections is an emerging challenge in patients with cystic fibrosis (CF). Multidrug therapy for prolonged durations is required and carries the significant burden of drug-related toxicity, cost and selective pressure for multiresistant bacteria. International guidelines acknowledge that clinical and in vitro data to support treatment regimens are limited, particularly in children. As part of a collaboration between the infectious diseases and respiratory units at our institution, we have developed a modified treatment guideline that aims to balance the aims of MABSC eradication and slowing disease progression with minimising drug toxicity and resistance. The outcomes of this treatment approach will be monitored and reported. In this manuscript, we discuss the available evidence for treatment choices and present our treatment guideline for paediatric patients with CF and MABSC infection.
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Affiliation(s)
- Eden C Andrew
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Tom Connell
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Infectious Diseases Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Phil Robinson
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Nigel Curtis
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Infectious Diseases Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - John Massie
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Colin Robertson
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Joanne Harrison
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Shivanthan Shanthikumar
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Infectious Diseases Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Mike Starr
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Steer
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Group A Streptococcal Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sarath Ranganathan
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Amanda Gwee
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Infectious Diseases Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Ibrahim LF, Hopper SM, Orsini F, Daley AJ, Babl FE, Bryant PA. Efficacy and safety of intravenous ceftriaxone at home versus intravenous flucloxacillin in hospital for children with cellulitis (CHOICE): a single-centre, open-label, randomised, controlled, non-inferiority trial. Lancet Infect Dis 2019; 19:477-486. [PMID: 30853250 DOI: 10.1016/s1473-3099(18)30729-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/07/2018] [Accepted: 11/14/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Outpatient parenteral antimicrobial therapy in children is common despite no evidence of its efficacy or safety from clinical trials. We aimed to compare the efficacy and safety of intravenous antibiotic therapy at home with that of standard treatment in hospital for children with moderate to severe cellulitis. METHODS The Cellulitis at Home or Inpatient in Children from the Emergency Department (CHOICE) trial was a randomised, controlled, non-inferiority trial in children aged 6 months to 18 years who presented to the emergency department at The Royal Children's Hospital (Melbourne, VIC, Australia) with uncomplicated moderate to severe cellulitis. Participants were randomly assigned to receive either intravenous ceftriaxone (50 mg/kg once daily) at home or intravenous flucloxacillin (50 mg/kg every 6 h) in hospital with web-based randomisation, stratified by age and periorbital cellulitis. The primary outcome was treatment failure, which was defined as no clinical improvement or occurrence of an adverse event, resulting in a change in empiric antibiotics within 48 h of the first dose. Secondary outcomes included adverse events and acquisition of antibiotic-resistant bacteria. Outcomes were assessed in all randomised participants with outcome data (intention-to-treat population) and in all individuals who received treatment as allocated and did not have any major protocol violations (per-protocol population). For home treatment to be non-inferior to hospital treatment, the difference between groups in the proportion of children with treatment failure in the intention-to-treat population had to be less than 15%. This trial is registered with ClinicalTrials.gov, number NCT02334124. FINDINGS Between Jan 9, 2015, and June 15, 2017, we screened 1135 children for eligibility, of whom 190 were randomly assigned to receive ceftriaxone at home (n=95) or flucloxacillin in hospital (n=95). The intention-to-treat analysis comprised 188 children (93 in the home group and 95 in the hospital group) because two children in the home group were found to be ineligible after randomisation and were excluded. Treatment failure occurred in two (2%) children in the home group and in seven (7%) children in the hospital group (risk difference -5·2%, 95% CI -11·3 to 0·8, p=0·088). In the per-protocol analysis, treatment failure occurred in one (1%) of 89 children in the home group and in seven (8%) of 91 children in the hospital group (-6·5%, -12·4 to -0·7). Fewer children treated at home than in hospital had an adverse event (two [2%] vs ten [11%]; p=0·048). There was no difference between groups in rates of nasal acquisition of meticillin-resistant Staphylococcus aureus or gastrointestinal acquisition of extended-spectrum β-lactamase-producing bacteria or Clostridium difficile after 3 months. INTERPRETATION Home treatment with intravenous ceftriaxone is not inferior to treatment in hospital with intravenous flucloxacillin for children with cellulitis. The standard of care for the intravenous treatment of uncomplicated cellulitis in children should be home or outpatient care when feasible. FUNDING The Royal Children's Hospital Foundation and Murdoch Children's Research Institute.
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Affiliation(s)
- Laila F Ibrahim
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Sandy M Hopper
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Emergency Department, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Francesca Orsini
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Melbourne Children's Trials Centre, Melbourne, VIC, Australia
| | - Andrew J Daley
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia; Microbiology Department, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Franz E Babl
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Emergency Department, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Penelope A Bryant
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia; Hospital-In-The-Home Department, The Royal Children's Hospital, Melbourne, VIC, Australia.
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Ibrahim LF, Hopper SM, Donath S, Salvin B, Babl FE, Bryant PA. Development and Validation of a Cellulitis Risk Score: The Melbourne ASSET Score. Pediatrics 2019; 143:peds.2018-1420. [PMID: 30606746 DOI: 10.1542/peds.2018-1420] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5972298232001PEDS-VA_2018-1420Video Abstract BACKGROUND: The evidence is unclear about the optimal route of treatment for children with cellulitis, specifically how to assess the risk of moderate-to-severe cellulitis requiring intravenous (IV) antibiotics. We aimed to derive and validate a cellulitis risk assessment scoring system to guide providers as to which patients require IV antibiotics. METHODS This was a prospective cohort study of children presenting to the emergency department aged 6 months to 18 years diagnosed with cellulitis from January 2014 to August 2017. Patients were divided into 2 groups based on route of antibiotics at 24 hours (the predetermined gold standard). Demographics and clinical features were compared. Clinicians were surveyed about which features they used to decide whether to start IV antibiotics. Combinations of differentiating features were plotted on receiver operating characteristic curves. RESULTS There were 285 children in the derivation cohort used to create the Melbourne Area, Systemic features, Swelling, Eye, Tenderness (ASSET) Score, which has a maximum score of 7. The area under the curve was 0.86 (95% confidence interval 0.83-0.91). Using a cutoff score of 4 to start IV antibiotics yielded the highest correct classification of 80% of patients (sensitivity 60%; specificity 93%). This score was validated in 251 children and maintained a robust area under the curve of 0.83 (95% confidence interval 0.78-0.89). CONCLUSIONS The Melbourne ASSET Score was derived and validated for cellulitis in children to guide clinicians regarding when to start IV antibiotics. Although intended for widespread use, if limitations exist in other settings, it is designed to allow for refinement and is amenable to local impact analysis.
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Affiliation(s)
- Laila F Ibrahim
- Department of Paediatrics, University of Melbourne, Parkville, Australia; and.,Murdoch Children's Research Institute
| | - Sandy M Hopper
- Department of Paediatrics, University of Melbourne, Parkville, Australia; and.,Murdoch Children's Research Institute.,Emergency Department
| | | | - Bennett Salvin
- Department of Paediatrics, University of Melbourne, Parkville, Australia; and
| | - Franz E Babl
- Department of Paediatrics, University of Melbourne, Parkville, Australia; and .,Murdoch Children's Research Institute.,Emergency Department
| | - Penelope A Bryant
- Department of Paediatrics, University of Melbourne, Parkville, Australia; and.,Murdoch Children's Research Institute.,Infectious Diseases Unit, Department of General Medicine, and.,Hospital-In-The-Home Department, The Royal Children's Hospital, Parkville, Australia
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Harewood FC, Curtis N, Daley AJ, Bryant PA, Gwee A, Connell TG. Adequate or Inadequate? The Volume of Blood Submitted for Blood Culture at a Tertiary Children's Hospital. Clin Pediatr (Phila) 2018; 57:1310-1317. [PMID: 29808741 DOI: 10.1177/0009922818778042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The volume of blood sampled for culture critically influences the results. This study aimed to determine (1) the volume of blood submitted for culture, (2) the proportion of blood cultures with adequate volume, (3) whether measured improvement from a previous educational intervention had been sustained, and (4) the impact of blood volume on culture result. The volume of blood submitted for cultures was determined over a 13-month period by weighing bottles before and after collection and before and after an educational intervention. The volume of blood submitted in 5127 culture bottles were measured. Fewer than 50% of all cultures were deemed adequate. A significant pathogen was isolated in 4.7% of blood cultures, and low-volume cultures were more likely to yield contaminant isolates (47/2422 [1.9%] vs 22/2705 [0.8%], P = .0005). Subsequently, the higher rate of contaminant isolates from low-volume cultures may affect selection and rationalization of antibiotic therapy.
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Affiliation(s)
- Freya C Harewood
- 1 The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- 2 Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- 3 University of Melbourne, Melbourne, Victoria, Australia
| | - Nigel Curtis
- 1 The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- 2 Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- 3 University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew J Daley
- 1 The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- 2 Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- 1 The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- 2 Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Amanda Gwee
- 1 The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- 2 Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- 3 University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas G Connell
- 1 The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- 2 Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Haeusler GM, Slavin MA, Bryant PA, Babl FE, Mechinaud F, Thursky KA. Management of fever and neutropenia in children with cancer: A survey of Australian and New Zealand practice. J Paediatr Child Health 2018; 54:761-769. [PMID: 29655245 DOI: 10.1111/jpc.13899] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/19/2017] [Accepted: 12/13/2017] [Indexed: 11/30/2022]
Abstract
AIM Variation in the management of fever and neutropenia (FN) in children is well described. The aim of this study was to explore the current management of FN across Australia and New Zealand and highlight areas for improvement. METHODS A practice survey was administered to paediatric health-care providers via four clinical and research networks. Using three clinical case vignettes, we explored risk stratification, empiric antibiotics, initial investigations, intravenous-oral switch, ambulatory management and antibiotic duration in children with cancer and FN. RESULTS A response was received from 104 participants from 16 different hospitals. FN guideline compliance was rated as moderate or poor by 24% of respondents, and seven different fever definitions were described. There was little variation in the selected empiric monotherapy and dual-therapy regimens, and almost all respondents recommended first-dose antibiotics within 1 h. However, 27 different empiric antibiotic combinations were selected for beta-lactam allergy. An incorrect risk status was assigned to the low-risk case by 27% of respondents and to the high-risk case by 41%. Compared to current practice, significantly more respondents would manage the low-risk case in the ambulatory setting provided adequate resources were in place (43 vs. 85%, P < 0.0001). There was variation in the use of empiric glycopeptides as well as use of aminoglycosides beyond 48 h. CONCLUSION Although the antibiotics selected for empiric management of FN are appropriate and consistent, variation and inaccuracies exist in risk stratification, the selection of monotherapy over dual therapy, empiric antibiotics chosen for beta-lactam allergy, use of glycopeptides and duration of aminoglycosides.
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Affiliation(s)
- Gabrielle M Haeusler
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia.,NHMRC National Centre for Infections in Cancer, University of Melbourne, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Paediatric Integrated Cancer Service, Victoria State Government, Melbourne, Victoria, Australia.,Department of Infection and Immunity, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia.,NHMRC National Centre for Infections in Cancer, University of Melbourne, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Infectious Diseases Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Francoise Mechinaud
- Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Karin A Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia.,NHMRC National Centre for Infections in Cancer, University of Melbourne, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Infectious Diseases Service, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,NHMRC National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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Abstract
The principle of As Low As Reasonable Achievable (ALARA) stems from the field of radiological protection. In the UK, this principle has been incorporated into the Health and Safety at Work Act 1974 and rather than applying solely to radiological hazards, applies to all hazards in totality. Given that the current methods for assessing hazards are somewhat isolated, in that one hazard is assessed independently of another, it can be challenging to ensure a truly holistic view of the risks, and demonstrate they have been reduced to ALARA or As Low As Is Reasonably Practicable (ALARP) as required in the UK regulatory regime. The following paper presents a proposed framework for the integrated assessment of risks from multiple hazards. In addition, it presents an overview of some of the key challenges that may be encountered when producing a holistic ALARA demonstration.
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Affiliation(s)
- P A Bryant
- EDF Energy (Nuclear New Build), Bridgewater House, Counterslip, Bristol, United Kingdom, BS1 6BX. Radiation Protection Office, University of Liverpool, Oliver Lodge Building, Oxford Street, Liverpool, United Kingdom, L69 7ZE
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Ibrahim LF, Hopper SM, Connell TG, Daley AJ, Bryant PA, Babl FE. Evaluating an admission avoidance pathway for children in the emergency department: outpatient intravenous antibiotics for moderate/severe cellulitis. Emerg Med J 2017; 34:780-785. [PMID: 28978652 DOI: 10.1136/emermed-2017-206829] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/22/2017] [Accepted: 08/31/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Children with moderate/severe cellulitis requiring intravenous antibiotics are usually admitted to hospital. Admission avoidance is attractive but there are few data in children. We implemented a new pathway for children to be treated with intravenous antibiotics at home and aimed to describe the characteristics of patients treated on this pathway and in hospital and to evaluate the outcomes. METHODS This is a prospective, observational cohort study of children aged 6 months-18 years attending the ED with uncomplicated moderate/severe cellulitis in March 2014-January 2015. Patients received either intravenous ceftriaxone at home or intravenous flucloxacillin in hospital based on physician discretion. Primary outcome was treatment failure defined as antibiotic change within 48 hours due to inadequate clinical improvement or serious adverse events. Secondary outcomes include duration of intravenous antibiotics and complications. RESULTS 115 children were included: 47 (41%) in the home group and 68 (59%) in the hospital group (59 hospital-only, 9 transferred home during treatment). The groups had similar clinical features. 2/47 (4%) of the children in the home group compared with 8/59 (14%) in the hospital group had treatment failure (P=0.10). Duration of intravenous antibiotics (median 1.9 vs 1.8 days, P=0.31) and complications (6% vs 10%, P=0.49) were no different between groups. Home treatment costs less, averaging $A1166 (£705) per episode compared with $A2594 (£1570) in hospital. CONCLUSIONS Children with uncomplicated cellulitis may be able to avoid hospital admission via a home intravenous pathway. This approach has the potential to provide cost and other benefits of home treatment.
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Affiliation(s)
- Laila F Ibrahim
- Department of RCH@Home, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Emergency, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Tom G Connell
- Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of General Medicine, Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Andrew J Daley
- Department of General Medicine, Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Microbiology, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Penelope A Bryant
- Department of RCH@Home, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of General Medicine, Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Franz E Babl
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Emergency, The Royal Children's Hospital, Parkville, Victoria, Australia
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Bryant PA, Katz NT. Inpatient versus outpatient parenteral antibiotic therapy at home for acute infections in children: a systematic review. Lancet Infect Dis 2017; 18:e45-e54. [PMID: 28822781 DOI: 10.1016/s1473-3099(17)30345-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 05/02/2017] [Accepted: 05/11/2017] [Indexed: 01/19/2023]
Abstract
Inpatient management is necessary in many situations, but medical and allied-health treatments are increasingly being used on an outpatient basis to allow patients who would traditionally have been admitted to hospital to remain at home. Home-based clinical management has many potential benefits, including reduced hospital-acquired infections, cost savings, and patient and family satisfaction. Studies in adults provide evidence for the benefits of home-based versus hospital-based intravenous antibiotics, but few studies inform practice in home-based intravenous antibiotic therapy for children. We systematically reviewed the efficacy, safety, satisfaction, and cost of home-based versus hospital-based intravenous antibiotic therapy for acute infections in children. We searched MEDLINE (from Jan 1, 1946, to Jan 31, 2017) and Embase (from Jan 1, 1974, to Jan 31, 2017) for studies investigating home-based and hospital-based intravenous antibiotic therapy and assessed them for quality. 2827 articles were identified and 19 studies were included in the systematic review. Efficacy results differed between studies depending on the outcome assessed. The incidence of complications and readmission to hospital was similar for hospital-based and home-based treatments. In seven (47%) of 15 studies, patients who had all or part of their treatment at home received treatment for longer than patients who were treated entirely in hospital. No studies showed that home-based treatment was less safe than hospital-based treatment. In all studies in which treatment satisfaction or costs were assessed, home-based treatment was satisfactory to patients or patients' families and less expensive per episode than hospital-based treatment by 30-75%. Thus, home-based intravenous antibiotic therapy might be popular and cost-effective, but randomised studies of the efficacy of this strategy are needed. This systematic review was registered with PROSPERO (number CRD42015024406).
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Affiliation(s)
- Penelope A Bryant
- Hospital-in-the-Home Department, The Royal Children's Hospital, Parkville, VIC, Australia; Infectious Diseases Unit, The Royal Children's Hospital, Parkville, VIC, Australia; Clinical Paediatrics Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
| | - Naomi T Katz
- Hospital-in-the-Home Department, The Royal Children's Hospital, Parkville, VIC, Australia; Clinical Paediatrics Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Kaufman J, Fitzpatrick P, Tosif S, Hopper SM, Donath SM, Bryant PA, Babl FE. Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial. BMJ 2017; 357:j1341. [PMID: 28389435 PMCID: PMC6284210 DOI: 10.1136/bmj.j1341] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective To determine if a simple stimulation method increases the rate of infant voiding for clean catch urine within five minutes.Design Randomised controlled trial.Setting Emergency department of a tertiary paediatric hospital, Australia.Participants 354 infants (aged 1-12 months) requiring urine sample collection as determined by the treating clinician. 10 infants were subsequently excluded.Interventions Infants were randomised to either gentle suprapubic cutaneous stimulation (n=174) using gauze soaked in cold fluid (the Quick-Wee method) or standard clean catch urine with no additional stimulation (n=170), for five minutes.Main outcome measures The primary outcome was voiding of urine within five minutes. Secondary outcomes were successful collection of a urine sample, contamination rate, and parental and clinician satisfaction with the method.Results The Quick-Wee method resulted in a significantly higher rate of voiding within five minutes compared with standard clean catch urine (31% v 12%, P<0.001), difference in proportions 19% favouring Quick-Wee (95% confidence interval for difference 11% to 28%). Quick-Wee had a higher rate of successful urine sample collection (30% v 9%, P<0.001) and greater parental and clinician satisfaction (median 2 v 3 on a 5 point Likert scale, P<0.001). The difference in contamination between Quick-Wee and standard clean catch urine was not significant (27% v 45%, P=0.29). The number needed to treat was 4.7 (95% confidence interval 3.4 to 7.7) to successfully collect one additional urine sample within five minutes using Quick-Wee compared with standard clean catch urine.Conclusions Quick-Wee is a simple cutaneous stimulation method that significantly increases the five minute voiding and success rate of clean catch urine collection.Trial registration Australian New Zealand Clinical Trials Registry ACTRN12615000754549.
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Affiliation(s)
- Jonathan Kaufman
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Patrick Fitzpatrick
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Shidan Tosif
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Susan M Donath
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Penelope A Bryant
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Franz E Babl
- Royal Children's Hospital, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
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Hensey CC, Freyne B, Bryant PA. Hospital-in-the-Home - essential to an integrated model of paediatric care. Ir Med J 2017; 110:493. [PMID: 28657271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- C C Hensey
- Department of General Paediatrics, Childrens University Hospital, Temple Street, Dublin 1
- Hospital-in-the-Home Program, RCH@Home Department* The Royal Childrens Hospital Melbourne, Victoria, Australia
| | - B Freyne
- Infectious Diseases Unit, Department of General Medicine, The Royal Childrens Hospital Melbourne, Victoria, Australia
- Infectious Diseases and Microbiology Group, Murdoch Childrens Research Institute, The Royal Childrens Hospital Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, The Royal Childrens Hospital Melbourne, Victoria, Australia
| | - P A Bryant
- Hospital-in-the-Home Program, RCH@Home Department, The Royal Childrens Hospital Melbourne, Victoria, Australia
- Infectious Diseases Unit, Department of General Medicine, The Royal Childrens Hospital Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, The Royal Childrens Hospital Melbourne, Victoria, Australia
- Clinical Paediatrics, Murdoch Childrens Research Institute* The Royal Childrens Hospital Melbourne, Victoria, Australia
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Hodgson KA, Huynh J, Ibrahim LF, Sacks B, Golshevsky D, Layley M, Spagnolo M, Raymundo CM, Bryant PA. The use, appropriateness and outcomes of outpatient parenteral antimicrobial therapy. Arch Dis Child 2016; 101:886-93. [PMID: 27166221 DOI: 10.1136/archdischild-2015-309731] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 04/20/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Outpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat children at home, but studies in children are scarce. We aimed to describe the use, appropriateness and outcomes of OPAT in children. DESIGN This was a 12-month prospective observational study. SETTING The hospital-in-the-home programme of The Royal Children's Hospital Melbourne. PATIENTS All patients receiving OPAT. INTERVENTIONS Data were collected including demographics, diagnosis, type of venous access and antibiotic choice. MAIN OUTCOME MEASURES Length of stay, adverse events, readmission rate and appropriateness of antibiotic use. RESULTS 228 patients received OPAT in 251 episodes. The median age was 7.4 years (range 1 week to 21 years), with 22 patients (10%) under 1 year. The most frequent diagnoses were exacerbation of cystic fibrosis (17%), urinary tract infection (12%) and cellulitis (9%). Most patients were transferred from the ward, but 18% were transferred directly from the emergency department, the majority with skin and soft-tissue infection (66%). Venous access was most commonly peripherally inserted central catheter (29%) and peripheral cannula (29%). 309 parenteral antibiotics were prescribed, most frequently ceftriaxone (28%) and gentamicin (19%). The majority of antibiotics (72%) were prescribed appropriately. However, 6% were deemed an inappropriate choice for the indication and 26% had inappropriate dose or duration. The incidence of central line-associated bloodstream infections was 0.9%. The unplanned readmission rate was 4%, with low rates of OPAT-related adverse events. Three children (1%) had an inadequate clinical response. CONCLUSIONS OPAT is a safe and effective way of providing antibiotics to children. Despite high rates of appropriate antibiotic use, improvements can still be made.
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Affiliation(s)
- Kate A Hodgson
- RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Julie Huynh
- RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Laila F Ibrahim
- RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Bronwyn Sacks
- RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Daniel Golshevsky
- RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Michael Layley
- RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Mark Spagnolo
- RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Chin-Mae Raymundo
- RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Penelope A Bryant
- RCH@Home Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia Clinical Paediatrics Group, Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia Department of Paediatrics, University of Melbourne, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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46
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Bowen AC, Sheorey H, Bryant PA, Robson J, Burgner DP. Polymerase chain reaction testing for faecal parasites: risks and alternatives. Med J Aust 2016; 204:262. [PMID: 27078595 DOI: 10.5694/mja15.01327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 12/18/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Asha C Bowen
- Princess Margaret Hospital for Children, Perth, WA
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Kaufman J, Tosif S, Fitzpatrick P, Hopper SM, Bryant PA, Donath SM, Babl FE. Quick-Wee: a novel non-invasive urine collection method. Emerg Med J 2016; 34:63-64. [PMID: 27565196 DOI: 10.1136/emermed-2016-206000] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/26/2016] [Accepted: 08/04/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Clean catch urine (CCU) collection in precontinent children is often time-consuming, with associated collection failure. We hypothesise that stimulating cutaneous reflexes hastens voiding for CCU. METHODS 40 children aged 1-24 months in the ED. Standard CCU was augmented with gentle suprapubic cutaneous stimulation using saline-soaked gauze (Quick-Wee method). RESULTS 12/40 (30%) children voided within 5 min for successful CCU. Parental and clinician satisfaction was high. CONCLUSIONS Quick-Wee appears to be a simple method to speed CCU in young children.
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Affiliation(s)
- Jonathan Kaufman
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Faculty of Medicine Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Shidan Tosif
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Faculty of Medicine Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Patrick Fitzpatrick
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Sandy M Hopper
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Faculty of Medicine Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan M Donath
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Faculty of Medicine Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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48
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Kaufman J, Fitzpatrick P, Tosif S, Hopper SM, Bryant PA, Donath SM, Babl FE. The QuickWee trial: protocol for a randomised controlled trial of gentle suprapubic cutaneous stimulation to hasten non-invasive urine collection from infants. BMJ Open 2016; 6:e011357. [PMID: 27515752 PMCID: PMC4985821 DOI: 10.1136/bmjopen-2016-011357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Urinary tract infections (UTIs) are common in young children. Urine sample collection is required to diagnose or exclude UTI; however, current collection methods for pre-continent children all have limitations and guidelines vary. Clean catch urine (CCU) collection is a common and favoured non-invasive collection method, despite its high contamination rates and time-consuming nature. This study aims to establish whether gentle suprapubic cutaneous stimulation with cold fluid-soaked gauze can improve the rate of voiding for CCU within 5 min in young pre-continent children. METHODS AND ANALYSIS This study is a randomised controlled trial of 354 infants (aged 1-12 months) who require urine sample collection, conducted in a single emergency department in a tertiary paediatric hospital in Melbourne, Australia. After standard urogenital cleaning, patients will be randomised to either a novel technique of suprapubic cutaneous stimulation using cold saline-soaked gauze in circular motions or no stimulation. The study period is 5 min, after which care is determined by the treating clinician if a urine sample has not been collected. PRIMARY OUTCOME whether the child voids within 5 min (yes/no). SECONDARY OUTCOMES parental and clinician satisfaction with the method, success in catching a urine sample if the child voids, and sample contamination rates. This trial will allow the definitive assessment of this novel technique, gentle suprapubic cutaneous stimulation with cold saline-soaked gauze, and its utility to hasten non-invasive urine collection in infants. ETHICS AND DISSEMINATION The study has hospital ethics approval and is registered with the Australian New Zealand Clinical Trials Registry-ACTRN12615000754549. The results of the study will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ACTRN12615000754549; Pre-results.
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Affiliation(s)
- Jonathan Kaufman
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick Fitzpatrick
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Shidan Tosif
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sandy M Hopper
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan M Donath
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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49
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Osowicki J, Wong KJ, Donnan L, Bryant PA. Blackheads, whiteheads, femoral head. J Paediatr Child Health 2016; 52:781. [PMID: 27439638 DOI: 10.1111/jpc.13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/11/2015] [Accepted: 08/31/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Joshua Osowicki
- Infectious Diseases Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Division of Pediatric Infectious Diseases, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Ke Juin Wong
- Infectious Diseases Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Leo Donnan
- Department of Orthopaedics, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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50
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McMullan BJ, Andresen D, Blyth CC, Avent ML, Bowen AC, Britton PN, Clark JE, Cooper CM, Curtis N, Goeman E, Hazelton B, Haeusler GM, Khatami A, Newcombe JP, Osowicki J, Palasanthiran P, Starr M, Lai T, Nourse C, Francis JR, Isaacs D, Bryant PA. Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines. Lancet Infect Dis 2016; 16:e139-52. [PMID: 27321363 DOI: 10.1016/s1473-3099(16)30024-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 03/04/2016] [Accepted: 03/29/2016] [Indexed: 12/22/2022]
Abstract
Few studies are available to inform duration of intravenous antibiotics for children and when it is safe and appropriate to switch to oral antibiotics. We have systematically reviewed antibiotic duration and timing of intravenous to oral switch for 36 paediatric infectious diseases and developed evidence-graded recommendations on the basis of the review, guidelines, and expert consensus. We searched databases and obtained information from references identified and relevant guidelines. All eligible studies were assessed for quality. 4090 articles were identified and 170 studies were included. Evidence relating antibiotic duration to outcomes in children for some infections was supported by meta-analyses or randomised controlled trials; in other infections data were from retrospective series only. Criteria for intravenous to oral switch commonly included defervescence and clinical improvement with or without improvement in laboratory markers. Evidence suggests that intravenous to oral switch can occur earlier than previously recommended for some infections. We have synthesised recommendations for antibiotic duration and intravenous to oral switch to support clinical decision making and prospective research.
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Affiliation(s)
- Brendan J McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, NSW, Australia
| | - David Andresen
- Department of Infectious Diseases, Immunology, and HIV Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, WA, Australia; PathWest Laboratory Medicine, WA, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, WA, Australia
| | - Minyon L Avent
- The University of Queensland, UQ Centre for Clinical Research and School of Public Health, Herston, QLD, Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, WA, Australia; Menzies School of Health Research, Darwin, NT, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, WA, Australia
| | - Philip N Britton
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Julia E Clark
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Celia M Cooper
- Department of Microbiology and Infectious Diseases, SA Pathology, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Nigel Curtis
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Emma Goeman
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Briony Hazelton
- Sydney Medical School, University of Sydney, NSW, Australia; Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia
| | - Gabrielle M Haeusler
- Department of Infectious Diseases and Infection Control, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Infection and Immunity, Monash Children's Hospital, Clayton, VIC, Australia
| | - Ameneh Khatami
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - James P Newcombe
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Joshua Osowicki
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Pamela Palasanthiran
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, NSW, Australia
| | - Mike Starr
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Tony Lai
- Department of Pharmacy, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Clare Nourse
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Joshua R Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
| | - David Isaacs
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
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