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Moore DP, Chetty T, Pillay A, Karsas M, Cloete J, Balakrishna Y, Reddy T, Archary M, van Kwawegen A, Thomas R, Nakwa FL, Waggie Z, Magrath S, Goga A, Jeena P. Antibiotic and antifungal use in paediatric departments at three academic hospitals in South Africa. IJID Reg 2024; 10:151-158. [PMID: 38314394 PMCID: PMC10835277 DOI: 10.1016/j.ijregi.2023.12.004] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 02/06/2024]
Abstract
Objectives South Africa implemented a National Strategic Framework to optimise antimicrobial stewardship in 2014; however, there is limited data on how this has affected prescribing, especially to children treated in academic centres. Methods We conducted a point prevalence survey using the World Health Organization (WHO) methodology to evaluate antibiotic and antifungal prescribing practices in paediatric departments at three academic hospitals in South Africa. Results We recorded 1946 antimicrobial prescriptions in 1191 children, with 55.2% and 39.2% of the antibiotics classified as WHO AWaRe Access and Watch drugs, respectively. There were significant differences in prescription of Reserve antibiotics and antifungals between institutions. Receipt of WHO Watch and Reserve antibiotics was independently associated with infancy (<12 months) and adolescents (13-17 years) (adjusted relative risk [aRR]: 2.09-9.95); prolonged hospitalisation (aRR: 3.29-30.08); rapidly or ultimately fatal illness (aRR: 1.94 to 5.52); and blood transfusion (aRR: 3.28-5.70). Antifungal prescribing was associated with treatment of hospital-associated infection (aRR: 2.90), medical prophylaxis (aRR: 3.30), and treatment in intensive care units (aRR: 2.15-2.27). Conclusions Guidance on optimisation of infection prevention and control practice and strengthening of antimicrobial stewardship would impact positively on the care of sick children in our setting.
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Affiliation(s)
- David P. Moore
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Terusha Chetty
- HIV And Other Infectious Diseases Unit, South African Medical Research Council & Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ashendri Pillay
- Department of Paediatrics and Child Health, Inkosi Alert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, South Africa
| | - Maria Karsas
- Department of Paediatrics and Child Health, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
| | - Jeané Cloete
- Department of Paediatrics and Child Health, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
| | - Yusentha Balakrishna
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council, Durban, South Africa
| | - Moherndran Archary
- Department of Paediatrics and Child Health, Inkosi Alert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, South Africa
| | - Alison van Kwawegen
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Reenu Thomas
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Firdose L. Nakwa
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Zainab Waggie
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Stephanie Magrath
- Faculty of Health Sciences, University of the Witwatersrand, York Road, Parktown, Johannesburg, South Africa
| | - Ameena Goga
- Department of Paediatrics and Child Health, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
- South African Medical Research Council, Pretoria, South Africa
| | - Prakash Jeena
- Department of Paediatrics and Child Health, Inkosi Alert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, South Africa
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Schoenbuchner SM, Huang C, Waldron CA, Thomas-Jones E, Hood K, Carrol ED, Pallmann P. Biomarker-guided duration of antibiotic treatment in children hospitalised with confirmed or suspected bacterial infection: statistical analysis plan for the BATCH trial and PRECISE sub-study. Trials 2023; 24:364. [PMID: 37254156 DOI: 10.1186/s13063-022-06956-9] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION The BATCH trial is a multi-centre randomised controlled trial to compare procalcitonin-guided management of severe bacterial infection in children with current management. PRECISE is a mechanistic sub-study embedded into the BATCH trial. This paper describes the statistical analysis plan for the BATCH trial and PRECISE sub-study. METHODS The BATCH trial will assess the effectiveness of an additional procalcitonin test in children (aged 72 h to 18 years) hospitalised with suspected or confirmed bacterial infection to guide antimicrobial prescribing decisions. Participants will be enrolled in the trial from randomisation until day 28 follow-up. The co-primary outcomes are duration of intravenous antibiotic use and a composite safety outcome. Target sample size is 1942 patients, based on detecting a 1-day reduction in intravenous antibiotic use (90% power, two-sided) and on a non-inferiority margin of 5% risk difference in the composite safety outcome (90% power, one-sided), while allowing for up to 10% loss to follow-up. RESULTS Baseline characteristics will be summarised overall, by trial arm, and by whether patients were recruited before or after the pause in recruitment due to the COVID-19 pandemic. In the primary analysis, duration of intravenous antibiotic use will be tested for superiority using Cox regression, and the composite safety outcome will be tested for non-inferiority using logistic regression. The intervention will be judged successful if it reduces the duration of intravenous antibiotic use without compromising safety. Secondary analyses will include sensitivity analyses, pre-specified subgroup analyses, and analysis of secondary outcomes. Two sub-studies, including PRECISE, involve additional pre-specified subgroup analyses. All analyses will be adjusted for the balancing factors used in the randomisation, namely centre and patient age. CONCLUSION We describe the statistical analysis plan for the BATCH trial and PRECISE sub-study, including definitions of clinical outcomes, reporting guidelines, statistical principles, and analysis methods. The trial uses a design with co-primary superiority and non-inferiority endpoints. The analysis plan has been written prior to the completion of follow-up. TRIAL REGISTRATION BATCH: ISRCTN11369832, registered 20 September 2017, doi.org/10.1186/ISRCTN11369832. PRECISE ISRCTN14945050, registered 17 December 2020, doi.org/10.1186/ISRCTN14945050.
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Affiliation(s)
| | - Chao Huang
- Hull York Medical School, University of Hull, Hull, UK
| | | | | | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Enitan D Carrol
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
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Thoft DS, Nielsen BK, Enggaard H. To become an expert within a week: Children's and parents' experiences of the child being diagnosed with type 1 diabetes and receiving diabetes education - A qualitative interview study. J Pediatr Nurs 2022; 67:e24-30. [PMID: 36307293 DOI: 10.1016/j.pedn.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 10/01/2022] [Accepted: 10/11/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To explore children's and parents' experiences of the child being diagnosed with type 1 diabetes and receiving diabetes education during hospitalisation. DESIGN AND METHODS A qualitative interpretive design was applied. Semi-structured interviews with 15 children and their parent(s) were conducted. Data were analysed via thematic analysis. RESULTS The analysis revealed three themes: To be diagnosed with diabetes turns one's world upside down; It is positive to meet friendly and helpful healthcare professionals; and Diabetes education is overwhelming but required. CONCLUSIONS To be hospitalised and receive a diabetes diagnosis is overwhelming. The family must learn, in a short time, the basic skills to manage the condition. While learning, the child may fluctuate between being active and passive. In this vulnerable situation, it is positive to meet helpful healthcare professionals. Children find the motivation to learn, as they want to self-manage and be independent. All necessary education is given, but often the families would like to be more actively involved in the teaching. Sometimes, the teaching is also very compressed. PRACTICE IMPLICATIONS It is important to be aware of the vulnerable situation of the family and to adjust education to the fluctuations of the child. Teaching should be simplified and broken down stepwise, using pictures, artefacts, etc., to support the learning. More involvement may make education even more engaging and interesting. It has to be considered whether the education can be compressed into too short a time, making it difficult to transfer to the everyday lives of the families.
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Phiri PGMC, Chan CWH, Wong CL, Choi KC, Ng MSN. Discrepancies between nurses' current and perceived necessary practices of family-centred care for hospitalised children and their families: A cross-sectional study. J Pediatr Nurs 2022; 62:e25-e31. [PMID: 34229915 DOI: 10.1016/j.pedn.2021.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 02/25/2021] [Revised: 06/04/2021] [Accepted: 06/27/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE This study investigated (1) the discrepancies between the nurses' current and perceived necessary practices of family-centred care (FCC), and (2) the nurses' demographic characteristics associated with current and perceived necessary practices of FCC for hospitalised children and their families in Malawi. DESIGN AND METHODS A cross-sectional study involving 444 nurses was conducted. The Family-Centred Care Questionnaire-Revised was used to examine the discrepancies between the nurses' current and perceived necessary practices of FCC. Univariate and multivariate statistical analyses were performed to identify the nurses' demographic characteristics associated with current and perceived necessary practices of FCC. RESULTS The total mean score of the nurses' current practices of FCC (M = 34.78, SD = 7.06) was significantly lower than that of the nurses' practices of FCC that were perceived as necessary (M = 38.63, SD = 5.60, p < 0.001). The nurses who were over 40 years of age (regression coefficient, β = 9.162, p = 0.014), had a postgraduate qualification (β = 23.314, p < 0.001), were separated or widowed (β = 9.661, p = 0.029), had a Tumbuka cultural background (β = 12.984, p < 0.001), were Seventh-day Adventist members (β = 8.863, p = 0.026), and worked in mission hospitals (β = 16.401, p = 0.021) were more likely to implement current practices of FCC. Conversely, the nurses who were members of the Moslem, Buddhist, or Hindi religious denomination (β = 6.587, p = 0.040), had a Tonga or Ngonde cultural background (β = 6.625, p = 0.046), and were nurse midwife technicians (β = -23.528, p = 0.012) were more likely to implement practices of FCC that they perceived as necessary. CONCLUSION Significant differences between the nurses' current and perceived necessary practices of FCC suggested that there were barriers to implementing necessary practices of FCC. The nurses' cultural and religious backgrounds were predictors of current practices of FCC, and this finding could direct the future development and testing of FCC interventions in Malawi. PRACTICE IMPLICATIONS Continued educational activities and research on the factors that contributed to the discrepancies between the nurses' current and perceived necessary practices of FCC and their impact on FCC in Malawi are critical.
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Affiliation(s)
- Patrick G M C Phiri
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong Special Administrative Region
| | - Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong Special Administrative Region
| | - Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong Special Administrative Region.
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong Special Administrative Region
| | - Marques S N Ng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong Special Administrative Region
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Phiri PGMC, Malunga SS, Phiri LS. Health-Related Quality of Life of Nurses Caring for Hospitalised Children and Their Families: A National Cross-Sectional Study. J Pediatr Nurs 2021; 61:157-165. [PMID: 34090080 DOI: 10.1016/j.pedn.2021.05.016] [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: 12/02/2020] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Health-related quality of life (HRQoL) continues to be understudied among nurses in developing countries. This study aimed to assess (1) the HRQoL of nurses in Malawi caring for hospitalised children and their families, and (2) the nurses' demographic characteristics associated with their HRQoL. DESIGN AND METHODS The cross-sectional study was carried out at 23 hospitals in Malawi, and 203 nurses participated, resulting in a 96% response rate. The Medical Outcomes Study 36-Item Short Form Health Survey was used to collect data. The physical and mental health component scores were evaluated and compared with those in a Cyprus study as the population norm. Both univariate and multivariate analyses were performed, with the significance level set at 0.05. RESULTS The nurses' HRQoL was moderately impaired; however, the mean scores of both the physical and the mental health components of the nurses in the Cyprus study were statistically lower than those of the Malawian nurses (t = 36.541, p < 0.001 and t = 19.477, p < 0.001, respectively). Age was independently associated with a better physical health status (β = 29.949, p = 0.038), while female nurses were more likely to report a negative physical health status compared with male nurses (β = -97.481, p = 0.002). CONCLUSION The findings suggested that the Malawian nurses were affected by work-related stress, which affected their mental and physical health status. The current findings represent preliminary data, and as such further studies on the association between work-related factors and HRQoL are needed. PRACTICE IMPLICATIONS Knowledge of HRQoL from the perspective of nurses can help healthcare organisations to develop interventions to limit the negative impacts of work-related stress on nurses caring for children.
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Affiliation(s)
| | | | - Lophina Sitima Phiri
- PACHA Malawi, College of Medicine, Pediatric Department, Queen Elizabeth Hospital, Malawi
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Birindwa AM, Kasereka JK, Gonzales-Siles L, Geravandi S, Mwilo M, Tudiakwile LK, Mwinja NL, Muhigirwa B, Kashosi T, Manegabe JT, Bugashane EB, Saili SM, Mungo C, Nordén R, Andersson R, Skovbjerg S. Bacteria and viruses in the upper respiratory tract of Congolese children with radiologically confirmed pneumonia. BMC Infect Dis 2021; 21:837. [PMID: 34412597 PMCID: PMC8374414 DOI: 10.1186/s12879-021-06570-1] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/12/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Acute pneumonia remains a leading cause of death among children below 5 years of age in the Democratic Republic of the Congo (DR Congo), despite introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in 2013. Potential pathogens in the nasopharynx of hospitalised children with pneumonia have not been studied previously in DR Congo. Here we compare clinical characteristics, risk factors and nasopharyngeal occurrence of bacteria and viruses between children with severe and non-severe pneumonia. METHODS Between June 2015 and June 2017, 116 children aged from 2 to 59 months hospitalised due to radiologically confirmed pneumonia at Panzi referral university hospital, Bukavu, Eastern DR Congo were included in the study and sampled from nasopharynx. A multiplex real-time PCR assay for detection of 15 different viruses and 5 bacterial species was performed and another multiplex PCR assay was used for pneumococcal serotype/serogroup determination. RESULTS During the study period 85 (73%) of the children with radiologically confirmed pneumonia met the WHO classification criteria of severe pneumonia and 31 (27%) had non-severe pneumonia. The fatality rate was 9.5%. Almost all (87%) children were treated with antibiotics before they were hospitalised, in most cases with amoxicillin (58%) or trimethoprim-sulfamethoxazole (20%). The frequency of potential pathogens in the nasopharynx of the children was high, and any viral or bacterial nucleic acids present at high levels, irrespective of species or type, were significantly associated with severe pneumonia as compared with non-severe cases (52% versus 29%, p = 0.032). White blood cell count > 20,000/μL and C-Reactive Protein > 75 mg/dL were associated with severe pneumonia at admission. Fatal outcome was in the multivariable analysis associated with having a congenital disease as an underlying condition. One or more pneumococcal serotypes/serogroups could be identified in 61 patients, and out of all identified serotypes 31/83 (37%) were non-PCV13 serotypes. CONCLUSIONS The occurrence of any bacteria or any viruses at high levels was associated with severe pneumonia at admission. Children with congenital disorders might need a higher attention when having symptoms of acute respiratory infection, as developed pneumonia could lead to fatal outcome.
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Affiliation(s)
- Archippe M. Birindwa
- grid.8761.80000 0000 9919 9582Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden ,Panzi Hospital, Bukavu, Democratic Republic of the Congo ,grid.442835.c0000 0004 6019 1275Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo ,Hôpital Général de Référence de Panzi, BP: 266, Bukavu, Democratic Republic of the Congo
| | - Jerry K. Kasereka
- Panzi Hospital, Bukavu, Democratic Republic of the Congo ,grid.442835.c0000 0004 6019 1275Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo
| | - Lucia Gonzales-Siles
- grid.8761.80000 0000 9919 9582Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Shadi Geravandi
- grid.8761.80000 0000 9919 9582Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Mambo Mwilo
- Panzi Hospital, Bukavu, Democratic Republic of the Congo ,grid.442835.c0000 0004 6019 1275Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo
| | - Léonard K. Tudiakwile
- Panzi Hospital, Bukavu, Democratic Republic of the Congo ,grid.442835.c0000 0004 6019 1275Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo
| | - Néné L. Mwinja
- Panzi Hospital, Bukavu, Democratic Republic of the Congo ,grid.442835.c0000 0004 6019 1275Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo
| | | | - Théophile Kashosi
- grid.442835.c0000 0004 6019 1275Université Evangélique en Afrique, Bukavu, Democratic Republic of the Congo
| | | | | | - Stay M. Saili
- Panzi Hospital, Bukavu, Democratic Republic of the Congo
| | - Clement Mungo
- Panzi Hospital, Bukavu, Democratic Republic of the Congo
| | - Rickard Nordén
- grid.8761.80000 0000 9919 9582Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Rune Andersson
- grid.8761.80000 0000 9919 9582Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582CARe – Centre for Antibiotic Resistance Research, Gothenburg University, Gothenburg, Sweden
| | - Susann Skovbjerg
- grid.8761.80000 0000 9919 9582Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden ,grid.1649.a000000009445082XDepartment of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582CARe – Centre for Antibiotic Resistance Research, Gothenburg University, Gothenburg, Sweden
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Huysentruyt K, Goyens P, Alliet P, Bontems P, Van Hautem H, Philippet P, Vandenplas Y, De Schepper J. More training and awareness are needed to improve the recognition of undernutrition in hospitalised children. Acta Paediatr 2015; 104:801-7. [PMID: 25847425 DOI: 10.1111/apa.13014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 10/16/2014] [Revised: 01/17/2015] [Accepted: 03/19/2015] [Indexed: 11/28/2022]
Abstract
AIM Reports suggest that 10% of hospitalised children in Europe are undernourished. We investigated whether nutritional screening tools (NST) were used in Belgian secondary-level hospitals, examined strategies for detecting undernutrition and identified barriers preventing the systematic management of undernutrition. METHODS A nationwide questionnaire-based survey of paediatric departments in Belgian secondary-level hospitals was carried out from September 2013 to February 2014. Respondents were dived into French-speaking (Walloon + Brussels) and Dutch-speaking (Flemish) departments. RESULTS We received replies from 71 of the 97 (73.2%) departments. Half of the departments - 39.5% Flemish speaking and 71.4% Walloon speaking - carried out nutritional screening. Undernutrition was identified by measuring weight and length or height (92.7% of cases), clinical appraisal (74.7%), mid-upper arm circumference and/or skin fold thickness (19.7%). There was no protocol for undernutrition in many Flemish (60.5%)- and Walloon (28.6%)-speaking departments. Reasons given for not screening were as follows: lack of training (46.9%), ignorance of NST (42.2%) and lack of time (29.7%). CONCLUSION Half of the paediatric departments in Belgian secondary-level hospitals did not carry out nutritional screening, and differences in current practices and attitudes may be due to cultural and/or educational differences.
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Affiliation(s)
- Koen Huysentruyt
- Department of Paediatrics; Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel (VUB); Brussels Belgium
| | - Philippe Goyens
- Nutrition and Metabolism Unit; Department of Paediatrics; University Children's Hospital Queen Fabiola; Brussels Belgium
| | | | - Patrick Bontems
- Department of Paediatrics; Centre Hospitalier Universitaire Tivoli; La Louvière Belgium
| | - Hilde Van Hautem
- Department of Paediatrics; Sint-Maria Hospital; Halle Belgium; for VVK (Vlaamse Vereniging voor Kindergeneeskunde)
| | - Pierre Philippet
- Department of Paediatrics; CHC - Espérance; Liège Belgium; for GBPF (Groupement Belge des Pédiatres de Langue Française)
| | - Yvan Vandenplas
- Department of Paediatrics; Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel (VUB); Brussels Belgium
| | - Jean De Schepper
- Department of Paediatrics; Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel (VUB); Brussels Belgium
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Raastad R, Tvete IF, Abrahamsen TG, Berild D, Leegaard TM, Walberg M, Müller F. A worrying trend in weight-adjusted paediatric antibiotic use in a Norwegian tertiary care hospital. Acta Paediatr 2015; 104:687-92. [PMID: 25753620 DOI: 10.1111/apa.12994] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/29/2014] [Accepted: 03/05/2015] [Indexed: 11/28/2022]
Abstract
AIM The World Health Organization recommends the defined daily dose (DDD) as the standard unit of measurement for antibiotic use, but this is not applicable in children. We aimed to assess paediatric antibiotic use in a Norwegian tertiary care hospital using a novel weight-adjusted method. METHODS We obtained antibiotic purchase data from the hospital pharmacy and administrative data for all admissions from 2002 to 2009 to the paediatric wards at Oslo University Hospital, Rikshospitalet. Recommended daily doses per 100 kg days (RDDs/kg days) were calculated based on national guidelines for paediatric antibiotic use, length of stay and estimated weight for sex and age using national growth references. RESULTS Total antibiotic use increased significantly from 51.8 to 65.5 RDDs/100 kg days. We found statistically significant annual increases in the consumption of carbapenems (18.0%), third-generation cephalosporins (6.0%) and imidazole derivatives (6.6%) and a considerable difference between total antibiotic use measured in RDDs/100 kg days and DDDs/100 bed days for neonates. CONCLUSION Weight-adjusted antibiotic use provided a more meaningful description of the quantities of antibiotics consumed than DDDs/100 bed days, particularly for neonates. Total antibiotic use, use of meropenem, third-generation cephalosporins and imidazole derivatives increased significantly despite low prevalence of antibiotic-resistant pathogens.
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Affiliation(s)
- Ragnhild Raastad
- Department of Infectious Diseases; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | | | - Tore G. Abrahamsen
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Pediatrics; Oslo University Hospital; Oslo Norway
| | - Dag Berild
- Department of Infectious Diseases; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Truls M. Leegaard
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Microbiology and Infection Control; Akershus University Hospital; Lørenskog Norway
| | - Mette Walberg
- Microbiology Section; Laboratory Centre; Vestre Viken Hospital Trust; Rud Norway
| | - Fredrik Müller
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Microbiology; Oslo University Hospital; Oslo Norway
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