1
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Jayawardena-Thabrew H, Warris A, Ferreras-Antolin L, Demirjian A, Drysdale SB, Emonts M, McMaster P, Paulus S, Patel S, Kinsey S, Vergnano S, Whittaker E, Ferreras-Antolin L. Nystatin is commonly prescribed as prophylaxis in children beyond the neonatal age. Med Mycol 2022; 61:6969424. [PMID: 36610724 DOI: 10.1093/mmy/myac097] [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] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/12/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
The indications for nystatin as prophylaxis or treatment are limited. In the PASOAP (Pediatric Antifungal Stewardship Optimizing Antifungal Prescription) study, high use of nystatin in hospitalized children beyond the neonatal age was observed. In this report, we present the data on nystatin use in infants and children ≥ 3 months who participated in the PASOAP study. Nystatin was prescribed mainly for prophylaxis. Congenital heart disease, cystic fibrosis, and chronic renal disease were the most commonly reported conditions in children receiving prophylactic nystatin. There is sparse evidence supporting the use of nystatin prophylaxis beyond neonates; trials in specific pediatric patient groups are required.
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Affiliation(s)
| | - Adilia Warris
- Medical Research Council Center for Medical Mycology, University of Exeter, Exeter, United Kingdom.,Department of Pediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, United Kingdom
| | | | - Laura Ferreras-Antolin
- Medical Research Council Center for Medical Mycology, University of Exeter, Exeter, United Kingdom.,Pediatric Infectious Diseases and Immunology Unit, St George's University Hospitals, NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | - Laura Ferreras-Antolin
- Medical Research Council Centre for Medical Mycology. University of Exeter , UK
- Paediatric Infectious Diseases and Immunology Unit. St George's University Hospitals NHS Foundation Trust , London , UK
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2
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Sherwood E, Vergnano S, Kakuchi I, Bruce MG, Chaurasia S, David S, Dramowski A, Georges S, Guy R, Lamagni T, Levy-Bruhl D, Lyytikäinen O, Naus M, Okaro JO, Oppegaard O, Vestrheim DF, Zulz T, Steer AC, Van Beneden CA, Seale AC. Invasive group A streptococcal disease in pregnant women and young children: a systematic review and meta-analysis. Lancet Infect Dis 2022; 22:1076-1088. [PMID: 35390294 PMCID: PMC9217756 DOI: 10.1016/s1473-3099(21)00672-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The incidence of invasive disease caused by group A streptococcus (GAS) has increased in multiple countries in the past 15 years. However, despite these reports, to the best of our knowledge, no systematic reviews and combined estimates of the incidence of invasive GAS have been done in key high-risk groups. To address this, we estimated the incidence of invasive GAS disease, including death and disability outcomes, among two high-risk groups-namely, pregnant women and children younger than 5 years. METHODS We did a systematic review and meta-analyses on invasive GAS outcomes, including incidence, case fatality risks, and neurodevelopmental impairment risk, among pregnant women, neonates (younger than 28 days), infants (younger than 1 year), and children (younger than 5 years) worldwide and by income region. We searched several databases for articles published from Jan 1, 2000, to June 3, 2020, for publications that reported invasive GAS outcomes, and we sought unpublished data from an investigator group of collaborators. We included studies with data on invasive GAS cases, defined as laboratory isolation of Streptococcus pyogenes from any normally sterile site, or isolation of S pyogenes from a non-sterile site in a patient with necrotising fasciitis or streptococcal toxic shock syndrome. For inclusion in pooled incidence estimates, studies had to report a population denominator, and for inclusion in pooled estimates of case fatality risk, studies had to report aggregate data on the outcome of interest and the total number of cases included as a denominator. We excluded studies focusing on groups at very high risk (eg, only preterm infants). We assessed heterogeneity with I2. FINDINGS Of the 950 published articles and 29 unpublished datasets identified, 20 studies (seven unpublished; 3829 cases of invasive GAS) from 12 countries provided sufficient data to be included in pooled estimates of outcomes. We did not identify studies reporting invasive GAS incidence among pregnant women in low-income and middle-income countries (LMICs) nor any reporting neurodevelopmental impairment after invasive GAS in LMICs. In nine studies from high-income countries (HICs) that reported invasive GAS in pregnancy and the post-partum period, invasive GAS incidence was 0·12 per 1000 livebirths (95% CI 0·11 to 0·14; I2=100%). Invasive GAS incidence was 0·04 per 1000 livebirths (0·03 to 0·05; I2=100%; 11 studies) for neonates, 0·13 per 1000 livebirths (0·10 to 0·16; I2=100%; ten studies) for infants, and 0·09 per 1000 person-years (95% CI 0·07 to 0·10; I2=100%; nine studies) for children worldwide; 0·12 per 1000 livebirths (95% CI 0·00 to 0·24; I2=100%; three studies) in neonates, 0·33 per 1000 livebirths (-0·22 to 0·88; I2=100%; two studies) in infants, and 0·22 per 1000 person-years (0·13 to 0·31; I2=100%; two studies) in children in LMICs; and 0·02 per 1000 livebirths (0·00 to 0·03; I2=100%; eight studies) in neonates, 0·08 per 1000 livebirths (0·05 to 0·11; I2=100%; eight studies) in infants, and 0·05 per 1000 person-years (0·03 to 0·06; I2=100%; seven studies) in children for HICs. Case fatality risks were high, particularly among neonates in LMICs (61% [95% CI 33 to 89]; I2=54%; two studies). INTERPRETATION We found a substantial burden of invasive GAS among young children. In LMICs, little data were available for neonates and children and no data were available for pregnant women. Incidences of invasive GAS are likely to be underestimates, particularly in LMICs, due to low GAS surveillance. It is essential to improve available data to inform development of prevention and management strategies for invasive GAS. FUNDING Wellcome Trust.
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Affiliation(s)
- Emma Sherwood
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Stefania Vergnano
- Paediatric Infectious Diseases, Bristol Royal Hospital for Children, University Hospitals Bristol NHS, Bristol, UK
| | - Isona Kakuchi
- Paediatric Infectious Diseases, Bristol Royal Hospital for Children, University Hospitals Bristol NHS, Bristol, UK
| | - Michael G Bruce
- Centers for Disease Control and Prevention, Arctic Investigations Program, Anchorage, Alaska, USA
| | - Suman Chaurasia
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Samara David
- British Columbia Centre for Disease Control, University of British Columbia, BC, Canada
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Scarlett Georges
- Infectious Diseases Department, Santé Publique France, French National Public Health Agency, St Maurice, France
| | - Rebecca Guy
- National Infection Service, UK Health Security Agency, London, UK
| | - Theresa Lamagni
- National Infection Service, UK Health Security Agency, London, UK
| | - Daniel Levy-Bruhl
- Infectious Diseases Department, Santé Publique France, French National Public Health Agency, St Maurice, France
| | - Outi Lyytikäinen
- National Institute for Health and Welfare, Department of Health Security, Infectious Disease Control and Vaccinations Unit, Helsinki, Finland
| | - Monika Naus
- British Columbia Centre for Disease Control, University of British Columbia, BC, Canada
| | | | - Oddvar Oppegaard
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Didrik F Vestrheim
- Department of Vaccine Preventable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Tammy Zulz
- Centers for Disease Control and Prevention, Arctic Investigations Program, Anchorage, Alaska, USA
| | - Andrew C Steer
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | - Anna C Seale
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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3
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Shears A, Demirjian A, McGarrity O, Vergnano S, Patel SV, McMaster P. Narrowing the spectrum: development of a UK paediatric antimicrobial prescribing summary. Arch Dis Child 2022; 107:698-699. [PMID: 35190382 DOI: 10.1136/archdischild-2022-323858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Annalie Shears
- Paediatrics, Manchester University NHS Foundation Trust, Manchester, UK
| | - Alicia Demirjian
- Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK.,Health Associated Infections and Antimicrobial Resistance, UK Health Security Agency, London, UK.,Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | | | - Stefania Vergnano
- Paediatric Infectious Diseases and Immunology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sanjay Valabh Patel
- Paediatric Infectious Diseases and Immunology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paddy McMaster
- Paediatric Infectious Diseases, Manchester University NHS Foundation Trust, Manchester, UK
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4
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Ferreras-Antolín L, Irwin A, Atra A, Chapelle F, Drysdale SB, Emonts M, McMaster P, Paulus S, Patel S, Rompola M, Vergnano S, Whittaker E, Warris A. Pediatric Antifungal Prescribing Patterns Identify Significant Opportunities to Rationalize Antifungal Use in Children. Pediatr Infect Dis J 2022; 41:e69-e74. [PMID: 34784303 PMCID: PMC8826618 DOI: 10.1097/inf.0000000000003402] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The need for pediatric antifungal stewardship programs has been driven by an increasing consumption of antifungals for prophylactic and empirical use. Drivers and rational of antifungal prescribing need to be identified to optimize prescription behaviors. METHODS A prospective modified weekly Point Prevalence Survey capturing antifungal prescriptions for children (> 90 days to < 18 years of age) in 12 centers in England during 26 consecutive weeks was performed. Demographic, diagnostic and treatment information was collected for each patient. Data were entered into an online REDCap database. RESULTS One thousand two hundred fifty-eight prescriptions were included for 656 pediatric patients, 44.9% were girls, with a median age of 6.4 years (interquartile range, 2.5-11.3). Most common underlying condition was malignancy (55.5%). Four hundred nineteen (63.9%) received antifungals for prophylaxis, and 237 (36.1%) for treatment. Among patients receiving antifungal prophylaxis, 40.2% did not belong to a high-risk group. In those receiving antifungal treatment, 45.9%, 29.4%, 5.1% and 19.6% had a diagnosis of suspected, possible, probable of proven invasive fungal disease (IFD), respectively. Proven IFD was diagnosed in 78 patients, 84.6% (n = 66) suffered from invasive candidiasis and 15.4% (n = 12) from an invasive mold infection. Liposomal amphotericin B was the most commonly prescribed antifungal for both prophylaxis (36.6%) and empiric and preemptive treatment (47.9%). Throughout the duration of the study, 72 (11.0%) patients received combination antifungal therapy. CONCLUSIONS Antifungal use in pediatric patients is dominated by liposomal amphotericin B and often without evidence for the presence of IFD. A significant proportion of prophylactic and empiric antifungal use was seen in pediatric patients not at high-risk for IFD.
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Affiliation(s)
- Laura Ferreras-Antolín
- From the Medical Research Council Centre for Medical Mycology, University of Exeter, United Kingdom
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Adam Irwin
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, United Kingdom
- The University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Ayad Atra
- Department of Paediatric Oncology, Royal Marsden Hospital, Downs Road, Sutton, London, United Kingdom
| | - Faye Chapelle
- Department of Infectious Diseases and Immunology, Evelina Children Hospital, London, United Kingdom
| | - Simon B. Drysdale
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Marieke Emonts
- Department of Paediatric Immunology, Infectious Diseases and Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paddy McMaster
- Department of Paediatric Infectious Diseases, Royal Manchester Childrens´ Hospital, Manchester, United Kingdom
| | - Stephane Paulus
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Sanjay Patel
- Department of Paediatric Infectious Diseases, University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - Menie Rompola
- Dept. of Paediatric Haematology and Oncology, Leeds General Infirmary, Leeds, United Kingdom
| | - Stefania Vergnano
- Department of Paediatric Infectious Diseases, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Elizabeth Whittaker
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust and Section of Paediatrics, Department of Infectious Diseases, Imperial College, London, United Kingdom
| | - Adilia Warris
- From the Medical Research Council Centre for Medical Mycology, University of Exeter, United Kingdom
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, United Kingdom
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5
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Vergnano S, Godbole G, Simbo A, Smith-Palmer A, Cormican M, Anthony M, Heath PT. Listeria infection in young infants: results from a national surveillance study in the UK and Ireland. Arch Dis Child 2021; 106:1207-1210. [PMID: 33985959 DOI: 10.1136/archdischild-2021-321602] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe the epidemiology, age at infection, clinical characteristics and outcome of listeria infection in young infants to inform management and empiric antibiotic choice in young infants. DESIGN Prospective 2-year surveillance of Listeria monocytogenes infection in young infants detected through the British Paediatric Surveillance Unit 'orange card' system and triangulated with the public health laboratories. SETTING National population study (England, Wales, Scotland and the Ireland) PATIENTS: All infants under 90 days with proven or probable invasive listeriosis MAIN OUTCOME MEASURES: Incidence, mortality, age of infection, clinical characteristics and outcome RESULTS: During a 2-year period (2017-2019), 27 cases of listeriosis in infants <90 days of age were reported. The incidence of listeriosis in this study was 1.8 per 100 000 live births with 7% mortality (2/27). Nearly all cases presented within the first 24 hours of life (26/27). The majority (20/27, 74%) were born preterm and 16/24 (67%) were born to women from ethnic minority backgrounds. CONCLUSIONS Invasive listeriosis in young infants in the UK and Ireland is rare and presents early in the neonatal period. National guidelines that recommend the use of amoxicillin as part of empiric regimes for sepsis and meningitis in infants over 1 month of age should be modified.
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Affiliation(s)
- Stefania Vergnano
- Paediatric Infectious Diseases, Bristol Royal Hospital for Children, Bristol, UK .,Infection and Immunity, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Gauri Godbole
- Gastrointestinal Pathogens Unit, National Infection Service, Public Health England, London, UK
| | - Ameze Simbo
- Gastrointestinal Pathogens Unit, National Infection Service, Public Health England, London, UK
| | | | - Martin Cormican
- Division of Microbiology, Galway University Hospitals, Galway, Ireland
| | - Mark Anthony
- Neonatology, John Radcliffe Hospital, Oxford, Oxfordshire, UK
| | - Paul T Heath
- Paediatric Infectious Disease Research Group, University of London Saint George's, London, UK
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6
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Maccora I, Ramanan AV, Vergnano S, Roderick MR. Sideroblastic anaemia, immunodeficiency, periodic fevers and developmental delay (SIFD) presenting as systemic inflammation with arthritis. Rheumatology (Oxford) 2021; 60:e234-e236. [PMID: 33493307 DOI: 10.1093/rheumatology/keab010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/24/2020] [Accepted: 12/19/2020] [Indexed: 01/28/2023] Open
Affiliation(s)
- I Maccora
- Paediatric Rheumatology Unit, Anna Meyer Children's University Hospital, School of Human Health Science, Florence, Italy
| | - A V Ramanan
- Bristol Royal Hospital for Children, Translational Health Sciences, University of Bristol, Bristol, UK
| | - S Vergnano
- Paediatric Immunology and Infectious Diseases Service, Bristol Royal Hospital for Children & Bristol Children's Vaccine Centre, Schools of Cellular and Molecular Medicine Population Health Sciences, University of Bristol, Bristol, UK
| | - M R Roderick
- Paediatric Immunology and Infectious Diseases Service, Bristol Royal Hospital for Children & Bristol Children's Vaccine Centre, Schools of Cellular and Molecular Medicine Population Health Sciences, University of Bristol, Bristol, UK
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7
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Vergnano S, Alders N, Armstrong C, Bamber AR, Bandi S, Evans JA, Hajiani N, Kenny J, Kucera F, Tometzki A, Uzun O, Wilkinson N, Ramanan AV. Severe refractory Kawasaki disease in seven infants in the COVID-19 era. Lancet Rheumatol 2020; 2:e520. [PMID: 32838312 PMCID: PMC7351415 DOI: 10.1016/s2665-9913(20)30231-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Stefania Vergnano
- Department of Paediatric Infectious Diseases, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
| | - Nele Alders
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Catherine Armstrong
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
| | - Andrew R Bamber
- Department of Paediatrics, North Bristol NHS Trust, Bristol, UK
| | - Srini Bandi
- Department of Paediatrics, Leicester Children's Hospital, Leicester, UK
| | - Jennifer A Evans
- Department of Paediatrics, Cardiff and Vale University Health Board-Child Health, Cardiff, UK
| | - Nadia Hajiani
- Department of Paediatrics, Leicester Children's Hospital, Leicester, UK
| | - Julia Kenny
- Department of Paediatric Infectious Diseases, Evelina London Children's Healthcare, London, UK
| | - Filip Kucera
- Department of Paediatric Cardiology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Andrew Tometzki
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
| | - Orhan Uzun
- Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, UK
| | - Nick Wilkinson
- Department of Paediatric Rheumatology, Evelina London Children's Healthcare, London, UK
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
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8
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Vergnano S, Bamford A, Bandi S, Chappel F, Demirjian A, Doerholt K, Emonts M, Ferreras-Antolin L, Goenka A, Jones L, Herberg JA, Hinds L, McGarrity O, Moriarty P, O'Riordan S, Patel M, Paulus S, Porter D, Stock K, Patel S. Paediatric antimicrobial stewardship programmes in the UK's regional children's hospitals. J Hosp Infect 2020; 105:736-740. [PMID: 32454075 DOI: 10.1016/j.jhin.2020.05.030] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/19/2020] [Indexed: 11/24/2022]
Abstract
A survey was conducted in UK regional children's hospitals with paediatric intensive care and paediatric infectious disease (PID) departments to describe the characteristics of paediatric antimicrobial stewardship (PAS) programmes. A structured questionnaire was sent to PAS coordinators. 'Audit and feedback' was implemented in 13 out of 17 centres. Microbiology-led services were more likely to implement antimicrobial restriction (75% vs 33% in PID-led services), to focus on broad-spectrum antibiotics, and to review patients with positive blood cultures. PID-led services were more likely to identify patients from e-prescribing or drug charts and review all antimicrobials. A PAS network has been established.
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Affiliation(s)
- S Vergnano
- University of Bristol, Bristol, UK; Bristol Royal Hospital for Children, Bristol, UK.
| | - A Bamford
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - S Bandi
- Leicester Royal Infirmary, Leicester, UK
| | - F Chappel
- Evelina London Children's Hospital, London, UK
| | - A Demirjian
- Evelina London Children's Hospital, London, UK
| | | | - M Emonts
- The Great North Children's Hospital, Newcastle, UK
| | | | - A Goenka
- Royal Manchester Children's Hospital, Manchester, UK
| | - L Jones
- Royal Hospital for Sick Children, Edinburgh, UK
| | | | - L Hinds
- Sheffield Children's Hospital, London, UK
| | - O McGarrity
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - P Moriarty
- Royal Belfast Hospital for Sick Children, Northern Ireland, Belfast, UK
| | | | - M Patel
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - S Paulus
- John Radcliffe Hospital, Oxford, UK
| | - D Porter
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - K Stock
- Royal Hospital for Children, Glasgow, UK
| | - S Patel
- Southampton Children's Hospital, Southampton, UK
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9
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Vergnano S, Chappell F, Bamford A, Demirjian A, Doerholt K, Emonts M, Goenka A, Jones L, Herberg JH, Hinds LH, McGarrity O, Moriarty P, Patel M, Paulus S, Porter D, Stock K, Patel S. UK Paediatric Antimicrobial Stewardship: a call for action. Access Microbiol 2020. [DOI: 10.1099/acmi.fis2019.po0078] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Stefania Vergnano
- Bristol Royal Children Hospital, Bristol, United Kingdom
- University of Bristol, Bristol, United Kingdom
| | | | - Alasdair Bamford
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London
| | - Alicia Demirjian
- Paediatric Infectious Diseases and Immunology, Evelina Children Hospital, London
| | - Katja Doerholt
- Paediatric Infectious Diseases and Immunology Department, St George's University Hospital, London
| | - Marieke Emonts
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne
- Paediatric Immunology, Infectious Diseases and Allergy Department, Great North Children's Hospital
| | - Anu Goenka
- Royal Manchester Children Hospitals, Manchester University Hospital NHS Foundation Trust, Manchester
| | - Laura Jones
- Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | | | - Lucy Hinds Hinds
- Sheffield Children NHS Foundation Trust, Sheffield, United Kingdom
| | - Orlagh McGarrity
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London
| | - Paul Moriarty
- Royal Belfast Hospital for Sick Children, Belfast, United Kingdom
| | - Mitul Patel
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | | | - David Porter
- Alder Hey Children Hospital, Liverpool, United Kingdom
| | - Kate Stock
- Royal Hospital for Children, Glasgow, United Kingdom
| | - Sanjay Patel
- Paediatric Infectious Diseases and Immunology Department, Southampton Children Hospital, Southampton, United Kingdom
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10
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Vergnano S, Seale AC, Fitchett EJA, Sharland M, Heath PT. Serious bacterial infections in neonates: improving reporting and case definitions. Int Health 2017; 9:148-155. [PMID: 28582556 DOI: 10.1093/inthealth/ihx011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 11/11/2016] [Accepted: 04/21/2017] [Indexed: 12/31/2022] Open
Abstract
Neonatal infections affect about 7 million neonates causing over 600 000 deaths every year. Estimating the burden is challenging as there are multiple reporting criteria and definitions for serious bacterial infections in neonates. Essential criteria for reporting serious neonatal bacterial infections have recently been published as the STROBE-NI checklist and, in the context of maternal vaccination, definitions have been published by the Brighton Collaboration Global Alignment of Immunization safety Assessment in pregnancy (GAIA) project. Standardisation of reporting criteria is essential to allow data comparability. This an important step in providing a clearer picture of the burden of serious bacterial infections in neonates and a welcome progress for guiding new investments in interventions.
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Affiliation(s)
- Stefania Vergnano
- Paediatric Infectious Disease Research Group, Department of Infection and Immunity, St George's University of London, Jenner wing, London, UK
| | - Anna C Seale
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK.,The Farr Institute of Health Informatics Research, University College London, London, UK
| | | | - Mike Sharland
- Paediatric Infectious Disease Research Group, Department of Infection and Immunity, St George's University of London, Jenner wing, London, UK
| | - Paul T Heath
- Paediatric Infectious Disease Research Group, Department of Infection and Immunity, St George's University of London, Jenner wing, London, UK
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11
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Sapuan S, Kortsalioudaki C, Anthony M, Chang J, Embleton ND, Geethanath RM, Gray J, Greenough A, Lal MK, Luck S, Pattnayak S, Reynolds P, Russell AB, Scorrer T, Turner M, Heath PT, Vergnano S. Neonatal listeriosis in the UK 2004-2014. J Infect 2016; 74:236-242. [PMID: 27867063 DOI: 10.1016/j.jinf.2016.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 02/02/2016] [Revised: 09/20/2016] [Accepted: 11/10/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To define the clinical features and outcomes of neonatal listeriosis, and identify the maternal risk factors to seek scope for improvement. METHODS Neonatal listeriosis was identified prospectively from a United Kingdom neonatal infection surveillance network (neonIN) between 2004 and 2014. The participating neonatal units completed a study-specific proforma. RESULTS The incidence of neonatal listeriosis was 3.4 per 100,000 live births. Of the 21 cases identified, 19 were confirmed with a median gestational age of 33 weeks and a median birth weight of 1960 g. The majority had clinical features (95%, 18/19), presented within the first 24 h (95%, 18/19), and received penicillin empirically (94%, 18/19). The neonatal case-fatality rate was 21% (24% if probable cases were included). A proportion of mothers were investigated (60%, 12/18) and diagnosed with listeriosis (58%, 7/12); 32% (6/19) were treated with antibiotics but only 33% (6/12) included penicillin. DISCUSSION Despite its rarity and the prompt and appropriate use of antibiotics neonatal listeriosis has a high case-fatality rate. There is room for improvement in the adherence to the empiric antibiotic choice for puerperal sepsis, according to the national guidelines as this, would target listeriosis. Strategies should be in place to prevent pregnancy-associated listeriosis in higher risk population.
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Affiliation(s)
- Shari Sapuan
- Paediatric Infectious Diseases Research Group, St George's University of London, Jenner Wing, Level 2, Room 2.215E, Mail Point J2C, London, SW17 0RE, UK.
| | - Christina Kortsalioudaki
- Paediatric Infectious Diseases Research Group, St George's University of London, Jenner Wing, Level 2, Room 2.215E, Mail Point J2C, London, SW17 0RE, UK.
| | - Mark Anthony
- Children's Services, John Radcliffe Hospital, Oxford University Hospitals NHSFT, Newborn Care Unit, Headington, Oxford, OX3 9DU, UK.
| | - John Chang
- Croydon Health Services NHS Trust, St George's University of London, Croydon University Hospital, 530 London Rd, Croydon, Surrey, CR7 7YE, UK.
| | - Nicholas D Embleton
- Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK.
| | - Ruppa M Geethanath
- City Hospital Sunderland NHSFT, Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP, UK.
| | - Jim Gray
- Birmingham Children's Hospital NHSFT, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Anne Greenough
- King's College London, King's Health Partners, Royal College of Paediatrics and Child Health, Neonatal Intensive Care Unit, King's College Hospital, 4th Floor Golden Jubilee Wing, Denmark Hill, SE5 9RS, UK.
| | - Mithilesh K Lal
- Department of Neonatal Medicine, The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
| | - Suzanne Luck
- Kingston Hospital NHS Trust, Galsworthy Rd, Kingston upon Thames, KT2 7QB, UK.
| | - Santosh Pattnayak
- Kent Neonatal Transport Service, Medway NHS Foundation Trust, Gillingham Kent, ME7 5NY, UK.
| | - Peter Reynolds
- Department of Paediatrics, St. Peter's Hospital, Ashford and St. Peter's Hospitals NHSFT, Royal Holloway University of London, Surrey & Sussex Neonatal ODN, Guildford Road, Surrey, KT16 0PZ, UK.
| | - Allison B Russell
- Birmingham Women's NHSFT, West Midlands Maternity and Children's Strategic Clinical Network, Mindelsohn Way, Birmingham, B15 2TG, UK.
| | - Timothy Scorrer
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Southwick Hill Road, Portsmouth, PO6 3LY, UK.
| | - Mark Turner
- Women's and Children's Health, University of Liverpool, Liverpool Women's NHSFT, Institute of Translational Medicine, Crown St, Liverpool, L8 7SS, UK.
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, St George's University of London, Jenner Wing, Level 2, Room 2.215E, Mail Point J2C, London, SW17 0RE, UK.
| | - Stefania Vergnano
- Paediatric Infectious Diseases Research Group, St George's University of London, Jenner Wing, Level 2, Room 2.215E, Mail Point J2C, London, SW17 0RE, UK; Paediatric Infectious Diseases, Bristol Royal Hospital for Children, University of Bristol, Level 6, UH Bristol Education and Research Centre, Upper Maudlin Street, Bristol BS2 8AE, UK.
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12
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Gharbi M, Doerholt K, Vergnano S, Bielicki JA, Paulus S, Menson E, Riordan A, Lyall H, Patel SV, Bernatoniene J, Versporten A, Heginbothom M, Goossens H, Sharland M. Using a simple point-prevalence survey to define appropriate antibiotic prescribing in hospitalised children across the UK. BMJ Open 2016; 6:e012675. [PMID: 27810974 PMCID: PMC5129034 DOI: 10.1136/bmjopen-2016-012675] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The National Health Service England, Commissioning for Quality and Innovation for Antimicrobial Resistance (CQUIN AMR) aims to reduce the total antibiotic consumption and the use of certain broad-spectrum antibiotics in secondary care. However, robust baseline antibiotic use data are lacking for hospitalised children. In this study, we aim to describe, compare and explain the prescription patterns of antibiotics within and between paediatric units in the UK and to provide a baseline for antibiotic prescribing for future improvement using CQUIN AMR guidance. METHODS We conducted a cross-sectional study using a point prevalence survey (PPS) in 61 paediatric units across the UK. The standardised study protocol from the Antibiotic Resistance and Prescribing in European Children (ARPEC) project was used. All inpatients under 18 years of age present in the participating hospital on the day of the study were included except neonates. RESULTS A total of 1247 (40.9%) of 3047 children hospitalised on the day of the PPS were on antibiotics. The proportion of children receiving antibiotics showed a wide variation between both district general and tertiary hospitals, with 36.4% ( 95% CI 33.4% to 39.4%) and 43.0% (95% CI 40.9% to 45.1%) of children prescribed antibiotics, respectively. About a quarter of children on antibiotic therapy received either a medical or surgical prophylaxis with parenteral administration being the main prescribed route for antibiotics (>60% of the prescriptions for both types of hospitals). General paediatrics units were surprisingly high prescribers of critical broad-spectrum antibiotics, that is, carbapenems and piperacillin-tazobactam. CONCLUSIONS We provide a robust baseline for antibiotic prescribing in hospitalised children in relation to current national stewardship efforts in the UK. Repeated PPS with further linkage to resistance data needs to be part of the antibiotic stewardship strategy to tackle the issue of suboptimal antibiotic use in hospitalised children.
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Affiliation(s)
- Myriam Gharbi
- NIHR Health Protection Research Unit Antimicrobial Resistance and Healthcare Associated Infection—Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Katja Doerholt
- Paediatric Infection Diseases, St George's Hospital NHS Trust, London, UK
| | - Stefania Vergnano
- Institute for Infection and Immunity—Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
| | - Julia Anna Bielicki
- Institute for Infection and Immunity—Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
| | - Stéphane Paulus
- Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Esse Menson
- Department of General Paediatrics, Evelina London Children's Hospital, London, UK
| | - Andrew Riordan
- Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Hermione Lyall
- Department of Infectious Diseases, St Mary's Hospital Imperial College Healthcare NHS Trust, London, UK
| | - Sanjay Valabh Patel
- Paediatric Infectious Diseases and Immunology, Southampton Children's Hospital, Southampton, UK
| | - Jolanta Bernatoniene
- Paediatric Infectious Disease and Immunology, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Hospital for Children, Bristol, UK
| | - Ann Versporten
- Department of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO) University of Antwerp, Antwerp, Belgium
| | | | - Herman Goossens
- Department of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO) University of Antwerp, Antwerp, Belgium
| | - Mike Sharland
- Paediatric Infection Diseases, St George's Hospital NHS Trust, London, UK
- Institute for Infection and Immunity—Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
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13
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Jones CE, Munoz FM, Kochhar S, Vergnano S, Cutland CL, Steinhoff M, Black S, Heininger U, Bonhoeffer J, Heath PT. Guidance for the collection of case report form variables to assess safety in clinical trials of vaccines in pregnancy. Vaccine 2016; 34:6007-6014. [PMID: 27793485 PMCID: PMC5139802 DOI: 10.1016/j.vaccine.2016.07.007] [Citation(s) in RCA: 20] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/06/2016] [Indexed: 12/01/2022]
Abstract
Vaccination in pregnancy is an effective strategy to prevent serious infections in mothers and their infants. Safety of this strategy is of principal importance to all stakeholders. As the number of studies assessing safety of vaccines in pregnancy increases, the need to ensure consistent collection and reporting of critical data to allow comparisons and data pooling becomes more important. The Global Alignment of Immunization Safety Assessment in Pregnancy (GAIA) project aims to improve data collection and create a shared understanding of maternal, fetal and neonatal outcomes in order to progress the global agenda for vaccination in pregnancy. The guidance in this document has been developed to harmonize the data collected in case report forms used for safety monitoring in clinical trials of vaccination in pregnant women. Data to be collected is prioritized to allow applicability in diverse research settings, including low and middle-income countries. Standardized data will enable the research community to have a common base upon which to conduct meta-analyses, strengthening the applicability of outcomes to different settings.
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Affiliation(s)
- Christine E Jones
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, UK.
| | | | | | - Stefania Vergnano
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, UK; School of Clinical Sciences, University of Bristol, UK
| | - Clare L Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, South Africa; Department of Science and Technology National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, South Africa
| | | | - Steven Black
- Center for Global Health, Cincinnati Children's Hospital, USA
| | | | - Jan Bonhoeffer
- University of Basel Children's Hospital, Basel, Switzerland
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, UK
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14
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Fitchett EJA, Seale AC, Vergnano S, Sharland M, Heath PT, Saha SK, Agarwal R, Ayede AI, Bhutta ZA, Black R, Bojang K, Campbell H, Cousens S, Darmstadt GL, Madhi SA, Meulen AST, Modi N, Patterson J, Qazi S, Schrag SJ, Stoll BJ, Wall SN, Wammanda RD, Lawn JE. Strengthening the Reporting of Observational Studies in Epidemiology for Newborn Infection (STROBE-NI): an extension of the STROBE statement for neonatal infection research. Lancet Infect Dis 2016; 16:e202-e213. [PMID: 27633910 DOI: 10.1016/s1473-3099(16)30082-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/14/2016] [Accepted: 04/28/2016] [Indexed: 12/22/2022]
Abstract
Neonatal infections are estimated to account for a quarter of the 2·8 million annual neonatal deaths, as well as approximately 3% of all disability-adjusted life-years. Despite this burden, few data are available on incidence, aetiology, and outcomes, particularly regarding impairment. We aimed to develop guidelines for improved scientific reporting of observational neonatal infection studies, to increase comparability and to strengthen research in this area. This checklist, Strengthening the Reporting of Observational Studies in Epidemiology for Newborn Infection (STROBE- NI), is an extension of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. STROBE-NI was developed following systematic reviews of published literature (1996-2015), compilation of more than 130 potential reporting recommendations, and circulation of a survey to relevant professionals worldwide, eliciting responses from 147 professionals from 37 countries. An international consensus meeting of 18 participants (with expertise in infectious diseases, neonatology, microbiology, epidemiology, and statistics) identified priority recommendations for reporting, additional to the STROBE statement. Implementation of these STROBE-NI recommendations, and linked checklist, aims to improve scientific reporting of neonatal infection studies, increasing data utility and allowing meta-analyses and pathogen-specific burden estimates to inform global policy and new interventions, including maternal vaccines.
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Affiliation(s)
| | - Anna C Seale
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK
| | - Stefania Vergnano
- Paediatric Infectious Disease Research Group, St George's University of London, London, UK
| | - Michael Sharland
- Paediatric Infectious Disease Research Group, St George's University of London, London, UK
| | - Paul T Heath
- Paediatric Infectious Disease Research Group, St George's University of London, London, UK
| | - Samir K Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Ramesh Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Adejumoke I Ayede
- Department of Paediatrics, College Of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Zulfiqar A Bhutta
- Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan; Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Robert Black
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kalifa Bojang
- Medical Research Council, The Gambia Unit, Banjul, The Gambia
| | - Harry Campbell
- Centre for Global Health Research, University of Edinburgh, Edinburgh, UK
| | - Simon Cousens
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit & DST/NRF Vaccine Preventable Diseases, Faculty Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Neena Modi
- Royal College of Paediatrics and Child Health, London, UK; Department of Medicine, Section of Neonatal Medicine, Imperial College London, London, UK
| | - Janna Patterson
- Maternal, Newborn, and Child Health, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Shamim Qazi
- Department of Maternal Newborn Child and Adolescent Health, WHO, Geneva, Switzerland
| | - Stephanie J Schrag
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Barbara J Stoll
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Stephen N Wall
- Saving Newborn Lives, Save the Children, Washington, DC, USA
| | - Robinson D Wammanda
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Ahmadu Bello University, Zaria, Nigeria
| | - Joy E Lawn
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK.
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15
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Seale AC, Head MG, Fitchett EJA, Vergnano S, Saha SK, Heath PT, Sharland M, Lawn JE. Neonatal infection: a major burden with minimal funding. Lancet Glob Health 2016; 3:e669-70. [PMID: 26475007 DOI: 10.1016/s2214-109x(15)00204-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 09/10/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Anna C Seale
- The Farr Institute of Health Informatics Research, University College London, London, UK; MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK.
| | - Michael G Head
- The Farr Institute of Health Informatics Research, University College London, London, UK; Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Stefania Vergnano
- Paediatric Infectious Disease Research Group, St George's University of London, London, UK
| | - Samir K Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Paul T Heath
- Paediatric Infectious Disease Research Group, St George's University of London, London, UK
| | - Mike Sharland
- Paediatric Infectious Disease Research Group, St George's University of London, London, UK
| | - Joy E Lawn
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK
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16
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Cailes B, Vergnano S, Kortsalioudaki C, Heath P, Sharland M. The current and future roles of neonatal infection surveillance programmes in combating antimicrobial resistance. Early Hum Dev 2015; 91:613-8. [PMID: 26386612 DOI: 10.1016/j.earlhumdev.2015.08.012] [Citation(s) in RCA: 21] [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] [Indexed: 10/23/2022]
Abstract
Neonatal sepsis is an important cause of morbidity and mortality, particularly in premature or low birth weight babies. Hospital-acquired blood stream infections represent a significant and largely preventable cause of disease in this population. Neonatal units have been identified as a common site for the development and transmission of antimicrobial-resistant pathogens, a significant issue in modern medicine. Neonatal surveillance programmes collect prospective data on infection rates and may be used to optimise therapy, benchmark practice and develop quality improvement programmes. Despite this, the number of networks is relatively few and these are largely concentrated in resource-rich nations. Furthermore, surveillance definitions may vary between programmes impairing our ability to draw comparisons between them. Better harmonisation is required between networks to ensure that they achieve their potential as a valuable tool for benchmarking of hospital-acquired infection rates between units.
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Affiliation(s)
- Benjamin Cailes
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's University of London, UK; Monash University, Melbourne, Australia.
| | - Stefania Vergnano
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's University of London, UK.
| | - Christina Kortsalioudaki
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's University of London, UK.
| | - Paul Heath
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's University of London, UK.
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's University of London, UK.
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17
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Bielicki J, Lundin R, Sharland M, Vergnano S. Antimicrobial resistance, prescribing and efficacy in children from the European to the global scene: From ARPEC to GARPEC. J PEDIAT INF DIS-GER 2015. [DOI: 10.3233/jpi-140425] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J. Bielicki
- Paediatric Infectious Diseases Research Group, St George's Univeresity of London, London, UK
| | | | - M. Sharland
- Paediatric Infectious Diseases Research Group, St George's Univeresity of London, London, UK
| | - S. Vergnano
- Paediatric Infectious Diseases Research Group, St George's Univeresity of London, London, UK
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18
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Sharland M, Vergnano S. Antimicrobial resistance in paediatric medicine. J PEDIAT INF DIS-GER 2015. [DOI: 10.3233/jpi-140424] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Michael Sharland
- Paediatric Infectious Diseases Research Group, St George's Univeresity of London, London, UK
| | - Stefania Vergnano
- Paediatric Infectious Diseases Research Group, St George's Univeresity of London, London, UK
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19
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Vergnano S, Kadambari S, Whalley K, Menson EN, Martinez-Alier N, Cooper M, Sanchez E, Heath PT, Lyall H. Characteristics and outcomes of human parechovirus infection in infants (2008-2012). Eur J Pediatr 2015; 174:919-24. [PMID: 25573462 DOI: 10.1007/s00431-014-2483-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [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: 10/18/2014] [Revised: 12/14/2014] [Accepted: 12/18/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED Human parechoviruses (HPeVs) cause a spectrum of disease ranging from self-limiting illness to severe disease and, sometimes, death. We describe the clinical characteristics and outcomes of HPeV infection in infants. The study describes the clinical and laboratory characteristics and outcomes of infants with HPeV infection during 2008-2012, from three paediatric hospitals in London each with a paediatric intensive care unit. The infants were retrospectively identified through laboratory and patient discharge databases and diagnosed through HPeV PCR. Fifty infants were identified. Half required admission to PICU. Infants less than 3 months were more likely to require PICU (16/25: p < 0.01). Clinical signs at presentation were often indistinguishable from those of bacterial sepsis and meningitis, but inflammatory markers were nearly always (95 % of cases) within normal ranges. Brain MRI showed white matter changes in 10/12 infants. Three of 19 infants with follow-up data (16 %) had significant neurological sequelae. CONCLUSION HPeV may cause severe disease and long-term neurological sequelae in young infants. HPeV should be considered in infants with clinical features of sepsis/meningitis with normal CSF microscopy. Prospective observational studies are warranted to better define the epidemiology of infection and thus inform future treatment trials.
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Affiliation(s)
- Stefania Vergnano
- Division of Clinical Science, Paediatric Infectious Diseases Research Group, St George's University of London, Jenner Wing, Level 2, Room 2.215E, Mail Point J2C, London, SW17 0RE, UK,
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20
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Oeser C, Vergnano S, Naidoo R, Anthony M, Chang J, Chow P, Clarke P, Embleton N, Kennea N, Pattnayak S, Reichert B, Scorrer T, Tiron I, Watts T, Sharland M, Heath PT. Neonatal invasive fungal infection in England 2004-2010. Clin Microbiol Infect 2014; 20:936-41. [PMID: 24479862 DOI: 10.1111/1469-0691.12578] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [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: 10/07/2013] [Revised: 01/21/2014] [Accepted: 01/26/2014] [Indexed: 12/20/2022]
Abstract
Rates of invasive fungal infection are highest among neonates, especially those of low birthweight. This study aimed to describe the current epidemiology of invasive neonatal fungal infections in a UK neonatal infection surveillance network. From 2004 to 2010 prospective multicentre surveillance was conducted by 14 neonatal units using a web-based database. Clinicians then completed a standardized pro forma for each positive fungal blood and/or cerebrospinal fluid culture. The overall incidence was 2.4/1000 neonatal unit admissions and was highest among babies <1000 g (extreme low birthweight, 18.8/1000). Only five infants (6%) were >1500 g. The majority of infections were caused by Candida albicans (59; 69%) and Candida parapsilosis (17; 20%); 33% of infants had received antifungal prophylaxis. Known risk factors (use of central venous catheter, parenteral nutrition, previous antibiotic use) were common among cases. The attributable case fatality rate was 21% (18/84). Extreme low birthweight infants remain at highest risk of invasive fungal infection and prophylaxis should be particularly considered for this group. The number needing to receive prophylaxis to prevent one case varies significantly among units, hence unit-specific decisions are required. Further research is still needed into the optimal empiric and therapeutic strategies.
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Affiliation(s)
- C Oeser
- Paediatric Infectious Diseases Research Group, Clinical Sciences, St George's, University of London, London, UK
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Abstract
A recent report by the Weekly Epidemiological Record of an outbreak of Neisseria meningitidis serogroup A in the Great Lakes region shows that meningococcal epidemics are an unsolved problem in resource-poor countries, particularly in Africa [1]. During the last epidemic wave in the 1990s, about 350,000 people developed meningitis and 1000 people died [101]. An effective polysaccharide vaccine has been available since the early 1970s. Unfortunately, attempts to contain the epidemics by timely detection of cases through active surveillance and prompt mass vaccination campaigns have failed to prevent the deaths of thousands of people in several African countries in the 1980s and 1990s. This article describes the epidemiology of N. meningitidis serogroup A, the available polysaccharide vaccines, their advantages and limitations. The current vaccination policies and their economic implications are discussed, to clarify why the use of an effective vaccine has, to date, been disappointing. The recent exciting developments with respect to conjugate vaccines are described.
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Affiliation(s)
- Stefania Vergnano
- International Perinatal Unit, Institute of Child Health, 30 Guildford Street, London WC1N IE4, UK.
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22
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Lewycka S, Mwansambo C, Rosato M, Kazembe P, Phiri T, Mganga A, Chapota H, Malamba F, Kainja E, Newell ML, Greco G, Pulkki-Brännström AM, Skordis-Worrall J, Vergnano S, Osrin D, Costello A. Effect of women's groups and volunteer peer counselling on rates of mortality, morbidity, and health behaviours in mothers and children in rural Malawi (MaiMwana): a factorial, cluster-randomised controlled trial. Lancet 2013; 381:1721-35. [PMID: 23683639 PMCID: PMC3796349 DOI: 10.1016/s0140-6736(12)61959-x] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Women's groups and health education by peer counsellors can improve the health of mothers and children. We assessed their effects on mortality and breastfeeding rates in rural Malawi. METHODS We did a 2×2 factorial, cluster-randomised trial in 185,888 people in Mchinji district. 48 equal-sized clusters were randomly allocated to four groups with a computer-generated number sequence. 24 facilitators guided groups through a community action cycle to tackle maternal and child health problems. 72 trained volunteer peer counsellors made home visits at five timepoints during pregnancy and after birth to support breastfeeding and infant care. Primary outcomes for the women's group intervention were maternal, perinatal, neonatal, and infant mortality rates (MMR, PMR, NMR, and IMR, respectively); and for the peer counselling were IMR and exclusive breastfeeding (EBF) rates. Analysis was by intention to treat. The trial is registered as ISRCTN06477126. FINDINGS We monitored outcomes of 26,262 births between 2005 and 2009. In a factorial model adjusted only for clustering and the volunteer peer counselling intervention, in women's group areas, for years 2 and 3, we noted non-significant decreases in NMR (odds ratio 0.93, 0.64-1.35) and MMR (0.54, 0.28-1.04). After adjustment for parity, socioeconomic quintile, and baseline measures, effects were larger for NMR (0.85, 0.59-1.22) and MMR (0.48, 0.26-0.91). Because of the interaction between the two interventions, a stratified analysis was done. For women's groups, in adjusted analyses, MMR fell by 74% (0.26, 0.10-0.70), and NMR by 41% (0.59, 0.40-0.86) in areas with no peer counsellors, but there was no effect in areas with counsellors (1.09, 0.40-2.98, and 1.38, 0.75-2.54). Factorial analysis for the peer counselling intervention for years 1-3 showed a fall in IMR of 18% (0.82, 0.67-1.00) and an improvement in EBF rates (2.42, 1.48-3.96). The results of the stratified, adjusted analysis showed a 36% reduction in IMR (0.64, 0.48-0.85) but no effect on EBF (1.18, 0.63-2.25) in areas without women's groups, and in areas with women's groups there was no effect on IMR (1.05, 0.82-1.36) and an increase in EBF (5.02, 2.67-9.44). The cost of women's groups was US$114 per year of life lost (YLL) averted and that of peer counsellors was $33 per YLL averted, using stratified data from single intervention comparisons. INTERPRETATION Community mobilisation through women's groups and volunteer peer counsellor health education are methods to improve maternal and child health outcomes in poor rural populations in Africa. FUNDING Saving Newborn Lives, UK Department for International Development, and Wellcome Trust.
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Affiliation(s)
- Sonia Lewycka
- Institute for Global Health, University College London, London, UK
| | | | - Mikey Rosato
- Institute for Global Health, University College London, London, UK
| | - Peter Kazembe
- Baylor College of Medicine Children’s Foundation, Lilongwe, Malawi
| | | | | | | | | | | | - Marie-Louise Newell
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, South Africa
| | - Giulia Greco
- Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - David Osrin
- Institute for Global Health, University College London, London, UK
| | - Anthony Costello
- Institute for Global Health, University College London, London, UK
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Rosato M, Lewycka S, Mwansambo C, Kazembe P, Phiri T, Chapota H, Vergnano S, Newell ML, Osrin D, Costello A. Research report--Volunteer infant feeding and care counselors: a health education intervention to improve mother and child health and reduce mortality in rural Malawi. Malawi Med J 2012; 24:39-42. [PMID: 23638270 PMCID: PMC3588215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
The aim of this report is to describe a health education intervention involving volunteer infant feeding and care counselors being implemented in Mchinji district, Malawi. The intervention was established in January 2004 and involves 72 volunteer infant feeding and care counselors, supervised by 24 government Health Surveillance Assistants, covering 355 villages in Mchinji district. It aims to change the knowledge, attitudes and behaviour of women to promote exclusive breastfeeding and other infant care practices. The main target population are women of child bearing age who are visited at five key points during pregnancy and after birth. Where possible, their partners are also involved. The visits cover exclusive breastfeeding and other important neonatal and infant care practices. Volunteers are provided with an intervention manual and picture book. Resource inputs are low and include training allowances and equipment for counselors and supervisors, and a salary, equipment and materials for a coordinator. It is hypothesized that the counselors will encourage informational and attitudinal change to enhance motivation and risk reduction skills and self-efficacy to promote exclusive breastfeeding and other infant care practices and reduce infant mortality. The impact is being evaluated through a cluster randomised controlled trial and results will be reported in 2012.
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Affiliation(s)
- Mikey Rosato
- Centre for International Health and Development, UCL, Institute of Child Health, 30 Guilford St, London WC1N 1EH ; Centre for Anthropological Research, University of Johannesburg, PO Box 524, Auckland Park, 2006, South Africa
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Martin A, Vergnano S, Heath PT, Anthony M, Russell AB, Kennea N, Watts T, Embleton N, Collinson A. Early onset group B streptococcus sepsis: guidelines review. J Infect Prev 2012. [DOI: 10.1177/1757177412437985] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Group B streptococcus (GBS) is the commonest cause of early onset sepsis in UK newborns. Several risk factors for early onset GBS sepsis (EOGBS) have been described. The presence of these risk factors provides an opportunity for intrapartum antibiotic prophylaxis (IAP) and forms the basis of current UK EOGBS prevention guidance. Having observed poor compliance with national guidelines in a review of EOGBS cases within the UK Neonatal Infection Surveillance Network (NeonIN), we reviewed 14 NeonIN unit guidelines. We found substantial variation in recommendations within and between units on indications for IAP and treatment of asymptomatic neonates, and discrepancies between obstetric and neonatal guidelines, potentially increasing infants’ risk of infection. The lack of high quality evidence in this area and related ambiguity in national guidance may have contributed to diverse local approaches. A common approach would permit prospective evaluation of an EOGBS prevention strategy, generating an evidence base to benefit future guidelines.
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Affiliation(s)
- Alice Martin
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - Paul T Heath
- Division of Child Health, St George’s, University of London, UK
| | | | | | | | - Timothy Watts
- Guys’ and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Andrew Collinson
- Neonatal Unit, Princess Alexandra Maternity Wing, Royal Cornwall Hospitals NHS Trust, UK
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Vergnano S, Fottrell E, Osrin D, Kazembe PN, Mwansambo C, Manandhar DS, Munjanja SP, Byass P, Lewycka S, Costello A. Adaptation of a probabilistic method (InterVA) of verbal autopsy to improve the interpretation of cause of stillbirth and neonatal death in Malawi, Nepal, and Zimbabwe. Popul Health Metr 2011; 9:48. [PMID: 21819599 PMCID: PMC3160941 DOI: 10.1186/1478-7954-9-48] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 08/05/2011] [Indexed: 11/16/2022] Open
Abstract
Background Verbal autopsy (VA) is a widely used method for analyzing cause of death in absence of vital registration systems. We adapted the InterVA method to extrapolate causes of death for stillbirths and neonatal deaths from verbal autopsy questionnaires, using data from Malawi, Zimbabwe, and Nepal. Methods We obtained 734 stillbirth and neonatal VAs from recent community studies in rural areas: 169 from Malawi, 385 from Nepal, and 180 from Zimbabwe. Initial refinement of the InterVA model was based on 100 physician-reviewed VAs from Malawi. InterVA indicators and matrix probabilities for cause of death were reviewed for clinical and epidemiological coherence by a pediatrician-researcher and an epidemiologist involved in the development of InterVA. The modified InterVA model was evaluated by comparing population-level cause-specific mortality fractions and individual agreement from two methods of interpretation (physician review and InterVA) for a further 69 VAs from Malawi, 385 from Nepal, and 180 from Zimbabwe. Results Case-by-case agreement between InterVA and reviewing physician diagnoses for 69 cases from Malawi, 180 cases from Zimbabwe, and 385 cases from Nepal were 83% (kappa 0.76 (0.75 - 0.80)), 71% (kappa 0.41(0.32-0.51)), and 74% (kappa 0.63 (0.60-0.63)), respectively. The proportion of stillbirths identified as fresh or macerated by the different methods of VA interpretation was similar in all three settings. Comparing across countries, the modified InterVA method found that proportions of preterm births and deaths due to infection were higher in Zimbabwe (44%) than in Malawi (28%) or Nepal (20%). Conclusion The modified InterVA method provides plausible results for stillbirths and newborn deaths, broadly comparable to physician review but with the advantage of internal consistency. The method allows standardized cross-country comparisons and eliminates the inconsistencies of physician review in such comparisons.
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Affiliation(s)
- Stefania Vergnano
- Centre for International Health and Development, UCL, Institute of Child Health 30 Guilford St, London WC1N1EH, UK.
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Vergnano S, Menson E, Kennea N, Embleton N, Russell AB, Watts T, Robinson MJ, Collinson A, Heath PT. Neonatal infections in England: the NeonIN surveillance network. Arch Dis Child Fetal Neonatal Ed 2011; 96:F9-F14. [PMID: 20876594 DOI: 10.1136/adc.2009.178798] [Citation(s) in RCA: 305] [Impact Index Per Article: 23.5] [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] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Neonatal infection is an important cause of morbidity and mortality. Neonatal infection surveillance networks are necessary for defining the epidemiology of infections and monitoring changes over time. DESIGN Prospective multicentre surveillance using a web-based database. SETTING 12 English neonatal units. PARTICIPANTS Newborns admitted in 2006-2008, with positive blood, cerebrospinal fluid or urine culture and treated with antibiotics for at least 5 days. OUTCOME MEASURE Incidence, age at infection, pathogens and antibiotic resistance profiles. RESULTS With the inclusion of coagulase negative Staphylococci (CoNS), the incidence of all neonatal infection was 8/1000 live births and 71/1000 neonatal admissions (2007-2008). The majority of infections occurred in premature (<37 weeks) and low birthweight (<2500 g) infants (82% and 81%, respectively). The incidence of early onset sepsis (EOS; ≤48 h of age) was 0.9/1000 live births and 9/1000 neonatal admissions, and group B Streptococcus (58%) and Escherichia coli (18%) were the most common organisms. The incidence of late onset sepsis (LOS; >48 h of age) was 3/1000 live births and 29/1000 neonatal admissions (7/1000 live births and 61/1000 admissions including CoNS) and the most common organisms were CoNS (54%), Enterobacteriaceae (21%) and Staphylococcus aureus (18%, 11% of which were methicillin resistant S aureus). Fungi accounted for 9% of LOS (72% Candida albicans). The majority of pathogens causing EOS (95%) and LOS (84%) were susceptible to commonly used empiric first line antibiotic combinations of penicillin/gentamicin and flucloxacillin/gentamicin, respectively (excluding CoNS). CONCLUSIONS The authors have established NeonIN in England and defined the current epidemiology of neonatal infections. These data can be used for benchmarking among units, international comparisons and as a platform for interventional studies.
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Affiliation(s)
- Stefania Vergnano
- Division of Child Health, St George's, University of London, Cranmer Terrace, London, UK.
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Lewycka S, Mwansambo C, Kazembe P, Phiri T, Mganga A, Rosato M, Chapota H, Malamba F, Vergnano S, Newell ML, Osrin D, Costello A. A cluster randomised controlled trial of the community effectiveness of two interventions in rural Malawi to improve health care and to reduce maternal, newborn and infant mortality. Trials 2010; 11:88. [PMID: 20849613 PMCID: PMC2949851 DOI: 10.1186/1745-6215-11-88] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 09/17/2010] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The UN Millennium Development Goals call for substantial reductions in maternal and child mortality, to be achieved through reductions in morbidity and mortality during pregnancy, delivery, postpartum and early childhood. The MaiMwana Project aims to test community-based interventions that tackle maternal and child health problems through increasing awareness and local action. METHODS/DESIGN This study uses a two-by-two factorial cluster-randomised controlled trial design to test the impact of two interventions. The impact of a community mobilisation intervention run through women's groups, on home care, health care-seeking behaviours and maternal and infant mortality, will be tested. The impact of a volunteer-led infant feeding and care support intervention, on rates of exclusive breastfeeding, uptake of HIV-prevention services and infant mortality, will also be tested. The women's group intervention will employ local female facilitators to guide women's groups through a four-phase cycle of problem identification and prioritisation, strategy identification, implementation and evaluation. Meetings will be held monthly at village level. The infant feeding intervention will select local volunteers to provide advice and support for breastfeeding, birth preparedness, newborn care and immunisation. They will visit pregnant and new mothers in their homes five times during and after pregnancy.The unit of intervention allocation will be clusters of rural villages of 2500-4000 population. 48 clusters have been defined and randomly allocated to either women's groups only, infant feeding support only, both interventions, or no intervention. Study villages are surrounded by 'buffer areas' of non-study villages to reduce contamination between intervention and control areas. Outcome indicators will be measured through a demographic surveillance system. Primary outcomes will be maternal, infant, neonatal and perinatal mortality for the women's group intervention, and exclusive breastfeeding rates and infant mortality for the infant feeding intervention.Structured interviews will be conducted with mothers one-month and six-months after birth to collect detailed quantitative data on care practices and health-care-seeking. Further qualitative, quantitative and economic data will be collected for process and economic evaluations. TRIAL REGISTRATION ISRCTN06477126.
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Affiliation(s)
- Sonia Lewycka
- Centre for International Health and Development, UCL Institute of Child Health, London, UK.
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Vergnano S, Embleton N, Collinson A, Menson E, Russell AB, Heath P. Missed opportunities for preventing group B streptococcus infection. Arch Dis Child Fetal Neonatal Ed 2010; 95:F72-3. [PMID: 19439431 DOI: 10.1136/adc.2009.160333] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND Group B streptococcus (GBS) is the most common cause of early onset (EO) neonatal infection in the UK. National guidelines for its prevention were introduced in 2003. We assessed the opportunities for prevention amongst cases of EO GBS using the electronic Neonatal Infection Surveillance Network (NeonIN). METHODS Culture proven EO GBS cases occurring between 2004 and 2007 were identified prospectively in eight neonatal units participating in NeonIN. Data concerning risk factors, intrapartum antibiotic (IAP) use and infant outcome were collected retrospectively. RESULTS There were 48 cases of GBS over the 4 years (0.52/1000 live-births); 22 male, median gestation 38 weeks. The most common clinical presentation was sepsis and the GBS-attributable mortality was 6%. Risk factors were present in 67% (32) and adequate IAP was given to six of these mothers (19%). If all women with risk factors received prophylaxis, 23 cases (48%) may have been prevented. CONCLUSIONS Better GBS prevention strategies are required in the UK.
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Affiliation(s)
- S Vergnano
- Division of Child Health, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
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Rosato M, Mwansambo CW, Kazembe PN, Phiri T, Soko QS, Lewycka S, Kunyenge BE, Vergnano S, Osrin D, Newell ML, Costello AMDL. Women's groups' perceptions of maternal health issues in rural Malawi. Lancet 2006; 368:1180-8. [PMID: 17011945 DOI: 10.1016/s0140-6736(06)69475-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [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: 10/24/2022]
Abstract
BACKGROUND Improvements in preventive and care-seeking behaviours to reduce maternal mortality in rural Africa depend on the knowledge and attitudes of women and communities. Surveys have indicated a poor awareness of maternal health problems by individual women. We report the perceptions of women's groups to such issues in the rural Mchinji district of Malawi. METHODS Participatory women's groups in the Mchinji district identified maternal health problems (172 groups, 3171 women) and prioritised problems they considered most important (171 groups, 2833 women). In-depth qualitative data was obtained through six focus-group discussions with the women's groups, three with women's group facilitators, and four interviews with facilitator supervisors. FINDINGS The maternal health problems most commonly identified by more than half the groups were anaemia (87%), malaria (80%), retained placenta (77%), obstructed labour (76%), malpresentation (71%), antepartum and postpartum haemorrhage (70% each), and pre-eclampsia (56%). The five problems prioritised as most important were anaemia (sum of rank score 304), malpresentation (295), retained placenta (277), obstructed labour (276). and postpartum haemorrhage (275). HIV/AIDS and sepsis were identified or prioritised much less because complexity and contextual factors hindered their consideration. INTERPRETATION Rural Malawian women meeting in participatory groups showed a developed awareness of maternal health problems and the concern and motivation to address them. Community mobilisation strategies, such as women's groups, might be effective at reducing maternal mortality because they can draw on the collective capacity in communities to solve problems and make women's voices heard by decision-makers.
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Affiliation(s)
- Mikey Rosato
- Centre for International Health and Development, Institute of Child Health, University College London, UK.
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Abstract
Neonatal infections currently cause about 1.6 million deaths annually in developing countries. Sepsis and meningitis are responsible for most of these deaths. Resistance to commonly used antibiotics is emerging and constitutes an important problem world wide. To reduce global neonatal mortality, strategies of proven efficacy, such as hand washing, barrier nursing, restriction of antibiotic use, and rationalisation of admission to neonatal units, need to be implemented. Different approaches require further research.
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Affiliation(s)
- S Vergnano
- International Perinatal Care Unit, Centre for International Child Health, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
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Abstract
PURPOSE OF REVIEW The overwhelming majority of the world's annual 4 million neonatal deaths occur in developing countries. This review therefore briefly addresses the burden, aetiology, prevention and management of serious neonatal bacterial infections in low-income settings. RECENT FINDINGS Bacterial infection is the biggest cause of neonatal admissions to hospitals, and probably the biggest cause of morbidity in the community, but its burden is unclear. The commonest serious infections involve bacteraemia, meningitis and respiratory infection, and case fatality rates may be as high as 45%. Key pathogens are Escherichia coli, Klebsiella species, Staphylococcus aureus and Streptococcus pyogenes. The incidence of neonatal infections with group B streptococcus is highly variable, as is the spectrum of antimicrobial resistance. SUMMARY Current areas of research include the rectification of micronutrient deficiencies, neonatal skin care, appropriate breastfeeding recommendations, cleansing of the birth canal, and simplified methods of diagnosis of infection. Operational activities include the control of neonatal tetanus, the diagnosis and treatment of sexually transmitted infections, integrated strategies for improving pregnancy, childbirth and neonatal survival, community-based management of acute respiratory infections, and community-based management of neonatal sepsis.
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Affiliation(s)
- David Osrin
- International Perinatal Care Unit, Centre for International Child Health, Institute of Child Health, University College London, London, UK.
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