Background: Antibiotic exposure in the pediatric intensive care unit (PICU) is very high, although 50% of all antibiotics may be unnecessary. We aimed to determine the utility of simple bedside screening tools and predicting factors to avoid antibiotic overuse in the ICU among children with diarrhea and critical illness. Methods: We conducted a retrospective, single-center, case-control study that included children aged 2–59 months who were admitted to PICU with diarrhea and critical illness between 2017 and 2020. Results: We compared young children who did not receive antibiotics (cases, n = 164) during ICU stay to those treated with antibiotics (controls, n = 346). For predicting the ‘no antibiotic approach’, the sensitivity of a negative quick Sequential Organ Failure Assessment (qSOFA) was similar to quick Pediatric Logistic Organ Dysfunction-2 (qPELOD-2) and higher than Systemic Inflammatory Response Syndrome (SIRS). A negative qSOFA or qPELOD-2 score calculated during PICU admission is superior to SIRS to avoid antibiotic overuse in under-five children. The logistic regression analysis revealed that cases were more often older and independently associated with hypernatremia. Cases less often had severe underweight, altered mentation, age-specific fast breathing, lower chest wall in-drawing, adventitious sound on lung auscultation, abdominal distension, developmental delay, hyponatremia, hypocalcemia, and microscopic evidence of invasive diarrhea (for all, p < 0.05). Conclusion: Antibiotic overuse could be evaded in PICU using simple bedside screening tools and clinical characteristics, particularly in poor resource settings among children with diarrhea.
Introduction: Neonatal septicemia is one of the most common causes of infection and mortality in neonates, due to which 30–50% of neonates die each year in developing nations. Various studies have suggested that bacteremia occurs in 20% of neonates, and approximately 1% die due to neonatal sepsis. It affects newborns below 1 month of age and encompasses systemic infections including meningitis, pneumonia, arthritis, osteomyelitis and urinary tract infections. Objective: To assess the Bacteriological profile of neonatal septicaemia and antibiotic susceptibility pattern of the isolates admitted in SCANU of a tertiary levels hospital of North Bengal, Bangladesh. Methods: A prospective study was conducted including 50 suspected cases of septicemia admitted to the Special Care Neonatal Unit (SCANU) of the selected Department of Paediatrics, TMSS Medical College, Bogura Bangladesh July to December 2022. Demographic data included birth weight, gestational age, postnatal age, and treatment as well as survival outcome. Clinical and laboratory data included the number of days between birth and admission to the SCANU, admitting and discharge diagnoses, and pharmacological treatment. Data was analysed by percentages of each antibiotic used. And which organism was responsible for neonatal sepsis. Results: Total 50 cases clinically suspected neonatal sepsis were included in the study. The mean age was 8.33±7.36 days, mean birth weight was 2816.25±288.6gm, male were predominant which was 70%. Among gestational age of the Neonates having septicemia Preterm (<37) 66% and Term (37 up to 42) 36%. Out of the 50 proven sepsis cases, 36 cases (72%) were early onset and 14 cases (28%) were late onset. In this study out of 50 cases 16 cases were culture positive septicemia which was 32%. Gram negative organism were predominant with 10 isolates (62.5%) in comparison to gram-positive 6 (37.5%) isolates was the most common S. aureus (25.0%) and E. coli (12.5%) among the organism isolated. Other organisms isolated were Staphylococcus Pneumoniae (6.3%), Staphylococcus epidermidis (18.7%), Proteus (18.7%), Listeria species (6.3%), Pseudomonas (6.3%), and Enterococci (6.3%). In this study, Staphylococcus aureus was the commonest organism isolated from both EOS (20%) and LOS (33.3%) followed by Staphylococcus epidermidis (10% & 33.3%). Amoxiclave is highly sensitive to S. aureus & E. coli. In this study, vancomycin showed 25.0% sensitivity to S. aureus but for Nitrofurantoin it was only 33.3%. The Listeria species isolates here were 100% sensitive to meropenum. In our study, ciprofloxacin showed 33.3% to 100% sensitivity to different isolates. Conclusion: In the present study, high bacterial resistance among the pathogens suspected to cause neonatal septicemia is demonstrated which can be controlled by prudent use of available antibiotics. This study suggests regular monitoring of the antimicrobial sensitivity of the causative organisms in a particular setting is very important.
Considering that it has been more than 24 months since SARS-CoV-2 emerged, it is crucial to identify measures that prevent and control pathogen transmission in workplace settings. Our aim was to report results of a hospital-based program that delivered hydroxychloroquine (HCQ) tablets as COVID-19 prophylaxis to the frontline healthcare workers (HCW)s who cared for COVID-19 patients and to evaluate the efficacy of HCQ. Setting and participants: Quasi-experimental, controlled, single-center study. The included participants were doctors, nurses, health workers, cleaning staff, and non-healthcare supportive staff. The main outcome was contracting COVID-19 anytime during the period of taking the prophylaxis, confirmed by RT-PCR. A total of 336 participants, without any clinical evidence of COVID-19 and without any known contact with family members, were included in the trial; 230 were assigned to HCQ and 106 declined to take any drug. Results: Among the participants, 43 (18.7%) in the HCQ group and 11 (10.4%) participants in the control group developed COVID-19. For the evaluation of side effects, we evaluated 12-lead ECGs of both groups at the baseline and after 4 weeks to monitor QTc interval. A total of 91% (198 of 217) participants in the prophylaxis group and 92% (11 of 12) in the control group had a QTc < 45o msec, which is within normal limits. Conclusions: Although the number of symptomatic infections in health personnel was lower in the control group, the difference was not statistically significant. However, in the absence of any effective pre-exposure prophylaxis medicine for COVID-19, practicing proper infection prevention and control (IPC) and vaccination is the only way forward.
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