Antibiotic utilization in hospitalized children under 2 years of age with influenza or respiratory syncytial virus infection – a comparative, retrospective analysis

Papan, Cihan; Willersinn, Meike; Weiß, Christel; Karremann, Michael; Schroten, Horst; Tenenbaum, Tobias

doi:10.1186/s12879-020-05336-5

Cited by 22 publications

(23 citation statements)

References 45 publications

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“…Our study found that, with the exception of the 37–60 months old age group, the proportion of length of hospital stay≥7 days in the other age groups was greater than 62.0%. However, Papan et al 18 found that the average hospital stay was about 5 days in a study of hospitalized children under 2 years of age with RSV infections.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Incidence and Clinical Characteristics of RSV Infection in Hospitalized Children: A Retrospective Study

Gong¹,

Wu²,

Lu³

et al. 2021

RMHP

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Objective To investigate the incidence and clinical characteristics of hospitalized children with respiratory syncytial virus (RSV) infection, and to provide evidence for the importance of preventive strategies and improvements in supportive care of RSV infection. Methods This retrospective study included children under 14 years who received throat swab test and were diagnosed with RSV infection from January 2019 to December 2020. Throat swabs and intravenous blood were the main sources of samples, which were obtained within 24 hours of hospitalization. Direct immunofluorescence assay was used to diagnose RSV infection. Results Among the 448 hospitalized children with RSV infection, males (71.9%) showed the highest proportion, the highest incidence was found in children<6 months old (45.3%), and 76.6% of them had pneumonia. Pharyngeal redness, cough, expectoration, and mental fatigue were the most common symptoms in hospitalized children of all ages. More than 60% of hospitalized children had increased lymphocyte count, aspartate aminotransferase, creatine kinase-MB form, lactate dehydrogenase, and α-HBDH levels. The rates of myocardial damage, respiratory failure, stay in the intensive care unit (ICU), use of mechanical ventilation, and absorption of oxygen were higher in children<6 months old. Except for children who were 37–60 months old, the percentage of length of hospital stay≥7 days in the other age groups was greater than 62.0%. Except for children who were 0–28 days old and>61 months old, the other age groups showed a re-hospitalization situation due to re-infection with RSV. In hospitalized children diagnosed with RSV infection from throat swabs, we also performed the RSV IgM test and found that 59.2% of them were positive, 8.0% of them were weakly positive, and 32.8% of them were negative. Conclusion This study analyzes the incidence and clinical characteristics of hospitalized children with RSV infection, which provides evidence for the importance of preventive strategies and improvements in supportive care of RSV infection.

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Section: Discussionmentioning

confidence: 99%

Analysis of Incidence and Clinical Characteristics of RSV Infection in Hospitalized Children: A Retrospective Study

Gong¹,

Wu²,

Lu³

et al. 2021

RMHP

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“…It can be assumed that the complexity of a diagnosis leads to potentially disregarded CoNS infections, consequently leading to undertreatment (i.e., delayed or withheld antibiotics) in some cases and thereby contributing to morbidity and mortality [ 45 ]. On the other hand, antibiotic overtreatment is associated with the development of antimicrobial resistance, severe adverse events, and higher costs, mainly due to the need for in-patient therapy [ 46 ]. Ultimately, an unnecessarily prolonged hospitalization does not only cause a loss in quality-adjusted life-years, but hospital bed occupancy exposes another factor of this complexity, which becomes particularly immanent during times of hospital capacity shortage, especially during pandemics, such as COVID-19 [ 47 ].…”

Section: The Diagnostic Complexities—how To Distinguish Between Infection and Contaminationmentioning

confidence: 99%

Update on Coagulase-Negative Staphylococci—What the Clinician Should Know

et al. 2021

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Coagulase-negative staphylococci (CoNS) are among the most frequently recovered bacteria in routine clinical care. Their incidence has steadily increased over the past decades in parallel to the advancement in medicine, especially in regard to the utilization of foreign body devices. Many new species have been described within the past years, while clinical information to most of those species is still sparse. In addition, interspecies differences that render some species more virulent than others have to be taken into account. The distinct populations in which CoNS infections play a prominent role are preterm neonates, patients with implanted medical devices, immunodeficient patients, and those with other relevant comorbidities. Due to the property of CoNS to colonize the human skin, contamination of blood cultures or other samples occurs frequently. Hence, the main diagnostic hurdle is to correctly identify the cases in which CoNS are causative agents rather than contaminants. However, neither phenotypic nor genetic tools have been able to provide a satisfying solution to this problem. Another dilemma of CoNS in clinical practice pertains to their extensive antimicrobial resistance profile, especially in healthcare settings. Therefore, true infections caused by CoNS most often necessitate the use of second-line antimicrobial drugs.

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“…10,11 Similar patterns were identified in previous observational studies examining antibiotic misuse for patients with viral respiratory infections. 22,26 Interestingly, we identified that female sex is an influential predictor for unnecessary antibiotic treatment. Higher rates of antibiotic overprescription were previously reported for adult women, even when correcting for prevalence of conditions necessitating antibiotic therapy (e.g.…”

Section: Discussionmentioning

confidence: 97%

“…These numbers are in the range of estimates observed in other studies, although between-study variability is high. 9, [19][20][21][22][23][24][25] Using a multivariate logistic model, we found predictors that explain some of the physicians' decision making process leading to administration of unnecessary antibiotic therapy. Drawing of blood, urine or CSF cultures had substantial associations with unnecessary antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

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Unnecessary antibiotic treatment of children hospitalized with RSV-bronchiolitis: risk factors and prescription patterns

Obolski

Kassem

Na’amnih

et al. 2021

Preprint

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Background: Respiratory syncytial virus (RSV) is a main cause of respiratory tract infections, especially affecting young children. Antibiotics are often unnecessarily prescribed for the treatment of RSV. Such treatments can have effects on antibiotic resistance in future bacterial infections of treated patients and the general population. Objectives: We sought to understand the risk factors for and patterns of unnecessary antibiotic prescription in children with RSV. Methods: In a single center retrospective study in Israel, we obtained data of children aged <2 years (n=1015) hospitalized for RSV-bronchiolitis during 2008-2018, and ascertained not to have bacterial coinfections. Antibiotic misuse was defined as prescription of antibiotics during hospitalization of the study population. Patient and clinical variables were assessed as predictors of unnecessary antibiotic treatment in a multivariable logistic regression model. Results: Unnecessary antibiotic treatment rate of children infected with RSV and ascertained not to have a bacterial coinfection was estimated at 33.4% (95% CI 30.5%-36.4%). Increased likelihood of antibiotic misuse was associated with drawing bacterial cultures, and with variables indicative of a severe patient status: lower oxygen saturation, higher body temperature, tachypnea and prior recent emergency room visit. Older age and female sex were also associated with increased likelihood of unnecessary antibiotic treatment. Conclusions: Unnecessary antibiotic treatment in RSV patients was highly common and may be largely attributed to the physicians' perception of patients' severity. Improving prescription guidelines, implementing antibiotic stewardship programs and utilizing decision support systems may help achieve a better balance between prescribing and withholding antibiotic treatment.

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Antibiotic utilization in hospitalized children under 2 years of age with influenza or respiratory syncytial virus infection – a comparative, retrospective analysis

Cited by 22 publications

References 45 publications

Analysis of Incidence and Clinical Characteristics of RSV Infection in Hospitalized Children: A Retrospective Study

Analysis of Incidence and Clinical Characteristics of RSV Infection in Hospitalized Children: A Retrospective Study

Update on Coagulase-Negative Staphylococci—What the Clinician Should Know

Unnecessary antibiotic treatment of children hospitalized with RSV-bronchiolitis: risk factors and prescription patterns

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