Disproportionate Exposure to Antibiotics in Children at Risk for Invasive Pneumococcal Disease: Potential for Emerging Resistance and Opportunity for Antibiotic Stewardship

Barlam, Tamar F.; Morgan, Jake R.; Kaplan, Warren; Outterson, Kevin; Pelton, Stephen I.

doi:10.1093/jpids/pix070

Cited by 4 publications

(17 citation statements)

References 8 publications

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“…The strains of nonsurvivors in this study were multi-drug resistant. Domestic and foreign reports also showed that S. pneumoniae was generally multi-drug resistant, and the resistance to penicillin and cephalosporins increased [ 6 , 26 , 27 ]. Compared with drug sensitivity analysis in the present study, a better consistency rate was achieved if the choice of antibiotics strictly abided by China’s “Guidelines for the Management of Community Communicable Pneumonia (2013 Revision)”.…”

Section: Discussionmentioning

confidence: 99%

Early clinical predictors for the prognosis of invasive pneumococcal disease

Guo

et al. 2020

BMC Infect Dis

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Background Risk factors related to mortality due to invasive pneumococcal disease (IPD) have been unveiled previously, but early clinical manifestations of IPD based on prognosis remain uncovered. Methods The demographic characteristics, clinical features, serotype, antibiotic susceptibility, and outcomes of 97 hospitalized children with laboratory-confirmed IPD from Suzhou, China, were collected and analyzed retrospectively. Results The median age was 0.69 (0.49–1.55) years in the non-survivor group compared with 2.39 (0.90–3.81) years in the survivor group. The mortality of 97 children with laboratory-confirmed IPD was 17.5% (17/97), and 53.6% of them were aged less than 2 years. Pathogens were mainly from the blood and cerebrospinal fluid, and sepsis was the most frequent type. Statistically significant differences were found in hyperpyrexia, vomiting, anorexia, lethargy, poor perfusion of extremities, Hb level, and Plt count between the nonsurvival and survival groups. Further, the multivariate regression analysis showed that early signs, including hyperpyrexia, vomiting, anorexia, lethargy, and poor perfusion of extremities, were independent risk factors for the in-hospital mortality of children with laboratory-confirmed IPD. The mortality was also associated with antimicrobial sensitivity in pneumococcal isolates. The microbes in 1/17 (5.9%) children who were prescribed an antibiotic showed antimicrobial sensitivity in the nonsurvival group, compared with 21/80 (26.3%) children who survived. The most common serotypes identified were 6B (35.3%, 6/17), 14 (23.5%, 4/17), 19F (23.5%, 4/17), 19A (5.9%, 1/17), 23F (5.9%, 1/17), and 20 (5.9%, 1/17) in the nonsurvival group. The coverage of IPD serotypes of the 7-valent pneumococcal conjugate vaccine (PCV7) was 88.2% (15/17), while that of the 13-valent S. pneumoniae vaccine (PCV13) was 94.1% (16/17) of the coverage in the nonsurvival group. Conclusions Recurrent hyperpyrexia, vomiting, anorexia, lethargy, and poor perfusion of extremities in the early stage were independent predictors for the in-hospital mortality of children with laboratory-confirmed IPD. Appropriate use of antibiotics and PCV immunization were the keys to improve the outcome of IPD.

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Section: Discussionmentioning

confidence: 99%

Early clinical predictors for the prognosis of invasive pneumococcal disease

Guo

et al. 2020

BMC Infect Dis

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“…Children demographic and clinical characteristics that could be of interest were extracted from the MHDR including (a) demographics: sex, race/ethnicity, class‐of‐age at the visit; (b) clinical diagnosis: identified in the discharge summary of the visit, by the primary diagnosis code based on International Classification of Diseases, ninth revision (ICD‐9) and tenth revision after 2015 (ICD‐10), including otitis, tonsillitis/pharyngitis, sinusitis, pneumonia, upper respiratory tract infections (URTIs), flu, rhinopharyngitis, bronchitis, laryngitis/tracheitis, infectious gastroenteritis and urinary tract infections; (c) comorbid conditions: children with at least one record documenting a specific condition were categorised as having that condition from the earliest coding occurrence in the visit or in the previous 12 months (evaluation of the comorbid conditions of the 2007 admissions included the screening of the previous year: 2006). The comorbidities were defined using the validated ICD algorithms of Feudtner et al 15 added to the conditions recognised by the Committee on Infectious Diseases of the American Academy of Pediatrics (AAP, 2012 Report) 1,16 ; and (d) site of visits (PC or ER) from the admission records.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Antimicrobials are among the most widely prescribed therapeutic agents 1,2 . Inappropriate use of antibiotics is a public health problem and contributes to the emergence of antibiotic resistance 1,2 . Children, especially young children, continue as the population with highest antibiotic exposure 3,4 despite specific programmes for judicious use of antibiotics in childhood 4‐6 .…”

Section: Introductionmentioning

confidence: 99%

“…The emergence of novel modern tools such as the use of data warehouse for epidemiological surveillance purposes, 12,13 as support for antibiotic stewardship programmes, could contribute to simplify and improve the knowledge and understanding in antibiotic prescribing to prepare quality improvement interventions 1 …”

Section: Introductionmentioning

confidence: 99%

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Gradual decline in outpatient antibiotic prescriptions in paediatrics: A data warehouse–based 11‐year cohort study

et al. 2020

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Aim To describe trends in antibiotic (AB) prescriptions in children in primary care over 11 years, using a large data warehouse. Methods A retrospective cohort study assessed outpatient AB prescriptions 2007‐2017, using the Massachusetts Health Disparities Repository. The evolution of paediatric outpatient AB prescriptions was assessed using time‐series analyses through annual per cent change (APC) for the population and for children with or without comorbid condition. Results About 25 000 children were followed in primary care with 31 248 AB prescriptions reported in the data warehouse. The youngest children had more AB prescriptions. Penicillins were prescribed most frequently (46%), then macrolides (28%). One third of children had comorbid conditions, receiving significantly more antibiotics (30.3 vs 21.0 AB/100 child‐years, relative risk: 1.43, 95% CI: 1.40, 1.46). Overall AB prescription decreased over the period (APC = −5.34%, 95% CI: −7.10, −3.54), with similar trends for penicillins (APC = −5.49; 95% CI: −8.27, −2.62) and macrolides (APC = −6.46; 95% CI: −8.37, −4.58); antibiotic prescribing declined more in children with comorbid conditions. Conclusion Outpatient AB prescribing decline was gradual and consistent in paediatrics over the period. Prescription differences persisted between age groups, conditions and indication. The availability of routine care data through data warehouse fosters the surveillance automation, providing inexpensive fast tools to design appropriate antimicrobial stewardship.

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Antibiotic Prescribing in Outpatient Children: A Cohort From a Clinical Data Warehouse

Grammatico‐Guillon

Shea

Jafarzadeh

et al. 2019

Clin Pediatr (Phila)

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Aim. To characterize antibiotic (ab) prescriptions in children. Methods. Evaluation of outpatient ab prescriptions in a 3-year cohort of children in primary care using a data warehouse (Massachusetts Health Disparities Repository) by comorbid conditions, demographics, and clinical indication. Results. A total of 15 208 children with nearly 120 000 outpatient visits were included. About one third had a comorbid condition (most commonly asthma). Among the 30 000 ab prescriptions, first-line penicillins and macrolides represented the most frequent ab (70%), followed by cephalosporins (16%). Comorbid children had 54.3 ab prescriptions/100 child-years versus 38.8 in children without comorbidity; ab prescription was higher in urinary tract infections (>60% of episodes), otitis, lower respiratory tract infections (>50%), especially in comorbid children and children under 2 year old. Ab prescriptions were significantly associated with younger age, emergency room visit, comorbid children, and acute infections. Discussion. A clinical data warehouse could help in designing appropriate antimicrobial stewardship programs and represent a potential assessment tool.

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Disproportionate Exposure to Antibiotics in Children at Risk for Invasive Pneumococcal Disease: Potential for Emerging Resistance and Opportunity for Antibiotic Stewardship

Cited by 4 publications

References 8 publications

Early clinical predictors for the prognosis of invasive pneumococcal disease

Early clinical predictors for the prognosis of invasive pneumococcal disease

Gradual decline in outpatient antibiotic prescriptions in paediatrics: A data warehouse–based 11‐year cohort study

Antibiotic Prescribing in Outpatient Children: A Cohort From a Clinical Data Warehouse

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