Management of Children Admitted to Hospitals across Bangladesh with Suspected or Confirmed COVID-19 and the Implications for the Future: A Nationwide Cross-Sectional Study

Abstract

There is an increasing focus on researching children admitted to hospital with new variants of COVID-19, combined with concerns with hyperinflammatory syndromes and the overuse of antimicrobials. Paediatric guidelines have been produced in Bangladesh to improve their care. Consequently, the objective is to document the management of children with COVID-19 among 24 hospitals in Bangladesh. Key outcome measures included the percentage prescribed different antimicrobials, adherence to paediatric guidelines and mortality rates using purposely developed report forms. The majority of 146 admitted children were aged 5 years or under (62.3%) and were boys (58.9%). Reasons for admission included fever, respiratory distress and coughing; 86.3% were prescribed antibiotics, typically parenterally, on the WHO ‘Watch’ list, and empirically (98.4%). There were no differences in antibiotic use whether hospitals followed paediatric guidance or not. There was no prescribing of antimalarials and limited prescribing of antivirals (5.5% of children) and antiparasitic medicines (0.7%). The majority of children (92.5%) made a full recovery. It was encouraging to see the low hospitalisation rates and limited use of antimalarials, antivirals and antiparasitic medicines. However, the high empiric use of antibiotics, alongside limited switching to oral formulations, is a concern that can be addressed by instigating the appropriate programmes.

Prevalence of Bacterial Coinfection and Patterns of Antibiotics Prescribing in Patients with COVID-19: A Systematic review and Meta-Analysis

“…Nevertheless, studies from Asia are reporting high use of antibiotics including the study of Hassan et al , which reported extremely high use of antibiotics (92%) in COVID-19 patients [72] , however, this study was not included in our meta-analysis as it has not met our inclusion criteria. We are also aware of more recent studies in Asia reporting high rates since our analysis [22, 73] .…”

“…Nevertheless, other respiratory viruses such as Middle East respiratory syndrome coronavirus (MERS-CoV) and SARS-CoV-1 have reported a very low prevalence of bacterial co-infection amongst infected patients [15,16] potentially attributable to the comparatively small number of cases reported [17] . Concerns regarding bacterial co-infection in COVID-19 patients has led to widespread use of antibiotics empirically in both hospital and community settings [18][19][20][21][22] . The significant increase in antibiotic prescribing during the pandemic challenges antimicrobial stewardship programmes and risks emergence of multi-drug resistant bacteria [23][24][25] , with their associated impact on morbidity, mortality and costs [26][27][28][29] .…”

“…Concerns regarding bacterial co-infection in COVID-19 patients has led to widespread use of antibiotics empirically in both hospital and community settings [18-22] . The significant increase in antibiotic prescribing during the pandemic challenges antimicrobial stewardship programmes and risks emergence of multi-drug resistant bacteria [23-25] , with their associated impact on morbidity, mortality and costs [26-29] .…”

Misdiagnosis of Bacterial Pathogens by the Diagnostic Centers: A Potential Route for Antibiotic Resistance

“…Antibiotic resistance is a global public health threat and, if not dealt with now, will become a severe issue, rendering surgical procedures risky and life-threatening. The root causes of antibiotic resistance development are poor drug quality, wrong antibiotic suggestions, wrong doses, excessive human and animal usage, environmental pollution from hospital untreated hospital sewage samples [22,[51][52][53]. Along with these causes, we hypothesize that inaccurate identification of pathogens by diagnostic centers can also lead to antibiotic resistance.…”

Multisystem Inflammatory Syndrome of a Neonate From a COVID-19-Infected Mother: A Case Report

“…The SARS-CoV-2 virus is a rare cause of fetal inflammatory response syndrome (FIRS) [ 18 ] and can be associated with multisystem inflammatory syndrome in children (MIS-C) [ 19 ]. However, in Bangladesh, Kawasaki disease (KD)-like symptoms/hyperinflammatory syndromes are a real possibility among children admitted with COVID-19 across countries [ 20 ]. This is a concern, primarily as such children, including neonates, may be managed in pediatric intensive care units (ICUs), with mortality in such units higher in lower- and middle-income countries than higher-income countries [ 21 , 22 ].…”