Metronidazole-sensitive organisms in children with severe acute malnutrition: an evaluation of the indication for empiric metronidazole treatment

Zangenberg, Mike; Abdissa, Alemseged; Johansen, Øystein Haarklau; Tesfaw, Getnet; Girma, Tsinuel; Kurtzhals, Jørgen A. L.

doi:10.1016/j.cmi.2019.05.022

Cited by 3 publications

(8 citation statements)

References 27 publications

(33 reference statements)

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“…Fifteen studies had a high risk of bias because the samples were not representative of the target population (eg, special populations) (eTable 3 in the Supplement). Most studies had either low (n = 88) or unclear (n = 5) risk of bias with regard to participant recruitment.…”

Section: Resultsmentioning

confidence: 87%

“…Age groups included neonates (n = 13); infants (n = 24); and children 2 years or younger (n = 12), 3 years or younger (n = 3), 5 years or younger (n = 2), 8 years or younger (n = 2), 10 years or younger (n = 1), and older than 10 years (n = 32) . Seventy-seven studies included healthy children; other populations were premature or low-birth-weight infants (n = 6), patients with oncologic or hematologic disease (n = 9), patients with a diagnosis of malnourishment (n = 1), and outpatients attending gastroenterology clinics without C difficile –associated clinical symptoms (n = 2) (eTable 2 in the Supplement).…”

Section: Resultsmentioning

confidence: 99%

“…Studies that fully (n = 80) or partially (n = 4) described the participants and setting were at low and unclear risk of bias, respectively. Eleven studies had a high risk of bias because of failure to describe the participants or setting in detail (eg, hospitalized children without admission diagnoses) …”

Section: Resultsmentioning

confidence: 99%

“…We compared the overall prevalence of C difficile detection according to geographic region: Africa (n = 5), North and South America (n = 25), Southeast Asia (n = 3), Eastern Mediterranean (n = 6), Europe (n = 40), and Western Pacific (n = 16) . Prevalence was also compared by income status: high income (n = 71), upper-middle income (n = 16), lower-middle income (n = 7), and low income (n = 1) . Overall, the prevalence in North and South America differed from that in Europe (β, −0.151; P = .001) and the Western Pacific (β, 0.136; P = .008) regions (Figure 3A).…”

Section: Resultsmentioning

confidence: 99%

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Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children

et al. 2021

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IMPORTANCE Detection of Clostridioides difficile has frequently been described in asymptomatic infants and children, but accurate estimates across the age spectrum are unavailable. OBJECTIVE To assess the prevalence of C difficile detection among asymptomatic children across the age spectrum. DATA SOURCES This systematic review and meta-analysis included a search of the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, Scopus, and Web of Science for articles published from January 1, 1990, to December 31, 2020. Search terms included Clostridium difficile, Peptoclostridium difficile, Clostridioides difficile, CDF OR CDI OR c diff OR c difficile, Clostridium infections OR cd positive diarrhea OR cd positive diarrhea OR Clostridium difficile OR Peptoclostridium difficile OR pseudomembranous colitis OR pseudomembranous enterocolitis, enterocolitis, and pseudomembranous. These were combined with the following terms: bacterial colonization and colonization OR colonized OR colonizing OR epidemiology OR prevalence OR seroprevalence. STUDY SELECTION Studies were screened independently by 2 authors. Studies were included if they reported testing for C difficile among asymptomatic children (ie, children without diarrhea) younger than 18 years.DATA EXTRACTION AND SYNTHESIS Data were extracted independently and in duplicate by 2 reviewers. Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines were used. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURESThe primary outcome was prevalence of C difficile detection among asymptomatic children. Secondary outcomes included prevalence of toxigenic vs nontoxigenic strains of C difficile and prevalence of C difficile detection stratified by geographic region, income status, testing method, and year of testing. RESULTS A total of 95 studies with 19 186 participants were included. Rates of detection of toxigenic or nontoxigenic C difficile were greatest among infants aged 6 to 12 months (41%; 95% CI, 32%-50%) and decreased to 12% (95% CI, 7%-18%) among children aged 5 to 18 years. The prevalence of toxigenic C difficile colonization was lower, peaking at 14% (95% CI, 8%-21%) among infants aged 6 to 12 months and decreasing to 6% (95% CI, 2%-11%) among children older than 5 years. Although prevalence differed by geographic region (ie, North and South America vs Europe: β, −0.151, P = .001; North and South America vs Western Pacific: β, 0.136, P = .007), there was no difference by testing method (ie, culture vs polymerase chain reaction: β, 0.069, P = .052; culture vs enzyme immunoassay: β, −0.178, P = .051), income class (low-middle income vs high income: β, −0.144, P = .23; upper-middle vs high income: β, −0.020,

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Section: Resultsmentioning

confidence: 87%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children

et al. 2021

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“…One EDTA plasma tube (Vacuette, Becton Dickinson (BD), Austria) and, if the child was not admitted to intensive care, one Serum Sep Clot tube (Vacuette, BD, Austria) were obtained. Furthermore, blood cultures were performed using aerobic and anaerobic blood culture vials (BACTEC Peds Plus and BACTEC Lytic/10 Anaerobic, BD, USA) as previously described .…”

Section: Methodsmentioning

confidence: 99%

Critical evaluation of the appetite test for children with severe acute malnutrition

Zangenberg

Abdissa

Johansen

et al. 2020

Tropical Med Int Health

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objectives The appetite test is used to risk stratify for children with severe acute malnutrition (SAM) in inpatient or outpatient care. The test is recommended in guidelines despite lack of evidence. We evaluated its ability to identify children at risk of a poor treatment outcome.methods We conducted an observational study of children diagnosed with SAM at three health facilities in Ethiopia. The appetite test was done independently, and the result did not affect decisions about hospitalisation and clinical care. Data were analysed using mixed linear and logistic regression models.results Appetite was tested in 298 (89%) of 334 children enrolled; 56 (19%) passed. Children failing the appetite test had a 6.6% higher weight gain per day (95% CI: 2.6, 10.8) adjusted for type of treatment, oedema, duration of follow-up and age than children passing the test. We found medical complications in 179 (54%) children. Medical complications were associated with blood markers of metabolic disturbance. Children with medical complications tended to have lower weight gain than those without complications (3.5%, 95% CI: À0.25, 7.0). Neither the appetite test nor medical complications were correlated with bacteraemia or treatment failure.conclusions Our findings question the use of the appetite test to identify children who need inpatient care. An assessment of medical complications alone could be a useful risk indicator but needs to be evaluated in other settings.keywords severe acute malnutrition, appetite, community management, risk assessment, therapeutic foods Sustainable Development Goals (SDGs): SDG 2 (zero hunger), SDG 3 (good health and well-being), SDG 17 (partnerships for the goals)

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Determinants of Undernutrition among Children Admitted to a Pediatric Hospital in Port Sudan, Sudan

Chiopris,

Valenti

et al. 2024

Nutrients

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Severe acute undernutrition (SAU) is still a crucial global health issue in the 0–59 months population, increasing the risk of mortality as well as of long-term consequences. In Sudan, 3.3 million children suffered from acute malnutrition between 2018 and 2019. This study was planned to evaluate, in the area of Port Sudan, the prevalence of acute undernutrition after the COVID-19 pandemic and to identify the most important factors favoring the development of acute undernutrition. The available clinical records of all the under-five children (n = 1012) admitted to the Port Sudan Emergency Pediatric Hospital from 1 February 2021 to 31 January 2022 were analyzed. The presence of wasting and kwashiorkor was assessed and children were categorized according to age, gender, place of residence, main reason for hospitalization, and underlying comorbidities. Acute undernutrition was evidenced in 493 (48.7%) children. Of them, only 16 (3.2%) were diagnosed with kwashiorkor. Children with SAU had a higher prevalence of acute gastroenteritis (p < 0.05) and parasitosis (p < 0.05). Infants aged 0–6 months were those with the lowest risk of undernutrition, whereas those aged 7–12 months were those with the greater risk. In these patients, multivariate analysis revealed that SAU and MAU were 2.5 times (OR 2.51; 95% CI, 1.79–3.55) and 5.5 times (OR 5.56; 95% CI, 2.59–18.7) higher. This study shows that the area of Port Sudan is still suffering from an alarming prevalence of severe wasting and the risk of developing acute undernutrition seems strictly related to the introduction of complementary feeding and tends to reduce with increasing age. Measures already in place to prevent acute malnutrition should be reinforced with improvement of mother education on child feeding.

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Metronidazole-sensitive organisms in children with severe acute malnutrition: an evaluation of the indication for empiric metronidazole treatment

Cited by 3 publications

References 27 publications

Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children

Prevalence of Detection of Clostridioides difficile Among Asymptomatic Children

Critical evaluation of the appetite test for children with severe acute malnutrition

Determinants of Undernutrition among Children Admitted to a Pediatric Hospital in Port Sudan, Sudan

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