237 Stable Performance with Reduced Antibiotic Use in Piglets Vaccinated with an E. coli F4/F18 Vaccine for the Prevention of F18-ETEC Post-weaning Diarrhea

2021 ◽  
Vol 99 (Supplement_1) ◽  
pp. 139-140
Author(s):  
Frédéric A Vangroenweghe
Keyword(s):  
Antibiotic Use ◽  
Watery Diarrhea ◽  
Economic Losses ◽  
Standard Group ◽  
Performance Parameters ◽  
Oral Vaccination ◽  
E Coli ◽  
Technical Performance ◽  
Stable Performance ◽  
The Impact

Abstract Post-weaning Escherichia coli diarrhea (PWD) remains a major cause of economic losses for the pig industry. PWD, caused by enterotoxigenic E. coli (ETEC), typically provokes mild to severe watery diarrhea between 5–10 days after weaning. Recently, an oral live bivalent E. coli F4/F18 vaccine (Coliprotec® F4/F18; Elanco) was approved on the European market, which reduces the impact of PWD provoked by F4-ETEC and F18-ETEC. The objective was to compare technical results and antibiotic use following E. coli F4/F18 vaccination with previous standard therapeutic approach under field conditions. A 1600-sow farm (weaning at 26 days) with diagnosed problems of PWD due to F18-ETEC was selected. Piglets were vaccinated at 21 days with the oral live bivalent E. coli F4/F18 vaccine. At weaning, no standard group medication (ZnO and antibiotics) was applied for prevention of PWD. Several performance parameters were collected: treatment incidence (TI100), mortality and days in nursery. Statistical analysis was performed using JMP 14.0 – comparison of means. Oral E. coli F4/F18 vaccination significantly reduced TI100 (7 ± 2 days to 0 ± 1 days; P < 0.05). Mortality rate remained stable (2.05% in Control to 1.96% in Vaccinated group; P < 0.05). Days in nursery (40 ± 3 days) remained at the same level compared to pre-vaccination. The results show that live E. coli F4/F18 vaccination against PWD has led to similar technical performance parameters and mortality, in combination with a significant reduction in medication use. In conclusion, control of PWD through oral vaccination is a successful option in order to prevent piglets from the negative clinical outcomes of F18-ETEC infection during the post-weaning period.

236 Performance and Antibiotic Use of Piglets Vaccinated with an E. coli F4/F18 Vaccination for the Prevention of F18-ETEC Post-weaning Diarrhea

2021 ◽  
Vol 99 (Supplement_1) ◽  
pp. 138-138
Author(s):  
Frédéric A Vangroenweghe ◽  
Annelies Van Poucke ◽  
Pascal Defoort
Keyword(s):  
Treatment Protocol ◽  
Antibiotic Use ◽  
Watery Diarrhea ◽  
Economic Losses ◽  
Standard Group ◽  
Performance Parameters ◽  
E Coli ◽  
Technical Performance ◽  
The Impact ◽  
Etec Infection

Abstract Post-weaning Escherichia coli diarrhea (PWD) remains a major cause of economic losses for the pig industry. PWD, caused by enterotoxigenic E. coli (ETEC), typically provokes mild to severe watery diarrhea between 5 and 10 days after weaning. Recently, an oral live bivalent E. coli F4/F18 vaccine (Coliprotec® F4/F18; Elanco) is available on the European market, which reduces the impact of PWD provoked by F4-ETEC and F18-ETEC. The objective was to compare technical results of E. coli F4/F18 vaccination with previous standard therapeutic approach under field conditions. A 1100-sow farm with diagnosed problems of PWD due to F18-ETEC was selected. Control piglets received the standard treatment protocol with antimicrobials during the post-weaning phase. Vaccinated piglets were immunized at 18 days with the oral live bivalent E. coli F4/ F18 vaccine. At weaning, no standard group medication (ZnO and antibiotics) was applied for prevention of PWD. Piglets were fed a commercial dry feed. Several performance parameters were collected: weight at d0-47, ADWG, ADFI, FCR, TI100 and mortality. Statistical analysis was performed with JMP 14.0 – comparison of means. Oral E. coli F4/F18 vaccination significantly reduced the mortality rate (3.56% to 1.67%; P< 0.05) and TI100 (10 to 0 days; P< 0.05). All other performance parameters (ADWG, ADFI and FCR) were at the same level compared to pre-vaccination. Live E. coli F4/F18 vaccination against PWD resulted in similar technical performance parameters, in combination with a significant reduction in the mortality and medication use. In conclusion, control of PWD through vaccination is a good option in order to prevent piglets from the negative clinical outcomes of F18-ETEC infection during the post-weaning period.

238 Vaccination with an E. coli F4/F18 Vaccine for the Prevention of F4-ETEC Post-weaning Diarrhea Resulted in Reduced Post-weaning Mortality and Antibiotic Use

2021 ◽  
Vol 99 (Supplement_1) ◽  
pp. 140-140
Author(s):  
Frédéric A Vangroenweghe
Keyword(s):  
Group Treatment ◽  
Antibiotic Use ◽  
Watery Diarrhea ◽  
Economic Losses ◽  
Standard Group ◽  
Oral Vaccination ◽  
E Coli ◽  
The Impact ◽  
Treatment Mortality ◽  
Etec Infection

Abstract Post-weaning Escherichia coli diarrhea (PWD) remains a major cause of economic losses for the pig industry. PWD, caused by enterotoxigenic E. coli (ETEC), typically provokes mild to severe watery diarrhea between 5–10 days after weaning, which may result in mortality. Most common adhesins in ETEC are F4 and F18 fimbriae. Therapy to combat PWD typically consists of antibiotic treatment in combination with ZnO (3,000 ppm). Recently, an oral live bivalent E. coli F4/F18 vaccine (Coliprotec® F4/F18; Elanco) was approved on the European market, which reduces the impact of PWD provoked by F4-ETEC and F18-ETEC. The objective was to evaluate mortality and antibiotic use following E. coli F4/F18 vaccination under field conditions. A 160-sow farm (weaning at 26 days) with diagnosed problems of PWD due to F4-ETEC was selected. Piglets were vaccinated at 21 days with the oral live bivalent E. coli F4/F18 vaccine. At weaning, no standard group medication (ZnO and antibiotics) was applied for prevention of PWD. Several performance parameters were collected: treatment incidence (TI100), mortality and days in nursery. Vaccination (n = 3 groups) was compared to a historical control (n = 3 groups) Oral E. coli F4/F18 vaccination significantly reduced TI100 (18.6 ± 6.3 days to 2.4 ± 1.9 days; P < 0.05) due to the reduction in days of antimicrobial group treatment. Mortality rate significantly reduced (11.2 ± 2.6% in control to 4.5 ± 1.5% in vaccinated group; P < 0.05) following vaccination. Days in nursery (48.5 ± 0.3 days) remained constant throughout the trial. The results show that live E. coli F4/F18 vaccination against PWD has significantly impacted mortality, in combination with a reduction in medication use. In conclusion, control of PWD through oral vaccination is a successful option in order to prevent piglets from the negative clinical outcomes of F18-ETEC infection during the post-weaning period.

Save the Quinolones! Impact of a Non-Restrictive Fluoroquinolone Reduction Initiative on Antibiotic Use and Resistance at an Urban Teaching Hospital

2021 ◽  
pp. 089719002110034
Author(s):  
Steven M. Smoke ◽  
Slava Plotkin ◽  
Neeki Patel ◽  
Patrick Hilden
Keyword(s):  
Antibiotic Resistance ◽  
Ecological Study ◽  
Antibiotic Use ◽  
Negative Consequences ◽  
Intervention Period ◽  
Post Intervention ◽  
E Coli ◽  
Before And After ◽  
Improving Patient Care ◽  
The Impact

Background: Many antibiotic stewardship programs have sought to reduce fluoroquinolone use due to their association with a myriad of negative consequences. In hospital settings with fewer resources, initiatives that are less labor intensive may offer a more feasible approach to addressing fluoroquinolone use and improving patient care. Objective: This study assessed the impact of a non-restrictive fluoroquinolone reduction initiative on antibiotic use and resistance. Methods: This was a retrospective pre- and post-interventional ecological study conducted from 2016 to 2017. The fluoroquinolone reduction initiative consisted of education on risks and alternatives. Buttons promoting “Save the Quinolones” were also worn to increase visibility. Outcome measures were the rate of fluoroquinolone use and antibiotic resistance in Staphylococcus aureus, Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and Pseudomonas aeruginosa before and after the intervention. Results: Overall, fluoroquinolone use decreased throughout the study, but there was a significantly greater rate of decrease in the post-intervention period (monthly decrease of 3.3% (1.3, 5.1) v. 7.4% (5, 9.8) p = 0.043). S. aureus susceptibility to oxacillin increased from 47.2% to 55.2% (difference 8.0, 95%CI 1.2 to 14.7). P. aeruginosa susceptibility to levofloxacin increased from 60% to 70.7% (difference 10.7, 95%CI 0.8 to 20.6). No differences in susceptibility rates of E. coli, P. mirabilis or K. pneumoniae were detected. Conclusion: This non-restrictive fluoroquinolone reduction initiative led to a significant decrease in fluoroquinolone use that was associated with decreased antibiotic resistance in S. aureus and P. aeruginosa.

Impact of Different Methods for Describing the Extent of Prior Antibiotic Exposure on the Association Between Antibiotic Use and Antibiotic-Resistant Infection

2007 ◽  
Vol 28 (6) ◽  
pp. 647-654 ◽  
Author(s):  
Emily P. Hyle ◽  
Warren B. Bilker ◽  
Leanne B. Gasink ◽  
Ebbing Lautenbach
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Antibiotic Use ◽  
Continuous Variable ◽  
Antibiotic Exposure ◽  
Categorical Variable ◽  
Antibiotic Resistant ◽  
E Coli ◽  
Multivariable Models ◽  
The Impact

Objective.Many studies have investigated the association between prior antibiotic use and antibiotic resistance. However, methods used in past studies to describe the extent of prior antibiotic use (eg, use of the 2 categories exposure versus no exposure and measurement of duration of exposure) have not been reviewed. The impact of the use of different methods for quantifying the use of antibiotics is unknown. The objectives of this study were to characterize past approaches to describing the extent of antibiotic use and to identify the impact of the use of different methods on associations between use of specific antibiotics and infection with an antibiotic-resistant-organism.Methods.We conducted a systematic review of studies that investigated risk factors for extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella species to identify variability in past approaches to describing the extent of antibiotic use. We then reanalyzed a data set from a prior study of risk factors for infection with ESBL-producing E. coli and Klebsiella species. We developed 2 separate multivariable models: 1 in which prior antibiotic use was described as a categorical variable (eg, exposure or no exposure) and 1 in which antibiotic use was described as a continuous variable (eg, measured in antibiotic-days). These models were compared qualitatively.Setting.Large academic medical center.Results.The 25 articles included in the systematic review revealed a variety of methods used to describe the extent of prior antibiotic exposure. Only 1 study justified its approach. Results from the 2 multivariable models that used different methodologic approaches differed substantially. Specifically, use of third-generation cephalosporins was a risk factor for infection with ESBL-producing E. coli and Klebsiella species when antibiotic use was described as a continuous variable but not when antibiotic use was described as a categorical variable.Conclusions.There has been no consistent method for assessing the extent of prior antibiotic exposure. The use of different methods may substantially alter the identified antimicrobial risk factors, which has important implications for the resultant interventions regarding antimicrobial use.

scholarly journals Antimicrobial properties of viscose yarns ring-spun with integrated amino-functionalized nanocellulose

Cellulose ◽  
2021 ◽  
Author(s):  
Vanja Kokol ◽  
Vera Vivod ◽  
Zdenka Peršin ◽  
Miodrag Čolić ◽  
Matjaž Kolar
Keyword(s):  
Skin Irritation ◽  
Cellulose Nanofibrils ◽  
Antimicrobial Properties ◽  
Ionic Surfactant ◽  
E Coli ◽  
Technical Performance ◽  
Durability Testing ◽  
Surface Modified ◽  
The Impact ◽  
Textile Sector

AbstractBio-based, renewable and biodegradable products with multifunctional properties are also becoming basic trends in the textile sector. In this frame, cellulose nanofibrils (CNFs) have been surface modified with hexamethylenediamine/HMDA and used as an antimicrobial additive to a ring-spun viscose yarn. The CNF-HMDA suspension was first characterized in relation to its skin irritation potential, antimicrobial properties, and technical performance (dispersability and suspensability in different media) to optimize its sprayability on a viscose fiber sliver with the lowest sticking, thus to enable its spinning without flowing and tearing problems. The impact of CNF-HMDA content has been examined on the yarn`s fineness, tensile strength, surface chemistry, wettability and antimicrobial properties. The yarn`s antimicrobial properties were increasing with the content of CNF-HMDA, given a 99% reduction for S. aureus and C. albicans (log 1.6–2.1) in up to 3 h of exposure at minimum 33 mg/g, and for E. coli (log 0.69–2.95) at 100 mg/g of its addition, yielding 45–21% of bactericidal efficacy. Such an effect is related to homogeneously distributed CNF-HMDA when sprayed from a fast-evaporated bi-polar medium and using small (0.4 mm) nozzle opennings, thus giving a high positive charge (0.663 mmol/g) without affecting the yarn`s tenacity and fineness, but improving its wettability. However, a non-ionic surfactant being used in the durability testing of functionalized yarn to 10-washing cycles, adheres onto it hydrophobically via the methylene chain of the HMDA, thus blocking its amino groups, and, as such, decreasing its antibacterial efficiency, which was slightly affected in the case when the washing was carried out without using it.

scholarly journals Molecular identification, genotyping of virulence-associated genes, and pathogenicity of cellulitis-derived Escherichia coli

2020 ◽  
Vol 13 (12) ◽  
pp. 2703-2712
Author(s):  
Mohamed M. Amer ◽  
Hoda M. Mekky ◽  
Hanaa S. Fedawy ◽  
A. EL-Shemy ◽  
M. A. Bosila ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Phylogenetic Analysis ◽  
Molecular Identification ◽  
Broiler Chickens ◽  
Molecular Techniques ◽  
Economic Losses ◽  
Fatty Tissue ◽  
E Coli ◽  
The Impact

Background and Aim: Avian colibacillosis, which is caused by avian pathogenic Escherichia coli (APEC), is a major bacterial disease that affects birds of all ages worldwide, causing significant economic losses. APEC manifests in several clinical forms, including cellulitis, and its high pathogenicity is attributed to harboring numerous virulence-associated genes (VGs). This study evaluated the pathogenicity of the cellulitis-derived E. coli (O78) strain through molecular identification of genes coding for seven virulence factors and by conducting an in vivo assessment of capability for cellulitis induction in broiler chickens. Materials and Methods: This study was performed using a previously isolated and identified cellulitis-derived E. coli (O78), which was screened for seven VGs using molecular detection and identification through polymerase chain reaction followed by nucleotide sequencing and phylogenetic analysis. Experimental infection by subcutaneous (SC) inoculation in broilers and its pathogenicity was confirmed in vivo by cellulitis induction. The impact of cellulitis on broiler performance was assessed. Results: Molecular genotyping proved that the isolate harbored five virulence genes (iroN, iutA, tsh, iss, and papC) and was negative for stx1 and hly genes. The amplified products for iroN, iss, and iutA were subjected to sequencing and phylogenetic analysis, and the results indicate the highest similarity and matching with E. coli submitted to the National Center for Biotechnology Information GenBank. SC inoculation of bacteria in broiler chickens resulted in cellulitis, as indicated by thick red edematous skin with yellowish-white material in the SC tissue at the inoculation site, and the abdominal muscle showed redness and increased vacuolization. Histopathological examination revealed moderate-to-severe caseous inflammatory reaction with a marked accumulation of heterophils and mononuclear cells in the SC fatty tissue. The average feed intake, body weight gain (BWG), and feed conversion ratio (FCR) were lower in infected chickens in comparison with those of the control non-infected chickens. Conclusion: This study proves that molecular techniques are accurate for pathogenicity determination in virulent bacteria, with the advantages of being rapid, time-saving, and economical. Cellulitis is associated with economic losses that are represented by a lower BWG and FCR.

scholarly journals 1985. Impact of Suppressing Ciprofloxacin Susceptibility Results on Antibiotic Utilization and Hospital-acquired Clostridioides difficile Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S664-S665
Author(s):  
Bryan P White ◽  
Daniel B Chastain ◽  
Karen Kinney ◽  
Katie Thompson ◽  
Jerry Kelley ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Interrupted Time Series Analysis ◽  
E Coli ◽  
Clostridioides Difficile ◽  
Antibiotic Utilization ◽  
Increased Risk ◽  
Days Of Therapy ◽  
Before And After ◽  
Hospital Acquired ◽  
The Impact

Abstract Background Fluoroquinolones (FQs) are broad-spectrum antibiotics associated with multiple adverse effects and an increased risk of Clostridioides difficile infections (CDI). Previous data suggest that suppression of FQ susceptibility results decreased FQ use. The purpose of this study was to examine the impact of suppressing ciprofloxacin susceptibility on antibiotic use, susceptibility, and CDI. Methods This was a single-center quasi-experimental study of the effect of the suppression of ciprofloxacin susceptibility on pan susceptible urine isolates for Klebsiella sp. and E. coli starting in March 2018 in the 11 months before and after the intervention. Monthly antibiotic utilization in days of therapy (DOT)/1,000 patient-days for levofloxacin, ciprofloxacin, ceftriaxone, trimethoprim/sulfamethoxazole (TMP/SMZ), fosfomycin, and nitrofurantoin, hospital-acquired CDI (HA-CDI) rates as defined by CDC, and Pseudomonas aeruginosa susceptibility was compared with interrupted time series analysis using Stata MP 12.1 before and after the intervention to compare the level, intercept, and rate, slope, of a trend line. Results There was no change in the level or rate of ciprofloxacin DOT (0.27, 95% CI: −0.94 to 1.48–3.49; 95% CI: −10.89 to 3.90) and levofloxacin DOT (−5.87, 95% CI: −17.79 to 6.06; −0.98, 95% CI −2.86 to 0.90) with the intervention, respectively. Level of P. aeruginosa susceptibility to ciprofloxacin level (8.13, 95% CI: 0.00 to 16.26) had a trend toward increasing and rate (1.65, 95% CI: 0.44 to 2.87) increased after the intervention. Ceftriaxone DOT level decreased after the intervention (P = 0.01), but the rate did not change. Cephalexin (P = 0.01) and nitrofurantoin (P = 0.01) DOT levels increased after the intervention without changes in rates. There was no change in the level or rate of HA-CDI, fosfomycin, or TMP/SMZ DOTs. Conclusion Suppressing ciprofloxacin susceptibility results on pan susceptible Klebsiella sp. and E. coli urine isolates was associated with increased P. aeruginosa susceptibility to ciprofloxacin and increased cephalexin and nitrofurantoin DOTs. No changes were seen in FQ use or HA-CDI rates. Disclosures All authors: No reported disclosures.

scholarly journals 1996. Enteric Multiplex PCR Testing: Antimicrobial Stewardship Friend or Foe

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S669-S669
Author(s):  
Mary Ellen Acree ◽  
Erin McElvania ◽  
Angella Charnot-Katsikas ◽  
Kathleen Beavis ◽  
Scott Matushek ◽  
...  
Keyword(s):  
Multiplex Pcr ◽  
Clinical Significance ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Aeromonas Species ◽  
Pathogenic Potential ◽  
E Coli ◽  
The Impact ◽  
Pcr Test

Abstract Background There are advantages and challenges associated with enteric multiplex PCR testing. Fast turnaround time can lead to prompt pathogen identification and antibiotic initiation, decreased length of stay and decreased time in isolation. Challenges include identification of multiple organisms, carrier state detection, and detection of organisms with uncertain pathogenic potential, which can lead to unnecessary antibiotic use. Methods Two institutions transitioned from stool culture to stool PCR testing for identification of diarrheal pathogens. On February 1, 2016, Center 1 employed the BioFire® FilmArray® GI Panel, which detects 22 organisms and includes targets of unclear clinical significance. Center 2 implemented the BD MAX™ Enteric Bacterial Panel on 3/6/2019, which reports 4 bacterial known pathogens. Fluoroquinolone (FQ) and third-generation cephalosporin (TGC) prescribing in response to positive PCR testing was assessed over a 1 month period. Antibiotics were counted when prescribed within 72 hours of the collection date. Results At Center 1, 332 GI PCR panels were ordered, 94 (28.3%) were positive and 15 (16%) were treated; 4 received an FQ (26%), and 11 (73%) received a TGC. Center 1 organisms included 44 Clostridioides difficile, 27 Norovirus, 8 Enteropathogenic E. coli, 7 Sapovirus, 4 Campylobacter species, 2 Giardia lamblia, 2 Rotavirus, 1 Shigella/Enteroinvasive E. coli and 1 Salmonella species. Of 642 PCR tests ordered at Center 2, 16 (2.5%) were positive and 11 (69%) were treated; 10 (91%) received a FQ, and 1 (9%) received a TGC. Center 2 organisms included 8 non-typhoidal Salmonella species, 5 Aeromonas species, 2 Shigella sonnei and 1 Salmonella typhi. Conclusion Implementation of an enteric multiplex PCR test with targets of uncertain clinical significance is more likely to yield an abnormal result than a PCR test with only known pathogens. However, careful interpretation of results can avoid unnecessary antimicrobial use. Antimicrobial stewardship teams should work in tandem with microbiology laboratories to implement enteric multiplex PCR tests and monitor the impact on antibiotic use. Larger studies are needed to definitively assess the impact of the GI panel on antimicrobial prescribing within the context of patient comorbidities and institutional practices. Disclosures All authors: No reported disclosures.

scholarly journals Multisite Controlled Blinded Field Studies to Evaluate the Effect of an Oral Live Escherichia Coli Bivalent F4/F18 Vaccine in Pig Nurseries with Mild Cases of Post-Weaning Diarrhea or Subclinical ETEC Infections.

2020 ◽  
Author(s):  
Eric Nadeau ◽  
Danielle Tremblay ◽  
Anna Magdalena Naderer ◽  
Klaus Hellmann
Keyword(s):  
Escherichia Coli ◽  
Weight Gain ◽  
Conversion Rate ◽  
Clinical Signs ◽  
Economic Losses ◽  
Feed Conversion ◽  
E Coli ◽  
Enteric Diseases ◽  
Feed Conversion Rate ◽  
The Impact

Abstract Background: Post-weaning diarrhea (PWD) caused by Escherichia coli is a worldwide economically important disease in pigs, linked with increased mortality and weight loss. F4- and F18-enterotoxigenic E. coli (ETEC) are the most diagnosed causes of PWD. The efficacy of live oral E. coli vaccines has been previously demonstrated on farms with confirmed clinical cases of PWD. However, the impact of vaccination in subclinical cases with mild or not noticeable clinical manifestations needed to be assessed. This study evaluated the effect of an oral dose of a live E. coli bivalent F4/F18 vaccine in nurseries without ongoing clinical PWD outbreaks but with a history of pathogenic E. coli circulating within the herd. Two controlled blinded studies were performed under commercial conditions in a total of 6 European sites. Overall, 1941 vaccinated piglets and 1976 control piglets were enrolled and were monitored for health, growth, and feed conversion rate. Results: No clinical outbreak of ETEC PWD has been observed in the tested farms. Two farms faced episodes of non-ETEC enteric diseases that required treatments. Nursery weight gain was not statistically different between groups in these two farms. However, the nursery weight gain of the vaccinated pigs was significantly higher by 0.80, 0.87 and 1.24 kg than of the control pigs in three of the four farms without non-ETEC enteric diseases (p<0.05) and by 0.69 kg (p=0.051) in the fourth one, leading to numerically heavier pigs at the exit of the four nurseries. No statistically difference was observed for the feed conversion rate, though it was numerically lower for vaccinated pigs of the two tested farms. Conclusions: Recent European legislations aimed at reducing the use of antibiotics and banning therapeutic use of zinc oxide in feed are leading to a search for alternatives to compensate animal health impacts and economic losses due to PWD. These studies demonstrate that, even in the absence of convincing clinical signs of PWD, ETEC infections limit nursery pig optimal growth performance that can be mitigated by vaccination with an oral live E. coli bivalent F4/F18 vaccine. These findings corroborate previous studies showing the effect of vaccination in clinical outbreaks of PWD.

scholarly journals A retrospective review on antibiotic use in acute watery diarrhea in children in a tertiary care hospital of Karachi, Pakistan

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253712
Author(s):  
Sonia Qureshi ◽  
Shahzadi Resham ◽  
Mariam Hashmi ◽  
Abdullah B. Naveed ◽  
Zoya Haq ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Hospital Stay ◽  
Retrospective Review ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Watery Diarrhea ◽  
Care Hospital ◽  
Acute Watery Diarrhea ◽  
Prolonged Hospital ◽  
The Impact

Introduction Responsible for at least one in nine pediatric deaths, diarrheal diseases are the leading, global cause of death. Further abetted by improper antibiotic use in a hospital setting, children with acute watery diarrhea can see prolonged hospital stays, and unwanted adverse effects such as antibiotic resistance. Hence, this study is aimed to identify the association between antibiotic usage for the treatment of acute watery diarrhea in children, and the impact this line of management has on the duration of their hospital stay. Methods A retrospective review was conducted at the department of Pediatric of Aga Khan University Hospital (AKUH) in Karachi. A total of 305 records of children aged 6 months to 5 years who were admitted with a diagnosis of acute watery diarrhea from June 2017 –December 2018 was screened, of which 175 fulfilled the eligibility criteria. A predesigned questionnaire was used to collect demographic information, comorbidities, and clinical features, severity of dehydration, clinical examination, treatment received, and laboratory investigations. The primary outcome of this study was the length of hospital stay measured against the number of hours a child stayed in hospital for treatment of acute watery diarrhea. The statistical analysis was carried out using STATA version 14 to reach conclusive results. Results 175 patients presented with acute watery diarrhea, out of which 106 (60.6%) did not receive antibiotics. The median (IQR) age of the group that did not receive antibiotics was 12.0 (12.0) months compared to 15.0 (12.0) months for the group that did receive antibiotics. In both groups, there were more males than females, less than 15% of the patients were severely malnourished (WHZ score -3SD) and less than 10% of the patients were severely dehydrated. The median (IQR) length of hospital stay (hours) was 32.0 (19.0) respectively for the group that did not receive antibiotic and 41.0 (32.0) for the group that did receive antibiotic therapy. The expected length of hospital stay for the group that received antibiotic therapy was 0.22 hours higher than the group that did not. Finally, as compared to females, hospital stay for males was longer by 0.25 hours. Conclusion In conclusion, antibiotic use was associated with a prolonged hospital stay in children with acute watery diarrhea as compared to children who did not receive antibiotics. Large scale robust prospective studies are needed to establish this association using this observational data.

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