#61: Antibiotic Use for Community-Acquired Pneumonia Among Hospitalized Children in Japan

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S13-S13
Author(s):  
Chiaki Tao-Kidoguchi ◽  
Eiki Ogawa ◽  
Kensuke Shoji ◽  
Isao Miyairi
Keyword(s):  
Physician Behavior ◽  
Point Of Care ◽  
Descriptive Analysis ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Clinical Criteria ◽  
Focus Of Infection ◽  
Tract Infections ◽  
Short Courses ◽  
Viral Etiologies

Abstract Background Judicious use of antimicrobials is the cornerstone of action against antimicrobial resistance. Respiratory tract infections account for over 80% of pediatric antibiotic use in Japan. Antibiotics are generally used empirically for most hospitalized patients with pneumonia although it is becoming clearer that viral etiologies account for approximately 70% of these cases. Defining the characteristics of patients who are managed with a short course of antibiotics and subsequently do well, may lead to setting clinical criteria for early termination of antibiotics. Methods We performed a retrospective descriptive analysis. Medical charts of patients aged 3 months to 18 years, who were admitted with a diagnosis of pneumonia, bronchitis, bronchiolitis, or asthma to the Department of Interdisciplinary medicine at the National Center for Child Health and Development from March 2018 through February 2019 were reviewed. Those who had respiratory symptoms and were started on antibiotics within 48 hours of hospitalization were included. Those who had a focus of infection elsewhere or were immunocompromised were excluded. Results Of the 556 candidates, 80 patients met the criteria. The median age was 1.5 years which included 42.5% (34/80) with comorbidities. Underlying conditions included 9 with trisomy 21, and 8 with perinatal issues. Rapid antigen testing was performed and 7 patients with RSV, 5 patients with influenza, 1 patient with human metapneumovirus were identified. The average duration of antibiotic therapy was 7.2 days (range 2–14 days). There were no statistical differences in the characteristics of patients who received antibiotics for more or less than 5 days. The positivity of the rapid antigen test tended to be higher in those who received antibiotics for a shorter period (25% vs. 15%). There were no differences in the rate of readmission or complications between the two groups. Conclusion We were unable to identify a clear characteristic of patients who received short courses of antibiotics for pneumonia. The trend observed for those who had a point of care testing may suggest that the use of a multiplex PCR testing covering a greater number of pathogens would influence physician behavior in antibiotic use.

Pan-European Survey of Patients' Attitudes to Antibiotics and Antibiotic Use

1996 ◽  
Vol 24 (3) ◽  
pp. 229-238 ◽  
Author(s):  
A Branthwaite ◽  
J-C Pechère
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
Once Daily ◽  
Working Adults ◽  
Telephone Interviews ◽  
Short Course ◽  
The Uk ◽  
Tract Infections ◽  
Short Courses

This study was carried out to determine patient perceptions of respiratory tract infections and attitudes to taking antibiotics, thus helping doctors to have a better understanding of their patients and their requirements. Telephone interviews were conducted in the UK, Belgium, France, Italy, Spain and Turkey using standardized questionnaires directed at patients who had taken an antibiotic or given one to their child for a respiratory tract infection within the previous 12 months. Approximately 200 working adults (≤ 55 years), 200 elderly adults (> 55 years) and 200 mothers of children (< 12 years) from each country were contacted; in total, 3610 subjects. Pressure on GPs to prescribe antibiotics was highlighted by over 50% of interviewees' believing that they should be prescribed for most respiratory tract infections. Although interviewees were positive about antibiotics, with over 75% judging them to be effective and to speed recovery, some ambivalence was shown. Most patients waited 2 – 3 days before consulting their doctor and over 80% of respondents expected symptoms to improve after 3 days' treatment. This provided a natural watershed for compliance, with most defaulters stopping after 3 days because they felt better. Second only to fewer side-effects, patients ranked shorter and more convenient dosage alongside efficacy as the improvements most sought in antibiotic therapy. In conclusion, patients regarded antibiotics as important in the treatment of respiratory tract infections, with interest shown in short-course, once-daily therapy. Doctors, however, need to reassure patients that short courses will eradicate infections and have minimal adverse effects on the immune system.

scholarly journals Prevalence of Co-Infection at the Time of Hospital Admission in COVID-19 Patients, A Multicenter Study

2020 ◽  
Author(s):  
Sara M Karaba ◽  
George Jones ◽  
Taylor Helsel ◽  
L Leigh Smith ◽  
Robin Avery ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Clinical Laboratory ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Clinical Criteria ◽  
Empiric Antibiotic ◽  
Definition Of ◽  
Time Of Presentation ◽  
Microbiologic Diagnosis ◽  
Viral Respiratory

Abstract Background Bacterial infections may complicate viral pneumonias. Recent reports suggest bacterial co-infection at time of presentation is uncommon in COVID-19; however, estimates were based on microbiology tests alone. We sought to develop and apply consensus definitions, incorporating clinical criteria to better understand the rate of co-infections and antibiotic use in COVID-19. Methods 1,016 adult patients admitted to five hospitals in the Johns Hopkins Health System between 3/1/2020-5/31/2020 with COVID-19 were evaluated. Adjudication of co-infection using definitions developed by a multidisciplinary team for this study were performed. Both respiratory and common non-respiratory co-infections were assessed. The definition of bacterial community-acquired pneumonia (bCAP) included proven (clinical, laboratory and radiographic criteria plus microbiologic diagnosis), probable (clinical, laboratory and radiographic criteria without microbiologic diagnosis), and possible (not all clinical, laboratory and radiographic criteria met) categories. Clinical characteristics and antimicrobial use were assessed in the context of the consensus definitions. Results Bacterial respiratory co-infections were infrequent (1.2%); 1 patient had proven bCAP, and 11 (1.1%) had probable bCAP. Two patients (0.2%) had viral respiratory co-infections. Although 69% of patients received antibiotics for pneumonia, the majority were stopped within 48 hours in patients with possible or no evidence of bCAP. The most common non-respiratory infection was urinary tract infection (present in 3% of the cohort). Conclusions Using multidisciplinary consensus definitions, proven or probable bCAP was uncommon in adults hospitalized due to COVID-19, as were other non-respiratory bacterial infections. Empiric antibiotic use was high, highlighting the need to enhance antibiotic stewardship in treatment of viral pneumonias.

scholarly journals 240. Reduction of antibiotic use in children admitted with viral respiratory tract infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S120-S120
Author(s):  
Ankhi Dutta ◽  
Huay-Ying Lo ◽  
Amrita Singh ◽  
Samrah Mobeen ◽  
Kelli Kulik ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Respiratory Infections ◽  
Significant Proportion ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Process Measures ◽  
Days Of Therapy ◽  
Tract Infections ◽  
Viral Respiratory

Abstract Background Viral respiratory tract infections (VRTI) accounts for a significant proportion of hospitalized children and contributes to a substantial use of health care resources and costs. American Academy of Pediatrics (AAP) recommends against using antibiotics in uncomplicated viral respiratory infections in children. Overuse of antibiotics ranges between 29–80%. The goal of an Antibiotic stewardship programs (ASP) is to decrease antibiotic misuse, lower costs, and prevent emergence of antibiotic resistance in the community. Proportion of children with Viral respiratory tract infections on antibiotics Methods Our smart aim was to reduce antibiotic use by 25% in admitted children with VRTI between October 2019-March 2020. Our outcome measure was to reduce inappropriate antibiotic use during the 2019–20 season by 25%. Process measures included percentage of antibiotic used in viral RTI, antibiotic days of therapy and appropriate audit-feedback from the ASP team to facilitate discontinuation or de-escalation of antibiotics based on culture data. Our balance measure included readmission rates in patients in whom antibiotics were discontinued or de-escalated. Several PDSA cycles implemented with predominant emphasis on communication between ASP team and primary providers. Results No differences were noted in patient demographics including sex, age, ethnicity between the viral season in 2018–19 and 2019–2020. In our previous study in 2018–2019 RSV season, there was 40.7% antibiotic use in patients admitted with RSV bronchiolitis. In 2019–2020 season we included all patients admitted with viral RTI. Of the 213 patients evaluated between October 2019 through Dec 2020, 40% of the patients received antibiotics. 100% of the antibiotics were justified, based on independent review of antibiotic data by the team. Most common cause of antibiotics were community acquired pneumonia, rule out sepsis and otitis media. Antibiotic discontinuation and de-escalation were achieved in over 90% of the justified antibiotics. Conclusion Though antibiotic usage was still at 40% at our institution, 100% of antibiotic use was deemed appropriate and significant proportion were discontinued or deescalated by the ASP team. The ASP team played a crucial role in communicating with the primary providers to advocate for appropriate antibiotic use in the children. Disclosures All Authors: No reported disclosures

PP16 Turning The Tide On Antibiotic Use With Consumers And Health Professionals

2018 ◽  
Vol 34 (S1) ◽  
pp. 71-71
Author(s):  
Jianyun Wu ◽  
Daniel Taylor ◽  
Jonathan Dartnell ◽  
Aine Heaney ◽  
Lynn Weekes ◽  
...  
Keyword(s):  
Health Professionals ◽  
Point Of Care ◽  
Family Physicians ◽  
Cumulative Effect ◽  
Antibiotic Use ◽  
Educational Interventions ◽  
Upper Respiratory Tract ◽  
Duration Of Symptoms ◽  
National Programs ◽  
Tract Infections

Introduction:Many countries have a national antimicrobial resistance strategy. In Australia, primary care is especially important because this setting encompasses a high proportion of antibiotic use. While antibiotic use decreased during the 1990s, it began to increase again in the mid-2000s. In response to this, in 2009 NPS MedicineWise implemented a series of nationwide educational interventions for consumers, family physicians (general practitioners), and community pharmacies that aimed to reduce excessive antibiotic use.Methods:For consumers a social marketing approach was used, including strategies that leveraged collectivism, nudge theory, celebrity endorsement, and co-creation. Channels included social, print, radio, and other media as well as practice waiting rooms and pharmacies. For health professionals, interventions included face-to-face education, audits, comparative prescribing feedback, case studies, and point-of-care materials. Surveys of consumers and family physicians were conducted periodically to evaluate changes in knowledge and behavior. National Pharmaceutical Benefits Scheme claims data were analyzed using a Bayesian structural time-series model to estimate the cumulative effect of interventions by comparing the observed and expected monthly dispensing volumes if the interventions had not occurred.Results:The consumer survey results indicated that more people were aware of antibiotic resistance (seventy-four percent in 2017 versus seventy percent in 2014), with the minority requesting or expecting antibiotics for upper respiratory tract infections (URTIs) (twenty-two percent in 2017). People underestimated the usual duration of symptoms for URTIs and were more inclined to expect antibiotics beyond that timeframe. Compared with non-participants, family physicians who participated in the program reported more frequent discussions about hand hygiene (ninety percent versus eighty-two percent) and proper use of antibiotics with patients (ninety-five percent versus eighty-eight percent). Between 2009 and 2015 there was an estimated fourteen percent reduction in prescriptions dispensed to concessional patients for antibiotics commonly prescribed for URTIs.Conclusions:Family physicians and consumers have responded positively to national programs. Sustaining and building on these improvements will require continued education and further innovation.

scholarly journals Role and place of levofloxacin in the treatment of community-acquired pneumonia

2021 ◽  
Vol 3 (2) ◽  
pp. 41-48
Author(s):  
D V Dmytriiev ◽  
O A Nazarchuk ◽  
Yu M Babina
Keyword(s):  
Low Income ◽  
Alternative Therapy ◽  
Treatment Method ◽  
Community Acquired Pneumonia ◽  
Low Income Countries ◽  
Development Of Resistance ◽  
Antibiotics Use ◽  
Potential Alternative ◽  
Tract Infections ◽  
Short Courses

Lower respiratory tract infections are the third mortality cause in the world and the first mortality cause in low-income countries. Community-acquired pneumonia (CAP) is a dangerous infectious pathology, especially in children younger than 5 years, elderly people and patients with compromised immunity. Antibiotic therapy is a standard treatment method for CAP. But an increase in antibiotics use caused a development of resistance in bacteria and onset of adverse events in humans. A new class of fluorchinolones is widely used nowadays in clinical practice. They have good activity against Gram-negative bacteria, as early chinolones, as well as against Gram-positive bacteria, such as pneumococci and atypical bacteria. An increasing amount of penicillin-resistant streptococcal pneumonia leads to more intensive studies of the use of new chinolones. In this review the data of 750 mg levofloxacin is presented. It is used in short courses for the treatment of severe and moderate CAP. Taking into account the broad spectrum of activity of levofloxacin ad bactericidal activity of this antibiotic, it can be a potential alternative therapy for the treatment of children and adults with CAP, especially with a tendency of an increase in antibiotic resistance of pneumococcus.

scholarly journals Rapid syndromic PCR testing in patients with respiratory tract infections reduces time to results and improves microbial yield

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
S. Serigstad ◽  
D. Markussen ◽  
H. M. S. Grewal ◽  
M. Ebbesen ◽  
Ø. Kommedal ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Influenza A ◽  
Controlled Trial ◽  
Antibiotic Use ◽  
Turnaround Time ◽  
Community Acquired Pneumonia ◽  
Diagnostic Methods ◽  
Randomised Controlled ◽  
Tract Infections ◽  
The Impact

AbstractLack of rapid and comprehensive microbiological diagnosis in patients with community acquired pneumonia (CAP) hampers appropriate antimicrobial therapy. This study evaluates the real-world performance of the BioFire FilmArray Pneumonia panel plus (FAP plus) and explores the feasibility of evaluation in a randomised controlled trial. Patients presenting to hospital with suspected CAP were recruited in a prospective feasibility study. An induced sputum or an endotracheal aspirate was obtained from all participants. The FAP plus turnaround time (TAT) and microbiological yield were compared with standard diagnostic methods (SDs). 96/104 (92%) enrolled patients had a respiratory tract infection (RTI); 72 CAP and 24 other RTIs. Median TAT was shorter for the FAP plus, compared with in-house PCR (2.6 vs 24.1 h, p < 0.001) and sputum cultures (2.6 vs 57.5 h, p < 0.001). The total microbiological yield by the FAP plus was higher compared to SDs (91% (162/179) vs 55% (99/179), p < 0.0001). Haemophilus influenzae, Streptococcus pneumoniae and influenza A virus were the most frequent pathogens. In conclusion, molecular panel testing in adults with CAP was associated with a significant reduction in time to actionable results and increased microbiological yield. The impact on antibiotic use and patient outcome should be assessed in randomised controlled trials.

OP85 Persistence Leads To Ongoing Decreases In Primary Care Antibiotic Use

2019 ◽  
Vol 35 (S1) ◽  
pp. 22-22
Author(s):  
Jonathan Dartnell ◽  
Kirsten Sterling ◽  
Aine Heaney ◽  
Suzanne Blogg
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Health Professionals ◽  
Educational Program ◽  
Point Of Care ◽  
Antibiotic Use ◽  
Upper Respiratory Tract ◽  
Defined Daily Doses ◽  
Time Series Modelling ◽  
Tract Infections

IntroductionAustralia has had high rates of antibiotic use in primary care. Consumer and health professional knowledge and practices in the community vary. In 2012, NPS MedicineWise implemented a five-year national educational program for consumers, general practitioners (GPs) and pharmacies to reduce antibiotic use in Australia.MethodsFor consumers, a social marketing approach was used focusing on the winter months. Strategies leveraged collectivism, nudge theory, celebrity endorsement and co-creation and used multiple communication channels. For health professionals, interventions were most intense in 2012 with additional activities implemented each year including face-to-face educational visiting, audits, comparative prescribing feedback, case studies and point-of-care materials. Surveys were conducted periodically to evaluate changes in knowledge and awareness. Pharmaceutical Benefits Scheme (PBS) claims data were analyzed. Organization for Economic Co-operation and Development data was used to compare Australian antibiotic per capita consumption to other countries. Time series analyses were used to estimate the cumulative program effect comparing observed and expected monthly dispensing volumes of antibiotics commonly prescribed for upper respiratory tract infections (URTIs), had interventions not occurred.ResultsBetween 2012 and 2017, GP antibiotic PBS prescriptions reduced by 18.4 percent. Antibiotic defined daily doses per 1000 inhabitants reduced from 23.7 in 2012 to 18.4 in 2016, similar to Norway (18.6 in 2016) and the UK (18.7). Time series modelling estimated 24.8 percent fewer GP antibiotic URTI prescriptions by 2017 versus no program. Consumer survey results indicated increased awareness of antibiotic resistance (50 percent in 2011, 74 percent in 2017) and the minority expect/request antibiotics for URTIs (22 percent in 2017).ConclusionsA five-year national educational program with multiple and repeated interventions for health professionals and consumers has resulted in ongoing reductions in antibiotic use in primary care.

A descriptive analysis of outpatient antibiotic use for urinary tract infections in Virginia

2020 ◽  
pp. 1-2
Author(s):  
Hasti Mazdeyasna ◽  
Shaina Bernard ◽  
Le Kang ◽  
Emily Godbout ◽  
Kimberly Lee ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Descriptive Analysis ◽  
Antibiotic Use ◽  
Tract Infections

scholarly journals Morbidity and Mortality Patterns in Children Admitted to Hospital in Thai Binh, Vietnam: A Five-year Descriptive Study with a Focus on Infectious Diseases

2020 ◽  
Author(s):  
Thi Dung Pham ◽  
Van Thuan Hoang ◽  
Thi Loi Dao ◽  
Xuan Duong Tran ◽  
Duc Long Phi ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Point Of Care ◽  
Antibiotic Use ◽  
Favourable Outcome ◽  
Morbidity And Mortality ◽  
Diagnostic Tools ◽  
Gastrointestinal Infections ◽  
Tract Infections ◽  
Future Evaluation ◽  
Point Of Care Tests

The objective of this study was to describe the overall pattern of morbidity and mortality of children seen at the Thai Binh Pediatric Hospital in Vietnam, with a focus on infectious diseases. A retrospective review of hospitalisation records was conducted from 1 January 2015 to 31 December 2019. Data were obtained from a total of 113,999 records. The median age of patients was 18 months, with 83.98% of patients aged &lt;5 years. Infectious diseases accounted for 61.0% of all cases. The most prevalent diseases were lower respiratory tract infections (32.8%), followed by gastrointestinal infections (13.3%) and confirmed influenza (5.4%). Most infections were not microbiologically documented. A total of 81.4% patients received at least one antibiotic. Most patients (97.0%) were hospitalised for less than 15 days. Regarding outcomes, 87.8% patients were discharged home with a favourable outcome. 12.0% were transferred to the Vietnam National Children&rsquo;s Hospital because their condition had worsened and 0.1% died. In total, infectious diseases accounted for 40.4% of deaths, followed by neonatal disorders (34.6%). Our data serves a basis for the identification of needs for diagnostic tools and for future evaluation of the effect of the targeted implementation of such facilities. Point-of-care tests, including real-time PCR assays to identify common pathogens should be implemented for more accurate diagnosis and more appropriate antibiotic use.

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