scholarly journals Clinical diagnosis and treatment of common respiratory tract infections in relation to microbiological profiles in rural health facilities in China: implications for antibiotic stewardship

2020 ◽  
Author(s):  
Xingrong Shen ◽  
Jilu Shen ◽  
Yaping Pan ◽  
Jing Cheng ◽  
Jing Chai ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Clinical Diagnosis ◽  
Antibiotic Stewardship ◽  
Rural China ◽  
Tier 2 ◽  
Residential Areas ◽  
Microbiological Testing ◽  
Township Health Center ◽  
Tract Infections ◽  
Structured Questionnaire

Abstract Background This paper tries to describe prevalence and patterns of antibiotics prescription and bacteria detection and sensitivity to antibiotics in rural China and implications for future antibiotic stewardship.Methods The study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations was conducted to record clinical diagnosis and antibiotic prescription. Semi-structured questionnaire survey was used to collected patient’s sociodemographic information and symptoms. Sputum and throat swabs were collected for bacterial culture and susceptibility testing.Results A total of 1068 (51.0% male vs 49.0% female) patients completed the study with diagnosis of respiratory tract infection (326,30.5%), bronchitis/tracheitis (249,23.3%), pharyngitis (119,11.1%) and others (374, 35.0%). They provided 683 sputum and 385 throat swab specimens. Antibiotics were prescribed for 88% of the RTI patients. Of all the specimens tested, 329 (31%) were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24% in all specimens), H. influenza (16%), H. parainfluenzae (15%), P. aeruginosa (6%), S.aureus (5%), M. catarrhalis (3%) and S. pneumoniae (2%).Conclusions The study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China. It reveals that prescription of antibiotics, especially broad spectrum and combined antibiotics, is still very common and there is a clear need for stewardship programs aimed at both reducing the number of prescriptions and promoting single and narrow-spectrum antibiotics.

scholarly journals Clinical symptoms and treatment of common respiratory tract infections in relation to microbiological profiles in rural health facilities in China: implications for antibiotic stewardship

2020 ◽  
Author(s):  
Xingrong Shen ◽  
Jilu Shen ◽  
Yaping Pan ◽  
Jing Cheng ◽  
Jing Chai ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Stewardship ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Clinical Symptoms ◽  
Rural China ◽  
Clinical Manifestations ◽  
Antibiotic Use ◽  
Presenting Symptoms ◽  
Tract Infections

Abstract Background: This study aims to identify the extent to which current clinical practice in the treatment of common respiratory tract infections (RTIs) is consistent with presenting symptoms and microbiological characteristics at health care settings in rural China and implications for future antibiotic stewardship.Methods: The study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations, structured and semi-structured interviews were conducted to investigate antibiotic use. Sputum and throat swabs were collected for bacterial culture and susceptibility testing.Results: A total of 1068 completed the study. Antibiotics were prescribed for 87.8% of RTI patients. Of all the specimens tested, 329 (30.8%) specimens were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24.15% in all specimens), H. influenza (16.19%), H. parainfluenzae (14.77%), S.aureus (5.11%), M. catarrhalis (3.41%) and S. pneumoniae (2.27%). The bacteria detection was associated with age (OR=1.91), season (OR=0.41 to 0.60), days since infection onset (OR=1.54 to 1.81), and runny or blocked nose (OR=1.39 to 1.61), cough with green or white sputum (OR=1.47 to 1.59). Antibiotic use was only linked with limited non-specific clinical manifestations e.g., days since infection onset (OR=0.53) and sore throat (OR=1.64).Conclusions: The study reveals that antibiotics prescription is still very common in rural China which is driven mainly by non-pathological factors rather than treatment of bacterial infections. The study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China.

scholarly journals Clinical symptoms and treatment of common respiratory tract infections in relation to microbiological profiles in rural health facilities in China: implications for antibiotic stewardship

2020 ◽  
Author(s):  
Xingrong Shen ◽  
Jilu Shen ◽  
Yaping Pan ◽  
Jing Cheng ◽  
Jing Chai ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Stewardship ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Rural China ◽  
Clinical Manifestations ◽  
Antibiotic Use ◽  
Anhui Province ◽  
Presenting Symptoms ◽  
Tract Infections

Abstract Background This study aims to identify the extent to which current clinical practice in the treatment of common respiratory tract infections (RTIs) is consistent with presenting symptoms and microbiological characteristics at health care settings in rural Anhui Province and implications for future antibiotic stewardship. Methods The study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations, structured and semi-structured interviews in village clinics and township health centers were conducted to investigate antibiotic use. Sputum and throat swabs were collected for bacterial culture and susceptibility testing. Results A total of 1068 (51.0% males and 49.0% females) completed the study. Antibiotics were prescribed for 87.8% of RTI patients. Of all the specimens tested, 329 (30.8%) specimens were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24.15% in all specimens), H. influenza (16.19%), H. parainfluenzae (14.77%), S.aureus (5.11%), M. catarrhalis (3.41%) and S. pneumoniae (2.27%). The bacteria detection was associated with age (OR = 1.91), season (OR = 0.41 to 0.60), days since infection onset (OR = 1.54 to 1.81), and runny or blocked nose (OR = 1.39 to 1.61), cough with green or white sputum (OR = 1.47 to 1.59). Antibiotic use was only linked with limited non-specific clinical manifestations e.g., days since infection onset (OR = 0.53) and sore throat (OR = 1.64). Conclusions The study reveals that antibiotics prescription is still very common in rural China which is driven mainly by patient reassurance and other non-pathological factors rather than treatment of bacterial infections. The study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China.

scholarly journals Clinical Symptoms and Treatment of Common Respiratory Tract Infections in Relation to Microbiological Profiles in Rural Health Facilities in China: Implications for Antibiotic Stewardship

2020 ◽  
Author(s):  
Xingrong Shen ◽  
Jilu Shen ◽  
Yaping Pan ◽  
Jing Cheng ◽  
Jing Chai ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Stewardship ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Clinical Symptoms ◽  
Rural China ◽  
Clinical Manifestations ◽  
Antibiotic Use ◽  
Presenting Symptoms ◽  
Tract Infections

Abstract Background This study aims to identify the extent to which current clinical practice in the treatment of common respiratory tract infections (RTIs) is consistent with presenting symptoms and microbiological characteristics at health care settings in rural China and implications for future antibiotic stewardship.Methods The study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations, structured and semi-structured interviews were conducted to investigate antibiotic use. Sputum and throat swabs were collected for bacterial culture and susceptibility testing.Results A total of 1068 completed the study. Antibiotics were prescribed for 87.8% of RTI patients. Of all the specimens tested, 329 (30.8%) specimens were isolated with bacteria. The most frequently detected bacteria were K. pneumonia (24.15% in all specimens), H. influenza (16.19%), H. parainfluenzae (14.77%), S.aureus (5.11%), M. catarrhalis (3.41%) and S. pneumoniae (2.27%). The bacteria detection was associated with age (OR=1.91), season (OR=0.41 to 0.60), days since infection onset (OR=1.54 to 1.81), and runny or blocked nose (OR=1.39 to 1.61), cough with green or white sputum (OR=1.47 to 1.59). Antibiotic use was only linked with limited non-specific clinical manifestations e.g., days since infection onset (OR=0.53) and sore throat (OR=1.64).Conclusions The study reveals that antibiotics prescription is still very common in rural China which is driven mainly by non-pathological factors rather than treatment of bacterial infections. The study establishes the feasibility of conducting microbiological testing outside Tier 2 and 3 hospitals in rural China.

Health Providers’ Advising on Symptom Management for Upper Respiratory Tract Infections: Does Elaboration of Reasoning Influence Outcomes Relevant to Antibiotic Stewardship?

2020 ◽  
Vol 39 (3) ◽  
pp. 349-374
Author(s):  
Kasey A. Foley ◽  
Erina L. MacGeorge ◽  
David L. Brinker ◽  
Yuwei Li ◽  
Yanmengqian Zhou
Keyword(s):  
Respiratory Tract ◽  
Symptom Management ◽  
Antibiotic Stewardship ◽  
Respiratory Tract Infections ◽  
Upper Respiratory Tract Infections ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Management Advice ◽  
Tract Infections ◽  
Advice Quality

Antibiotic-resistant infections, fueled by unwarranted antibiotic prescribing, are an increasing threat to public health. Reducing overprescribing and promoting antibiotic stewardship requires managing patient expectations for and understanding about the utility of antibiotics. One hotspot for overprescribing is upper respiratory tract infections, for which the best treatment is often non-antibiotic symptom management behaviors. Guided by advice response theory, the current study examines how providers’ reason-giving for symptom management advice affected perceptions of advice quality, efficacy for symptom monitoring and management, and satisfaction with care for patients who were not prescribed antibiotics for their upper respiratory tract infections. Transcribed medical visits were coded for symptom management advice reason-giving and patients completed post-visit surveys. Greater provider elaboration about instruction was independently and positively associated with evaluations of advice quality. Results also indicate several significant interactions between types of reason-giving. Implications of these findings for advice theory and clinical practice are addressed in the discussion.

Impact of an Antibiotic Stewardship Program on Antibiotic Prescription for Acute Respiratory Tract Infections in Children: A Prospective Before-After Study

2019 ◽  
Vol 58 (11-12) ◽  
pp. 1166-1174 ◽  
Author(s):  
Nalinee Aoybamroong ◽  
Worawit Kantamalee ◽  
Kunlawat Thadanipon ◽  
Chonnamet Techasaensiri ◽  
Kumthorn Malathum ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Stewardship ◽  
Respiratory Tract Infections ◽  
Instant Messaging ◽  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
Acute Respiratory Tract Infection ◽  
Stewardship Program ◽  
Tract Infections ◽  
E Mail

We assessed the effectiveness of an antibiotic stewardship program (ASP) on antibiotic prescriptions for acute respiratory tract infection (ARTI) in a medical school. Our ASP included delivering an antibiotic use guideline via e-mail and LINE (an instant messaging app) to faculty staff, fellows, and residents, and posting of the guideline in examination rooms. Medical records of pediatric patients diagnosed with ARTI were reviewed to assess the appropriateness of antibiotic prescription. ASP could increase the rate of appropriateness from 78% (1979 out of 2553 visits) to 83.4% (2449 out of 2935 visits; P < .001). The baseline of appropriateness was higher in residents (95%) compared with fellows (82%) and faculty staff (75%). The ASP significantly increased the appropriateness only in faculty staff, especially in semiprivate clinics (75% to 83%, P < .001). In conclusion, our ASP increased appropriateness of antibiotic prescriptions for ARTI, with the greatest impact among faculty staff in semiprivate clinics.

scholarly journals Broad Range Detection of Viral and Bacterial Pathogens in Bronchoalveolar Lavage Fluid of Children to Identify the Cause of Lower Respiratory Tract Infections

2020 ◽  
Author(s):  
Heping Wang ◽  
Jiali Gu ◽  
Xiaonan Li ◽  
Christa E. van der Gaast de Jongh ◽  
Wenjian Wang ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Clinical Diagnosis ◽  
Pathogen Detection ◽  
Bacterial Pathogens ◽  
Clinical Diagnostics ◽  
Large Set ◽  
Detection Rates ◽  
Multiplex Qpcr ◽  
Accurate Treatment ◽  
Tract Infections

Abstract OBJECTIVES: Knowledge on the etiology of LRTIs is essential for improvement of the clinical diagnosis and accurate treatment. Molecular detection methods were applied to identify a broad range of bacterial and viral pathogens in a large set of bronchial alveolar lavage (BAL) fluid samples. The patterns of detected pathogens were correlated to the clinical symptoms.METHODS: BAL fluid samples and clinical data were collected from 573 hospitalized children between 1 month and 14 years of age with LRTIs, enrolled from January to December 2018. Pathogens were detected using standardized clinical diagnostics, with a sensitive, high-throughput GeXP-based multiplex PCR and with multiplex qPCR. Data were analyzed to describe the correlation between the severity of respiratory tract disease and the pathogens identified.RESULTS: The pathogen detection rate with GeXP-based PCR and multiplex qPCR was significantly higher than by clinical routine diagnostics (76.09% VS 36.13%,χ2 = 8.191, P=0.004). The most frequently detected pathogens in the BAL fluid were human adenovirus (HADV)(21.82%), Mycoplasma pneumoniae (20.24%), human rhinovirus (13.96%), Streptococcus pneumoniae (8.90%) and Haemophilus influenzae (8.90%). In 16.4 % of the cases co-infection with two or three different pathogens was found. Viral detection rates declined with age, while atypical pathogen detection rates increased with age. Oxygen supply in the HADV and Influenza H1N1 infected patients was more frequent (49.43%) than in patients infected with other pathogens.CONCLUSION: Broad range detection of viral and bacterial pathogens using molecular methods is a promising and implementable approach to improve clinical diagnosis and accurate treatment of LRTI in children.

scholarly journals Outcome of upper respiratory tract infections in healthy children: Antibiotic stewardship in treatment of acute upper respiratory tract infections

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Ejaz Ahmed Khan ◽  
Mazhar Hussain Raja ◽  
Shehla Chaudhry ◽  
Tehreem Zahra ◽  
Salman Naeem ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Stewardship ◽  
Respiratory Tract Infections ◽  
Upper Respiratory Tract Infections ◽  
Healthy Children ◽  
Supportive Treatment ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections

Objective: The objective of the study was to assess the outcome of upper respiratory tract infections (URTI) in healthy children. Methods: This descriptive study was conducted on 314 children aged 3-36 months in the paediatric outpatient clinic and emergency department with symptoms of URTI (fever, cough, rhinorrhoea) for ≤5 days. Patient’s demographics, clinical features, laboratory data and outcome were recorded. Follow up phone calls were made to parents on day 7 (response 93.6%) and day 14 (response 94.6%) to record outcome. Results: A total of 314 children with URTIs were included. Majority (57.6%) were males and <1year of age (40%). Common manifestations of URTI were fever (89%), cough (79%), rhinorrhoea (62%), pharyngitis (79%) and conjunctivitis (46%). More than half (53%) had history of contact with URTI in a family member. Mean duration of symptoms was 2.7±1.3 days. Majority (93%) of children were given supportive treatment and only 6.7% received antibiotics initially. Most of children (76%) recovered within one week and 91.8% within two weeks with supportive care only. Only 4% children were hospitalized and 12% required follow up visit of which 16% needed oral antibiotics. Complications or deaths did not occur. Conclusions: Majority of URTIs in healthy children resolved with supportive treatment and do not require antibiotics. Antibiotic stewardship in simple URTIs should be practiced using awareness and advocacy campaigns. doi: https://doi.org/10.12669/pjms.36.4.1420 How to cite this:Khan EA, Raja MH, Chaudhry S, Zahra T, Naeem S, Anwar M. Outcome of upper respiratory tract infections in healthy children: Antibiotic stewardship in treatment of acute upper respiratory tract infections. Pak J Med Sci. 2020;36(4):---------.  doi: https://doi.org/10.12669/pjms.36.4.1420 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Leveraging Existing and Soon-to-Be-Available Novel Diagnostics for Optimizing Outpatient Antibiotic Stewardship in Patients with Respiratory Tract Infections

2020 ◽  
Author(s):  
Kelly A Cawcutt ◽  
Robin Patel ◽  
Jeff Gerber ◽  
Angela M Caliendo ◽  
Sara E Cosgrove ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Respiratory Tract ◽  
Antibiotic Stewardship ◽  
Bacterial Infections ◽  
Respiratory Tract Infections ◽  
Future Research ◽  
Antibacterial Resistance ◽  
Research Needs ◽  
Effective Implementation ◽  
Tract Infections

Abstract Respiratory tract infections (RTIs) drive many outpatient encounters and despite being predominantly viral, are associated with high rates of antibiotic prescriptions. With rising antibacterial resistance, optimization of prescribing of antibiotics in outpatients with RTIs is a critical need. Fortunately, this challenge arises at a time of increasing availability of novel RTI diagnostics to help discern which patients have bacterial infections warranting treatment. Effective implementation of antibiotic stewardship is needed, but optimal approaches for ambulatory settings are unknown. Future research needs are reviewed in this summary of a research summit convened by the Infectious Diseases Society of America in the fall of 2019.

Sign in / Sign up

Export Citation Format

Share Document