Background

Early antibiotic exposure is associated with childhood obesity. When untreated infections are accounted for, early infections predict subsequent obesity, and antibiotic exposure in later infancy (>6 months of age) is no longer associated. However, antibiotic exposure in early infancy (<6 months) remains associated with later childhood obesity. We surveyed a birth cohort in Southern California Kaiser Hospitals (SCAL) to assess this association.

Methods

Among SCAL children born between 2008 - 2012, term infants with 2 years of follow-up and a body-mass-index (BMI) measurement at 48 - 59 months were studied. Gender, method of delivery; maternal BMI; timing and number of antibiotic exposures by 2 years of life; and BMI at age 48-59 months were recorded. Maternal and infant predictors of later elevated BMI (>95%ile) were assessed by multi-variable analysis.

Results

In this cohort of 66 735 infants, most (64%) received antibiotics by age 2 years. In multi-variable analysis, maternal obesity was a strong predictor of childhood obesity (hazard ratio (HR) = 2.74; 95% confidence interval 2.47 - 3.04). Very early antibiotic exposure (ie, <6 months) predicted later obesity in children of non-obese mothers (HR = 1.15; 1.07-1.24), but among children of obese mothers, the opposite trend was seen, with very early use of antibiotics associated with a decrease in subsequent obesity (HR=0.90; 0.79-1.03).

Conclusions

As in previous studies, the risk of childhood obesity was higher after very early antibiotic exposure in our population, but this increased risk is mitigated by the mother's obesity status. While children of obese mothers are at high risk of obesity in general, this risk may be lower in those exposed to very early antibiotics. The reasons for this disparity should be the subject of further study.

Background

A former study reported higher prescribing of systemic antibiotics in German paediatric outpatients compared to their Dutch, Danish and British peers in the years 2005-2008. This population-based retrospective study aimed to assess recent trends of antibiotic prescribing in German children and adolescents.

Methods

This study was conducted as sequential annual cross-sectional analyses based on a full sample of outpatient prescription claims of the German Statutory Health Insurance. All statutory health insured German children and adolescents aged 0-14 years (n=9,389,183 in 2018) were included, covering 83% of the German paediatric population. Annual antibiotic prescription rates (2010–2018) were calculated per 1,000 persons for the age groups 0–1, 2–5, 6–9 and 10–14 years. Poisson regression was employed to estimate trends of prescription rates.

Results

Over the course of the study the age-standardized antibiotic prescription rate fell from 746 prescriptions per 1,000 persons in 2010 to 428 in 2018 (-43%, p<0.001). Decrease was most marked in the age groups 0–1 year (−50%) and 2–5 years (−44%). In 2018, use was highest in the age group 2-5 years, amounting to 683 prescriptions per 1,000 persons (0–1 year: 320, 6–9 years: 417, 10–14 years: 273). Prescription rates varied by a factor of 1.9 between federal states. Overall, 32% of prescribed antibiotics were cephalosporins (2^nd and 3^rd generation).

Conclusions

Considerable reductions of paediatric antibiotic use indicate a change towards more judicious prescribing habits. In contradiction to recommendations by German practice guidelines, high use of 2^nd and 3^rd generation cephalosporins suggests frequent first-line prescribing of these antibiotics for common childhood infections. Substantial spatial variations of paediatric antibiotic prescribing indicate the need for regionally targeted interventions.

Background

Antibiotic exposure interferes with normal flora leading to colonisation with resistant organisms. Data on vancomycin resistant enterococcus (VRE) and candida colonisation in neonates are sparse, often limited to single-centre studies. Colonisation is linked with invasive infection, with associated morbidity/mortality. Preliminary colonisation data are presented from septic infants recruited to the NeoVanc trial (www.neovanc.org) from 14 NICUs in Estonia, Greece, Italy, Spain and UK.

Methods

Stool/rectal, axilla and nasal swabs were collected at Day 0(D0–initiation of vancomycin), end of vancomycin therapy(EVT), short-term follow-up(STFU). Samples were plated onto selective agar to screen for VRE/candida. Morphologically different colonies were purity–plated and species identified using MALDI–TOF. Vancomycin susceptibility testing was performed to confirm VRE.

Results

Data are available for 1667 samples from 215 infants.

115/215(53.5%) were male; median PMA was 32(IQR 29–37) weeks.

8/215(3.7%) infants were colonised with VRE (all Enterococcus faecium) at ≥1 timepoint. Median PMA 36(IQR 35–39) weeks. 4/8(50%) infants acquired VRE colonisation during/after vancomycin treatment. 6/7(85.7%) infants were colonised at STFU. VRE colonised infants were from 3 sites (2 Greek; 1 Italian); prevalence was 12.5–25% at these sites.

57/215(26.5%) were colonised with Candida spp. at ≥1 timepoint. Median PMA 32(IQR 29–36) weeks. 21/57(33.3%) infants became colonised during/after vancomycin therapy. Colonisation with Candida albicans (30/57) was most common followed by Candida parapsilosis (22/57). 12/21(57.1%) acquisitions were non–C. albicans species. 13/57 infants acquired candida between D0 and EVT; 18/57 colonised at D0 lost this by EVT. 32/57(56.1%) were colonised at STFU.

Conclusions

VRE colonisation was infrequent in this neonatal population, occurring in older babies and then persisting. Candida colonisation was more prevalent and intermittent. Candida attained after D0 was more common with non–C. albicans species; likely acquired from the NICU environment.

On behalf of NeoVanc Consortium

Clinical Trial Registration

ClinicalTrials.gov NCT02790996

Background

Surgical Antibiotic prophylaxis (SAP) decreases the incidence of surgery-associated infection, but inappropriate antibiotic use is frequently documented. The WHO’s 2018 Guidelines recommend for SAP prior to surgical incision and against SAP prolongation after completion of the operation. The aim of this study was to describe SAP practices in children across European hospitals and to identify possible targets for improvement.

Methods

A prospective observational study was conducted among 10 hospitals in 6 countries from the RANIN-KIDS Network (Reducing Antimicrobial use and Nosocomial INfections in KIDS). Data collected on 50 consecutive operations per hospital included the type of procedure, wound-class classification, choice of antibiotic, timing of administration related to surgical incision and its duration. Data on clean and clean-contaminated operations were analyzed.

Results

582 operations were recorded; 482 were clean or clean-contaminated. Antibiotics were administered in 312(65%) cases.

In 6/10 hospitals SAP was mostly given at the operating room (OR), right before the incision. In 1 hospital more than half of antibiotics were administrated at the OR after the incision. 5/10 hospitals reported cases of SAP given only after the end of the operation.

Administration of antibiotics after the operation showed great variability among hospitals [median 69% (IQR:50-83.3%)] with high percentages even past 24 hours [median:31.3%(IQR: 27.9-61.0%)] and SAP as commonest reason given(Table1).

Conclusions

We report significant variability in the practices of SAP in pediatric patients undergoing clean and clean-contaminated operations both in terms of the time of administration and duration. These preliminary data will be used as a guide for tailor-made interventions in each hospital.

Background

Pregnancy antibiotic exposure increases the risk of offspring hospitalisation with upper and lower respiratory tract infections, but whether there are similar associations for commoner, less severe infections is unknown. We used linked population data from Norway to investigate the relationship between pregnancy antibiotic exposure and offspring risk of ear, nose and throat (ENT) procedures, which reflect previous recurrent mild infections.

Methods

All live-born, singleton births between 2008 and 2018 were identified from national registries. Antibiotic exposure during pregnancy was defined from the prescription database. ENT procedures in the child before age 10 years were identified by procedural codes.

Exposure and risk of first ENT procedure were analysed in Cox proportional hazard models (covariates in Table). We evaluated the timing and number of prescribed antibiotics and performed a sensitivity analysis in a pre-specified sub-population; healthy mothers, no pregnancy complications, vaginal birth and normal birth parameters.

Results

Of 538,028 included children, 151,363 (28%) were exposed to antibiotics prenatally and 48,556 (9%) underwent a procedure. Exposure was associated with increased risk of ENT procedures (hazard ratio, HR 1.27, 95% CI 1.25-1.30) in a dose-dependent manner. Caesarean section was associated with increased risk of procedures compared to vaginal delivery (HR 1.17, 95% CI 1.14-1.20). Pregnancy antibiotics and mode of birth did not show an interaction effect. Estimates from the sub-population sensitivity analysis were comparable.

Conclusions

Antibiotic exposure during pregnancy is associated with increased risk of ENT operations in childhood, which may be indicative of heightened susceptibility to recurrent early life infections. These findings are relevant for antibiotic prescribing and stewardship in pregnancy. A possible contributory mechanism to this increased risk is disruption of the postnatal microbiome by antibiotics in pregnancy, with concomitant effects on early immune development.