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Background

Neonates in the neonatal intensive care units(NICUs) are vulnerable to nosocomial infections, which in turn are associated with increased infection-related morbidities and mortalities.

Aims

This study aimed to identify the sources of Enterococcus faecium/Staphylococcus capitis outbreak and describe effective infection control measures applied to terminate two nosocomial infection outbreaks.

Methods

Two outbreaks occurred during an 85-day period in two disconnected subunits, that share the same attending physicians. A total of 7 cases of sepsis occurred. Environmental surveillances including Adenosine triphosphate(ATP) bioluminescence assay monitoring and environmental cultures were carried out in parallel to 29 healthcare workers’ hand cultures.

Results

During 4 years prior to the outbreaks, a total of 260 neonatal sepsis occurred. CoNS(n=164,63%), VSE(n=32,12.3%), MRSA(n=21,8.1%), were reported as the most common pathogens. Coincidentally, the causative pathogens of the outbreaks were E. faecium(n=4/7) and S. capitis(n=3/7). In the environmental cultures, both were cultured from both medical and non-medical devices located remotely from the patients. ATP titers were found to be the highest on a keyboard(2706 RLU). Hand cultures were done, and S. capitis was cultured in n=9/29(31%). All S. capitis obtained from the environments as well as hands that had similar antibiotic sensitivity profiles with the pathogen underwent Pulsed-Field Gel Electrophoresis, showing identical genotypes. The following interventions were applied:changing keyboards to sanitizable medical ones, changing methods and frequencies of universal and targeted environmental disinfection. No more infections by the nosocomial pathogens of the outbreak have occurred since, then.

Conclusions

We identified that the colonized pathogens on non-medical devices can be a source of infection.

Background

Background:

Infections acquired during ECLS are common and can significantly increase ECLS duration and decrease survival. A review of Extracorporeal Life Support Organization (ELSO) data from 1998-2008 found that the incidence of infection increases with longer runs.

Aims

Aim:

To look at the bacteriological profiles and infections rates in our cohort.

Methods

Methods:

We collected data from year 2014 to 2018. This study involved 68 patients. In this study we did not include any background of the patients which included the ethnicity, specific age, gender, definite diagnosis, outcome and the 30-day outcome. The period of positive cultures are divided into two durations which are 1) 7 days or less (≤7 days) and 2) More than 7 days (›7 days).

Results

Results:

The maximum number of days of ECLS was 15 days with the average of 6.2 days for the post-cardiac surgery patients, 21 days for non-post cardiac patients with the average of 6.3 days.Risk of infection increased after 7 days, with the p-value of primary bloodstream infection of 0.0383 and non-bloodstream infection of 0.008. The main microorganisms identified were Coagulase Negative Staphylococcus (CONS), Candida species and Pseudomonas aeruginosa.

Conclusions

As shown in our study, the risk of infection increases with more than 7 days on ECLS, hence, it might be more advisable to do routine cultures if the patients are on ECLS for more than 7 days or when there is clinical suspicion suggestive of infection. The main microorganisms responsible for infection was Coagulase Negative Staphylococcus (CONS). A standardized prophylaxis antibiotics protocol is required.

Background

Unregulated antimicrobial use, lack of clinical microbiology laboratories and trained personnel are driving antimicrobial resistance in developing countries. .

Aims

The objective of the study was to compare antimicrobial prescription days recommended by pediatric residents and pediatricians in Addis Ababa, Ethiopia with guidelines published by internationally recognized bodies.

Methods

This descriptive cross-sectional study was conducted from February - July, 2020. Data on recommendations on length of antimicrobial prescription were collected from pediatricians and pediatric residents in Addis Ababa, Ethiopia. Responses were summarized using descriptive quantitative analysis and their conformity to recommendations of internationally recognized guidelines was evaluated. Differences between sub-groups was determined by the Mann-Whitney U test. Analyses were done using Statistical package for the social sciences (SPSS) version 20.0 and significant differences ascertained at p-value < 0.05.

Results

A total of 88 respondents participated in the stud. Many respondents suggested prescription days exceeding recommendations for common pediatric infections; notably for conjunctivitis, cystitis, cellulitis and lower respiratory infections. Antimicrobial durations often came short of standard recommendations for tonsillopharyngitis, amebiasis and pyomyositis. Pediatricians favored less prescription days for endocarditis, hospital acquired pneumonia, cystitis and conjunctivitis. Inter-group differences were significant when prescribing for meningococcal meningitis, otitis media, Candida central line infections and non-gonococcal septic arthritis. Overall, respondents suggested 11,828.6 prescription days exceeding guideline recommendations.

Conclusions

Prescription days offered by pediatric residents and pediatricians practicing in Addis Ababa, Ethiopia differed from those recommended by guidelines for most childhood infections. Observance of evidence-based antimicrobial guidelines leads to favorable patient outcomes, fewer drug-related toxicities and prevention of antimicrobial resistance.

Background

Odontogenic facial cellulitis (OFC) is a frequent complaint in pediatric emergency and inpatient services worldwide. Successful management requires an appropriate antibiotic regimen and, if indicated, surgery. There are no widespread guidelines regarding antibiotic choice, with prescription relying mainly on local practices, due to the lack of studies evaluating clinical outcomes with different antibiotic regimens.

Aims

To describe the effectiveness of penicillin G in the treatment of OFC in a pediatric population from Bogotá, Colombia.

Methods

Retrospective cohort study conducted in a pediatric hospital in Bogotá, Colombia. Patients with OFC were identified from the Stewardship Program and Antibiotic Control program database. Clinical and laboratory data were extracted from the medical records after approval from the Institutional Review Board. Statistical analysis was performed in R environment.

Results

201 patients with OFC, admitted to the hospital from December 2019 to February 2021, were included in the study. 176 (87.5%) patients were treated with penicillin G as first-line treatment; 170 (96.5%) were considered to have a satisfactory response to treatment. Further, 9 (4.5%) patients were treated with similar spectrum amoxicillin; all of them were considered to have a satisfactory response to treatment. There was no need to stop treatment because of adverse events.

Conclusions

Our study is, perhaps, the biggest case series using Penicillin G as monotherapy in the treatment of OFC. The results obtained suggest that Penicillin G is safe and effective when used for this infection. New research (randomized clinical trials) must be conducted in order to evaluate other outcomes (including cost), and avoid possible bias.

Background

The growth of antimicrobial resistance (AMR) worldwide has led to increased focus on antimicrobial stewardship (AMS) and infection prevention and control (IPC) measures, although primarily in high-income countries (HIC).

Aims

We aimed to compare paediatric AMS and IPC resources/activities between low- and middle-income countries (LMIC) and HIC, and to determine the barriers and priorities for AMS and IPC in LMIC as assessed by clinicians in those settings.

Methods

An online questionnaire was distributed to clinicians working in HIC and LMIC healthcare facilities in 2020.

Results

Participants were from 135 healthcare settings in 39 LMIC and 27 HIC. Formal AMS and IPC programs were less frequent in LMIC than HIC settings (AMS 42% versus 76%; IPC 58% versus 89%). Only 47% of LMIC facilities conducted audits of antibiotic use for paediatric patients, with less reliable availability of World Health Organization ‘Access’ list antibiotics. Hand hygiene promotion was the most common IPC intervention in both LMIC and HIC settings (82% versus 91%), although LMIC hospitals had more limited access to reliable water supply for handwashing and antiseptic hand rub. The greatest perceived barrier to paediatric AMS and IPC in both LMIC and HIC was lack of education: only 17% of LMIC settings had regular/required education on antimicrobial prescribing, and only 25% on IPC.

Conclusions

Marked differences exist in availability of AMS and IPC resources in LMIC as compared to HIC. A collaborative international approach is urgently needed to combat AMR, using targeted strategies that address the imbalance in global AMS and IPC resource availability and activities.

Background

Self-medication with antibiotics is frequent and it comes to 35% in low-income countries with limited resources and thus represents a public health problem.

Aims

The objective was to measure the factors associated with antibiotic self-medication as well as the knowledge and attitudes of caregivers in pediatric emergency department.

Methods

Case-control study of patients with a infectious diagnosis who came to emergency room in two hospitals in Bogota, Colombia. A case was a patient that reported self-medication who was matched to 3 controls who went to the emergency room at the same time and didn't report this behavior on a survey. The results were compared using logistic regression analysis with an odds ratio(OR) and 95% confidence intervals.

Results

A total of 729 patients, 182 cases, and 547 controls were included. If the mother OR=0.56[0.40-0.79] and father OR=0.62[0.43-0.89] have a high level of education, the probability of self-medication is lower. Requesting antibiotics from the physician OR=3.92[1.59-9.66], buying antibiotics without a prescription OR=23.66[11.76-47.59], and recommending antibiotics among family members OR=2.90[1.75-4.82] resulted in an increased likelihood of self-medication. There was a higher probability of self-medication among older children OR=1.13[1.09-1.17] and those with a greater number of siblings OR=1.25[1.09-1.43]. Having received antibiotics within the last 3 months increased the probability of self-medication OR=6.27[4.35-9.04].

Conclusions

An increase in self-medication was identified as connected to an older age in years, previous use of antibiotics, presence of siblings, and parents with lower levels of education. The attitudes and knowledge of the caregivers suggested improper use of antibiotics on the Colombian pediatric population.

Background

Antimicrobial Stewardship Programs (ASP) represent a strategy to optimize antimicrobial use. Different outcomes are measured as ASP impact. Days of therapy (DOT) and cost represent an important measure. Few studies in pediatric hospitals in Latin America describes economic impact of ASP.

Aims

The aim of this study is to present the impact on antibiotic use and economic impact after 5 consecutive years of an ASP in a reference pediatric hospital in South America.

Methods

This is an observational, retrospective, and descriptive study. Comparing use and costs of antimicrobial use from 2016 – 2021. Days of therapy (DOT), and direct cost of antibiotics will be used to estimate impact of ASP.

Results

In 2016, before ASP implementation, antibiotics represented US 193034. After rigorously ASP, controlling broad spectrum antibiotics(BSA) since 2017 and from 2019 including also narrow spectrum antibiotics(NSA) the total cost was 107606, a 44% reduction in total costs Graph 1. Comparing savings, NSA decreases theirs cost in 22%, while BSA 60% Graph 2. Top reductions in antibiotics costs are presented in first place by ertapenem US 9151 vs. 813 (-91%), ceftriaxone US 29080 vs. 6209 (-79%) and caspofungin US 24403 vs. 6050 (-75)Graph 3. Cost savings represent important DOT reductions since different specific interventions were implemented Graph 4.

Conclusions

An ASP program with dedicated time controlling not only BSA, in a resource limited setting achieved important cost savings. These findings should encourage others centers and administrators to implement an ASP. Costs and decrease in DOT, are only part of the real impact of ASP.