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Background and Objectives@#The etiology of pneumonia in the pediatric population varies by age group. Among patients one month to 59 months old, viral pathogens are the most common cause of lower respiratory infections. The study aims to determine the frequency distribution of antibiotic prescription among patients one month to 59 months old and to determine the adherence of primary care facilities to local guidelines with recommended antibiotics. @*Methods@#A descriptive retrospective study using electronic medical records was conducted at two primary care sites. Patients aged 1 month to 59 months old seeking consult via telemedicine or face-to-face diagnosed with community acquired pneumonia from April 2019-March 2020 in the rural facility and May 2019-April 2020 in the remote facility were included in the study. The primary outcome was to determine the patterns of antibiotic use in pneumonia in remote and rural areas and adherence to the recommended antibiotics by the 2016 Philippine Academy of Pediatric Pulmonologists pediatric community-acquired pneumonia clinical practice guidelines (CPG). @*Results@#There were 30 pediatric patients diagnosed with pneumonia in the rural facility and 213 in the remote facility. Of these patients with pneumonia, 96.7% and 94.8% were prescribed antibiotics in the rural and remote sites, respectively. The most commonly prescribed antibiotic in the rural facility was co-amoxiclav (26.7%), while amoxicillin (51.6%) was the most common in the remote facility. Adherence to the CPG in the rural site was lower at 23.3% (n=8/30) compared to the remote site which was 55.9% (n=119/213). @*Conclusion@#Primary care physicians prescribed antibiotics in over 90% of the time upon the diagnosis of pneumonia in children aged one month to 59 months old, despite viral pneumonia being the more common in primary care setting. Adherence to recommended antibiotics was higher in the remote setting than in the rural setting. Use of EMR to monitor quality of care can improve patient outcomes and safety, pointing out the importance of improving the quality of documentation in the study sites.
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Pediatría , Neumonía , Atención Primaria de SaludRESUMEN
Background: Irrational prescription is a major contributor to the antimicrobial resistance. Resident doctors are the major focus of interventional programs aimed at rational prescription of antibiotics. So, their knowledge, attitude and practice regarding rational antibiotic prescription need to be assessed to plan future strategies.Methods: A questionnaire based cross sectional study among interns and resident doctors of a Government Medical College was conducted. Questionnaire consisted of questions to assess knowledge, attitude and practice of resident doctors in rational antibiotic prescriptions and multiple-choice questions to assess practice of hospital antibiotic policy.Results: 80 participants were enrolled in the study. All participants responded to yes or no questions and 47 answered multiple choice questions. 40% were aware of the current hospital antibiotic policy and 29% knew the term antibiotic stewardship. Only 15% were confident in their knowledge on antimicrobial resistance. 87.5% think there is no use in prescribing an antibiotic in common cold. 36.3% overprescribes antibiotics in their daily practice. Only 32.5% practiced de-escalation. 90% were educating patients regarding correct use of antibiotics. 90% send samples for culture and sensitivity but only 22.2% waited for results to start antibiotics.Conclusions: There is a need for approaches that includes implementation of antibiotic policy and to plan for effective teaching programs regarding antibiotic resistance and importance of rational prescription of antibiotics which can improve the quality of antibiotic prescription and minimize antibiotic resistance.
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Resumen Introducción: Staphylococcus aureus es una frecuente causa de bacteriemias y el incremento en las tasas de resistencia dificulta su tratamiento inicial. La incidencia de bacteriemias por S. aureus resistente a meticilina (SAMR) ha aumentado, principalmente en las infecciones adquiridas en el medio hospitalario. Este estudio pretende caracterizar clínicamente a los pacientes con bacteriemia por S. aureus detectados en un hospital de Medellín y definir su perfil de resistencia microbiana. Métodos: cohorte retrospectiva en un hospital de tercer nivel. Se incluyeron pacientes >16 años con aislamiento para Staphylococcus aureus en sangre periférica. Se registró información relacionada con el episodio, el sitio de adquisición, la clasificación microbiológica y las características clínicas. Resultados: de 775 reportes de hemocultivos positivos para S. aureus, finalmente se ingresaron 698 pacientes al estudio. La mediana de edad fue de 58 años (RIQ=42-69), 383 eran hombres (54.9%). En 354 pacientes (50.7%) la bacteriemia era de origen nosocomial y el 26.2% (n=183) eran SAMR. En 123 (17.6%) bacteriemias adquiridas en la comunidad, la frecuencia de SAMR fue 33.3% (n=41). El antecedente más frecuente fue tener un catéter vascular en 321 pacientes (46%). Se inició terapia empírica en 67.2% de los casos (n=469). Respecto a la gravedad, la mediana del puntaje SOFA fue de 4 (RIQ=1-5), APACHE II de 15 (RIQ=10-19) y la mortalidad fue del 24.9% (n=174). Conclusiones: a pesar de que la mayoría de bacteriemias son de origen nosocomial, el reporte más frecuente fue SAMS tanto en el grupo nosocomial como en el de la comunidad. Sin embargo, la mortalidad en el grupo de bacteriemia nosocomial fue inferior comparada con la de la comunidad. (Acta Med Colomb 2018; 43: 200-206).
Abstract Introduction: Staphylococcus aureus is a frequent cause of bacteremia and the increase in resistance rates makes initial treatment difficult. The incidence of bacteraemia due to methicillin-resistant S. aureus (MRSA) has increased, mainly in infections acquired in the hospital environment. This study aims to clinically characterize patients with S. aureus bacteremia detected in a Medellín hospital and to define their microbial resistance profile. Methods: retrospective cohort in a tertiary hospital. Patients >16 years with isolation for Staphylococcus aureus in peripheral blood were included. Information related to the episode, the acquisition site, the microbiological classification and the clinical characteristics were recorded. Results: Of 775 reports of blood cultures positive for S. aureus, 698 patients were finally admitted to the study. The median age was 58 years (RIQ = 42-69), 383 were men (54.9%). In 354 patients (50.7%) the bacteremia was of nosocomial origin and 26.2% (n = 183) were MRSA. In 123 (17.6%) bacteremia acquired in the community, the frequency of MRSA was 33.3% (n = 41). The most frequent antecedent was to have a vascular catheter in 321 patients (46%). Empirical therapy was initiated in 67.2% of the cases (n = 469). Regarding severity, the SOFA score median was 4 (RIQ = 1-5), APACHE II of 15 (RIQ = 10-19) and mortality was 24.9% (n = 174). Conclusions: although the majority of bacteremia are of nosocomial origin, the most frequent report was MSSA in both the nosocomial and community groups. Despite this, mortality in the nosocomial bacteremia group was lower compared with that of the community. (Acta Med Colomb 2018; 43: 200-206).
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Humanos , Masculino , Persona de Mediana Edad , Staphylococcus aureus , Prescripciones de Medicamentos , Mortalidad , BacteriemiaRESUMEN
Background: Infectious disease is one of the importance causes of mortality and morbidity in India, therefore pattern of use of antibiotics requires separate study as they differ from adult, Therefore the aim of our study is to observe the antibiotic prescription in the tertiary care hospital.Methods: A prospective observational study was carried out in the children admitted in PICU. The study was started after obtaining the approval from Institutional Ethics Committee. Written informed consent was obtained from a parent or legal guardian of participants.Results: There were 50 patients were enrolled. The maximum antibiotics were prescribed from cephalosporin class (42; 40.38%) which included ceftriaxone, cefixime, cefotaxim, cefpodoxime. The majority of cephalosporins were prescribed in miscellaneous cases followed by respiratory tract infections, gastrointestinal tract, Central nervous tract infections and nil in CVS cases, secondly higher number of antibiotics prescribed was metronidazole and from Aminopenicillin class which includes amoxiclav and ampicillin and another beta lactamase which includes ureidopenicilin and carbepenem. The majority of aminopenicillin were prescribed in miscellaneous group infections followed by respiratory tract infections.Conclusions: From this study, it can conclude that commonly antibiotic were from 3rd generation cephalosporins followed by metronidazole and other ? lactamase inhibitor and all of the antibiotics were prescribed as per the national guidelines.
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Introducción: Las infecciones asociadas a gérmenes multirresistentes son un problema de salud pública. El conocimiento de las prácticas de prescripción de antibióticos permite establecer programas de optimización de uso de antibióticos que mejoren la calidad de atención y disminuyan la tasa de infecciones asociadas a gérmenes resistentes. La neumonía, infección de vías urinarias e infección de piel y tejidos blandos son de las principales causas de ingresos a salas de hospitalización pediátricas, por lo que son patologías clave para los programas de gestión de antimicrobianos. Material y métodos:Realizamos un estudio observacional, descriptivo, transversal durante 3 meses con pacientes admitidos al Hospital de Especialidades Pediátricas con diagnósticos de neumonía, infección de vías urinarias e infecciones de piel y tejidos blandos con el objetivo de determinar las características de la prescripción de antibióticos. Resultados y conclusiones: 127 sujetos fueron elegibles. 16.5% de estos, carecían de criterios de hospitalización. La selección del antibiótico empírico fue acorde con lo recomendado por las guías en 78.7% de los pacientes. La totalidad de los sujetos recibieron antibióticos prescritos en las dosis e intervalos adecuados. 66.1% cumplían criterios para terapia secuencial, la misma fue realizada en 7.9% de los casos. Las recomendaciones de infectología fueron seguidas por el médico tratante en 68.7% de los casos. El estudio señala la importancia de establecer criterios diagnósticos y de hospitalización, así como instaurar políticas de gestión de antibióticos que incluya un plan de duración.
Introduction: Infections associated with multiresistant germs are a public health problem. Knowledge of antibiotic prescribing practices allows the establishment of antibiotic optimization programs that improve the quality of care and decrease the rate of infections associated with resistant germs. Pneumonia, urinary tract infection and skin and soft tissue infections are among the main causes of admissions to pediatric hospital wards, therefore are key pathologies for antibiotic stewardship programs. Material and methods: We conducted an observational, descriptive, cross-sectional study for 3 months, involving patients with pneumonia, urinary tract infection and skin and soft tissue infections to determine the characteristics of antibiotic prescription in the hospitalization wards of the Hospital de Especialidades Pediátricas Omar Torrijos Herrera. Results and conclusions: 127 patients were elegible. 16.5% lacked criteria for hospitalization. The empiric antibiotic matched the guidelines in 78.7% of the cases. 100% of the patients received antibiotics prescribed normed doses and intervals. 66.1% fulfilled criteria for sequential therapy, this was performed in 7.9% of the cases. Infection recommendations were followed by the treating physician in 68.7% of the cases. We address the importance of establishing diagnostic and hospitalization criteria, as well as instituting antibiotic stewardship policies that include a scheduled therapy plan and step down therapy to improve the use of antibiotics.
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Objective To assess antibiotic prescription habits,cost pattern and the prospective intervention in Intensive Care Unit was analyzed.Methods Data on antibiotic utilization and antibiotics susceptibility were col-lected prospectively from individual electronic charts from July 2014 to September 2014.Results 225 of 246 patients surveyed used antimicrobial during the ICU stay,and antibacterial drug utilization rate was 91.46%.Cefperazone-sulbactam and piperacillin-tazobactam were the most prescribed medications.Total defined daily dose ( DDDs) was 1121.1 DDDs.Bacteria culture was 98 positive in 677 cases and 101 pathogenic bacteria were isolated.Conclusion Interventional programs should focus on promoting infectious control with rational antibiotic prescription aimed at mini-mizing the future emergence of bacterial resistance and futile.
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Background: Antibiotic resistance is a rising problem in Malaysia. For instance, high antibiotic prescribing rate for upper respiratory tract infection and inappropriate choice of antibiotic is a significant healthcare concern in Malaysia. Our main objective was to study knowledge, attitude and practice of antibiotic prescribing among medical officers in Kedah, Malaysia. Methods: A cross sectional study was conducted in outpatient departments of health clinics and hospitals in Kedah from June 2013 until December 2013. Sample size was 118 and systematic sampling was conducted. Research tool used was a validated questionnaire from studies conducted in Congo and Peru. Results: Response rate was 84.8%. Majority of our respondents were female doctors (71.0%), local graduates (63.0%), and practiced for 4 years or less (61.0%). 52.0% of the respondents prescribed antibiotics more than once daily. Mean knowledge score on antibiotics was 5.31 ±1.19 (95% CI: 5.06; 5.54). More than half (62.0%) of our respondents were confident in antibiotic prescribing and there were merely 18.0% of them consulted any colleagues prior to prescription. There was a significant difference in frequency of antibiotic prescribing between junior doctors and senior doctors (P-value: 0.036). In addition, there was also a significant association between frequency of antibiotic prescribing and awareness of antibiotic resistance in their daily practice. (P-value: 0.002). Conclusion: Knowledge on antibiotic was moderate among our medical officers and antibiotic prescribing was frequent. Training and courses on appropriate antibiotic prescribing should be emphasized to ensure the best practice in antibiotic prescription.