Assessment of inappropriate antibiotic use in pediatric patients: Point-prevalence study.

AIM: This study aimed to determine inappropriate antibiotic use in a children's hospital using the point-surveillance method. MATERIAL AND METHODS: One hundred thirteen hospitalized patients were included in the study on the study day. In all patients, data regarding age, sex, antibiotic use, type and dose of antibiotic if used, multiple antibiotic use, presence or absence of consultation with infectious diseases specialist before initiation of antibiotic, form of antibiotic use (empiric, targeted or prophylactic), and reason for antibiotic use were recorded. Inappropriate antibiotic use was determined by an infectious diseases specialist. RESULTS: The rate of antibiotic use was 70.8%. Of the patients receiving antibiotics, 43% were using more than one antibiotic. It was found that 73.7% of antibiotics were prescribed for empiric purposes and 14.3% for targeted therapy, whereas 12% were prescribed for prophylactic purposes. The rate of inappropriate antibiotic use was 33.8% among patients who were given antibiotics. Unnecessary antibiotic prescription was the most common cause for inappropriate antibiotic use (51.9%), followed by unnecessary multiple antibiotic use (29.6%), inaccurate dosing (11.1%), use of broader spectrum than required (7.4%), and use of antibiotics with narrower spectrum than needed (3.7%). The rate of inappropriate antibiotic use was significantly lower in antibiotics that required confirmation by an infectious diseases specialist (6.7%) than those not requiring confirmation (26.3%; p=0.023). The rate of inappropriate antibiotic use was significantly lower in antibiotics prescribed by infectious diseases specialists (8.6%) than those prescribed by other physicians (26.5%, p=0.027). CONCLUSION: Antibiotic use based on consultation with an infectious diseases specialist decreased inappropriate antibiotic use.

Using a high-flow nasal cannula provides superior results to OxyMask delivery in moderate to severe bronchiolitis: a randomized controlled study.

The effectiveness of using a face mask with a small diffuser for oxygen delivery (OxyMask) was compared to use of a high-flow nasal cannula (HFNC) in patients with moderate or severe bronchiolitis.The study population in this open, phase 4, randomized controlled trial consisted of 60 patients aged 1-24 months diagnosed with moderate or severe bronchiolitis and admitted to an intensive care unit (ICU) for oxygen therapy. The patients were randomized into two groups according to the method of oxygen delivery: a diffuser mask group and an HFNC group.There were seven failures in the mask group and none in the HFNC group. The survival probability differed significantly between the two treatment methods (p = 0.009).Time to weaning off oxygen therapy was 56 h in the HFNC group and 96 h in the mask group (p < 0.001).Conclusion: HFNC use decreased the treatment failure rate and the duration of both oxygen therapy and ICU treatment compared to the diffuser mask, which implies that an HFNC should be the first choice for treating patients admitted to the ICU with severe bronchiolitis. What is known: • A high-flow nasal cannula (HFNC) does not significantly reduce the time on oxygen compared to standard therapy in children with moderate to severe bronchiolitis. Observational studies show that, since the introduction of HFNC, fewer children with bronchiolitis need intubation. For children with moderate to severe bronchiolitis there is no proof of its benefit. What Is New: • In children with moderate to severe bronchiolitis, HFNC provides faster and more effective improvement than can be achieved with a diffuser mask.

Use of a chlorhexidine-impregnated dressing reduced catheter-related bloodstream infections caused by Gram-positive microorganisms.

OBJECTIVE: We compared the protective effects of secure Chlorhexidine Gluconate (CHG)-containing dressings with those of non-antimicrobial transparent dressings. METHODS: This prospective, comparative, single-center clinical study was conducted in a tertiary pediatric intensive care unit from October 2014 to March 2017. The inclusion criterion was catheterization of the jugular vein for ≥48 hour. The study was conducted in two phases. Non-antimicrobial standard dressings were applied both before and after the CHG- dressing phase to negate any coincidental temporal effect. During the standard-dressing phases, the dressings did not include any antimicrobial; transparent CHG-impregnated dressings were applied during the test phase. All patients were divided into two groups by the type of dressing applied (standard and CHG-containing dressings). RESULTS: The standard- and CHG-dressing groups contained 68 and 63 patients, respectively. The median durations of catheterization were 13 (8-22) and 14 (2-28) days, respectively (p>0.05). The Catheter-Related Bloodstream Infection (CRBSI) rate was somewhat lower in the CHG-dressing group (20.6 vs. 26.5%), but the difference was not statistically significant (p>0.05). In the CHG-dressing group, CRBSIs caused by Gram-positive microorganisms totaled 0%, but the figure was 8.8% in the control group (p=0.028). CONCLUSIONS: CHG dressings reduced CRBSIs caused by Gram-positive microorganisms.