Reducing antibiotic prescribing for children presenting to primary care with acute respiratory tract infection

Blair, P.S. et al. (2017) BMJ Open. 7:e014506

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Objective: To investigate recruitment and retention, data collection methods and the acceptability of a ‘within-consultation’ complex intervention designed to reduce antibiotic prescribing.

Conclusion: Differential recruitment may explain the paradoxical antibiotic prescribing rates. Future cluster level studies should consider designs which remove the need for individual consent postrandomisation and embed the intervention within electronic primary care records.

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Risk Factors for Community-Associated Clostridium difficile Infection in Children

Adams, D.J. et al. The Journal of Pediatrics | Published online: 7 April 2017

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Objective: To characterize the medication and other exposures associated with pediatric community-associated Clostridium difficile infections (CA-CDIs).

Conclusions: CA-CDI is associated with medications regularly prescribed in pediatric practice, along with exposure to outpatient healthcare clinics and family members with CDI. Our findings provide additional support for the judicious use of these medications and for efforts to limit spread of CDI in ambulatory healthcare settings and households.

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Bloodstream infections are the most common type of HCI in neonates, children, and adolescents

Zingg, W. et al. The Lancet Infectious Diseases. Published online: 12 January 2017

Background: In 2011–12, the European Centre for Disease Prevention and Control (ECDC) held the first Europe-wide point-prevalence survey of health-care-associated infections in acute care hospitals. We analysed paediatric data from this survey, aiming to calculate the prevalence and type of health-care-associated infections in children and adolescents in Europe and to determine risk factors for infection in this population.

Findings: We analysed data for 17 273 children and adolescents from 29 countries. 770 health-care-associated infections were reported in 726 children and adolescents, corresponding to a prevalence of 4·2% (95% CI 3·7–4·8). Bloodstream infections were the most common type of infection (343 [45%] infections), followed by lower respiratory tract infections (171 [22%]), gastrointestinal infections (64 [8%]), eye, ear, nose, and throat infections (55 [7%]), urinary tract infections (37 [5%]), and surgical-site infections (34 [4%]). The prevalence of infections was highest in paediatric intensive care units (15·5%, 95% CI 11·6–20·3) and neonatal intensive care units (10·7%, 9·0–12·7). Independent risk factors for infection were age younger than 12 months, fatal disease (via ultimately and rapidly fatal McCabe scores), prolonged length of stay, and the use of invasive medical devices. 392 microorganisms were reported for 342 health-care-associated infections, with Enterobacteriaceae being the most frequently found (113 [15%]).

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Helping parents spot the signs of sepsis

Sepsis awareness campaign will help parents and carers of young children recognise the symptoms of sepsis.

A nationwide campaign has been launched to help parents spot the symptoms of sepsis to protect young children and save lives.The campaign is principally aimed at parents and carers of young children aged 0 to 4.

The campaign, delivered by Public Health England and the UK Sepsis Trust, follows a number of measures already taken by the NHS to improve early recognition and timely treatment of sepsis. This includes a national scheme to make sure at-risk patients are screened for sepsis as quickly as possible and receive timely treatment on admission to hospital.

Leaflets and posters are being sent to GP surgeries and hospitals across the country. These materials, developed with experts, will urge parents to call 999 or take their child to A&E if they display any of the following signs:

  • looks mottled, bluish or pale
  • is very lethargic or difficult to wake
  • feels abnormally cold to touch
  • is breathing very fast
  • has a rash that does not fade when you press it
  • has a fit or convulsion

The UK Sepsis Trust estimates that there are more than 120,000 cases of sepsis and around 37,000 deaths each year in England.

Click Here to Download Sepsis Symptoms Poster

Prevention of Catheter-Associated Bloodstream Infections in a Pediatric ICU

Düzkaya, D.S. et al. (2016) Critical Care Nurse. 36(6) pp. e1-e7

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Background: Bloodstream infections related to use of catheters are associated with increased morbidity and mortality rates, prolonged hospital lengths of stay, and increased medical costs.

Conclusions: Use of chlorhexidine-impregnated dressings reduced rates of catheter-related bloodstream infections, contamination, colonization, and local catheter infection in a pediatric intensive care unit but was not significantly better than use of standard dressings.

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Using a simple point-prevalence survey to define appropriate antibiotic prescribing in hospitalised children across the UK

Gharbi, M. et al. BMJ Open. 6:e012675

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Background: The National Health Service England, Commissioning for Quality and Innovation for Antimicrobial Resistance (CQUIN AMR) aims to reduce the total antibiotic consumption and the use of certain broad-spectrum antibiotics in secondary care. However, robust baseline antibiotic use data are lacking for hospitalised children. In this study, we aim to describe, compare and explain the prescription patterns of antibiotics within and between paediatric units in the UK and to provide a baseline for antibiotic prescribing for future improvement using CQUIN AMR guidance.

Methods: We conducted a cross-sectional study using a point prevalence survey (PPS) in 61 paediatric units across the UK. The standardised study protocol from the Antibiotic Resistance and Prescribing in European Children (ARPEC) project was used. All inpatients under 18 years of age present in the participating hospital on the day of the study were included except neonates.

Results: A total of 1247 (40.9%) of 3047 children hospitalised on the day of the PPS were on antibiotics. The proportion of children receiving antibiotics showed a wide variation between both district general and tertiary hospitals, with 36.4% ( 95% CI 33.4% to 39.4%) and 43.0% (95% CI 40.9% to 45.1%) of children prescribed antibiotics, respectively. About a quarter of children on antibiotic therapy received either a medical or surgical prophylaxis with parenteral administration being the main prescribed route for antibiotics (>60% of the prescriptions for both types of hospitals). General paediatrics units were surprisingly high prescribers of critical broad-spectrum antibiotics, that is, carbapenems and piperacillin-tazobactam.

Conclusions: We provide a robust baseline for antibiotic prescribing in hospitalised children in relation to current national stewardship efforts in the UK. Repeated PPS with further linkage to resistance data needs to be part of the antibiotic stewardship strategy to tackle the issue of suboptimal antibiotic use in hospitalised children.

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Childhood flu programme: information for practitioners

The Department of Health has updated its guidance document The National Childhood Flu Immunisation Programme 2016/17 Information for healthcare practitioners

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Image source: http://www.gov.uk/

The document includes information on:

  • what flu is
  • the flu vaccine
  • dosage
  • administering the vaccine
  • advice on vaccinating children with an egg allergy
  • further resources