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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Antibiotic prescribing and resistance

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Public Health England has published English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report 2016.

The ESPAUR report includes national data on antibiotic prescribing and resistance, and hospital antimicrobial stewardship implementation. It forms a standard against which antimicrobial use and antimicrobial resistance can be compared in successive years and a resource for commissioning and implementing antimicrobial stewardship policies in England.

Additional link: PHE press release

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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Are Current Electronic Prescribing Systems Facilitating Antimicrobial Stewardship in Acute National Health Service Hospital Trusts in East of England?

Ladenheim, D. et al. Journal of Hospital Infection. Published online: July 29, 2016

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Antimicrobial stewardship (AMS) programs in hospitals seek to optimise antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs, slow the spread of antimicrobial resistance and reduce the incidence of healthcare associated infections. The Start Smart – then Focus toolkit published by Public Health England provides an evidenced-based approach for improving antimicrobial prescribing for acute National Health Service (NHS) Hospital Trusts in England.

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