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Antimicrobial Prescribing during Infant Hospital Admissions in a Birth Cohort in Dhaka, Bangladesh

Empirical antimicrobial use is common in hospitalized infants and may contribute to antimicrobial resistance in low- and middle-income countries. In this observational birth cohort study nested in a randomized controlled trial in Dhaka, Bangladesh, inpatient antimicrobial prescription data were extr...

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Autores principales: Boone, Katherine, Morris, Shaun K, Doshi, Sejal, Black, Jason, Mohsin, Minhazul, Ahmed, Tahmeed, Al Mahmud, Abdullah, Roth, Daniel E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319631/
https://www.ncbi.nlm.nih.gov/pubmed/33221898
http://dx.doi.org/10.1093/tropej/fmaa093
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author Boone, Katherine
Morris, Shaun K
Doshi, Sejal
Black, Jason
Mohsin, Minhazul
Ahmed, Tahmeed
Al Mahmud, Abdullah
Roth, Daniel E
author_facet Boone, Katherine
Morris, Shaun K
Doshi, Sejal
Black, Jason
Mohsin, Minhazul
Ahmed, Tahmeed
Al Mahmud, Abdullah
Roth, Daniel E
author_sort Boone, Katherine
collection PubMed
description Empirical antimicrobial use is common in hospitalized infants and may contribute to antimicrobial resistance in low- and middle-income countries. In this observational birth cohort study nested in a randomized controlled trial in Dhaka, Bangladesh, inpatient antimicrobial prescription data were extracted from serious adverse event forms completed for hospitalizations of infants (0–12 months of age). The primary outcome was the proportion of inpatient admissions where systemic antimicrobials were prescribed. Infant and hospitalization-related factors associated with antimicrobial prescriptions were determined. Among 1254 infants, there were 448 admissions to 32 facilities from 2014 to 2016. Antimicrobials were prescribed in 73% of admissions with a mean antimicrobial exposure rate of 0.25 antimicrobials per day of admission [95% confidence intervals (95% CIs): 0.24–0.27]. The most common antibiotics were aminoglycosides (29%), penicillins (26%) and third-generation cephalosporins (25%). In all, 58% of antibiotics were classified as ‘access’, 38% ‘watch’ and 1% ‘reserve’ using the World Health Organization (WHO) Essential Medicines List classification. WHO-recommended antimicrobial regimens were used in 68% of neonatal sepsis and 9% of lower respiratory tract infection (LRTI) admissions. ‘Watch’ antimicrobials were used in 26% of neonatal sepsis and 76% of LRTI admissions. Compared with private facilities, antimicrobial prescription rates were lower at government [rate ratio (RR) 0.71; 95% CI: 0.61–0.83] and charitable facilities (RR 0.39; 95% CI: 0.28–0.53), after adjustment for household wealth index and parental education. Younger infant age, older maternal age and longer admission were associated with higher prescription rates. These findings highlight the need for paediatric antimicrobial stewardship programs in Bangladesh.
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spelling pubmed-83196312021-07-30 Antimicrobial Prescribing during Infant Hospital Admissions in a Birth Cohort in Dhaka, Bangladesh Boone, Katherine Morris, Shaun K Doshi, Sejal Black, Jason Mohsin, Minhazul Ahmed, Tahmeed Al Mahmud, Abdullah Roth, Daniel E J Trop Pediatr Original Paper Empirical antimicrobial use is common in hospitalized infants and may contribute to antimicrobial resistance in low- and middle-income countries. In this observational birth cohort study nested in a randomized controlled trial in Dhaka, Bangladesh, inpatient antimicrobial prescription data were extracted from serious adverse event forms completed for hospitalizations of infants (0–12 months of age). The primary outcome was the proportion of inpatient admissions where systemic antimicrobials were prescribed. Infant and hospitalization-related factors associated with antimicrobial prescriptions were determined. Among 1254 infants, there were 448 admissions to 32 facilities from 2014 to 2016. Antimicrobials were prescribed in 73% of admissions with a mean antimicrobial exposure rate of 0.25 antimicrobials per day of admission [95% confidence intervals (95% CIs): 0.24–0.27]. The most common antibiotics were aminoglycosides (29%), penicillins (26%) and third-generation cephalosporins (25%). In all, 58% of antibiotics were classified as ‘access’, 38% ‘watch’ and 1% ‘reserve’ using the World Health Organization (WHO) Essential Medicines List classification. WHO-recommended antimicrobial regimens were used in 68% of neonatal sepsis and 9% of lower respiratory tract infection (LRTI) admissions. ‘Watch’ antimicrobials were used in 26% of neonatal sepsis and 76% of LRTI admissions. Compared with private facilities, antimicrobial prescription rates were lower at government [rate ratio (RR) 0.71; 95% CI: 0.61–0.83] and charitable facilities (RR 0.39; 95% CI: 0.28–0.53), after adjustment for household wealth index and parental education. Younger infant age, older maternal age and longer admission were associated with higher prescription rates. These findings highlight the need for paediatric antimicrobial stewardship programs in Bangladesh. Oxford University Press 2020-11-22 /pmc/articles/PMC8319631/ /pubmed/33221898 http://dx.doi.org/10.1093/tropej/fmaa093 Text en © The Author(s) [2020]. Published by Oxford University Press. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Paper
Boone, Katherine
Morris, Shaun K
Doshi, Sejal
Black, Jason
Mohsin, Minhazul
Ahmed, Tahmeed
Al Mahmud, Abdullah
Roth, Daniel E
Antimicrobial Prescribing during Infant Hospital Admissions in a Birth Cohort in Dhaka, Bangladesh
title Antimicrobial Prescribing during Infant Hospital Admissions in a Birth Cohort in Dhaka, Bangladesh
title_full Antimicrobial Prescribing during Infant Hospital Admissions in a Birth Cohort in Dhaka, Bangladesh
title_fullStr Antimicrobial Prescribing during Infant Hospital Admissions in a Birth Cohort in Dhaka, Bangladesh
title_full_unstemmed Antimicrobial Prescribing during Infant Hospital Admissions in a Birth Cohort in Dhaka, Bangladesh
title_short Antimicrobial Prescribing during Infant Hospital Admissions in a Birth Cohort in Dhaka, Bangladesh
title_sort antimicrobial prescribing during infant hospital admissions in a birth cohort in dhaka, bangladesh
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319631/
https://www.ncbi.nlm.nih.gov/pubmed/33221898
http://dx.doi.org/10.1093/tropej/fmaa093
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