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The Utility of Bedside Assessment Tools and Associated Factors to Avoid Antibiotic Overuse in an Urban PICU of a Diarrheal Disease Hospital in Bangladesh
Background: Antibiotic exposure in the pediatric intensive care unit (PICU) is very high, although 50% of all antibiotics may be unnecessary. We aimed to determine the utility of simple bedside screening tools and predicting factors to avoid antibiotic overuse in the ICU among children with diarrhea...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8532929/ https://www.ncbi.nlm.nih.gov/pubmed/34680835 http://dx.doi.org/10.3390/antibiotics10101255 |
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author | Afroze, Farzana Faruk, Md. Tanveer Kamal, Mehnaz Kabir, Farhad Sarmin, Monira Sharifuzzaman, Chakraborty, Mithun Hossain, Md. Rezaul Shikha, Shamima Sharmin Chowdhury, Visnu Pritom Islam, Md. Zahidul Ahmed, Tahmeed Chisti, Mohammod Jobayer |
author_facet | Afroze, Farzana Faruk, Md. Tanveer Kamal, Mehnaz Kabir, Farhad Sarmin, Monira Sharifuzzaman, Chakraborty, Mithun Hossain, Md. Rezaul Shikha, Shamima Sharmin Chowdhury, Visnu Pritom Islam, Md. Zahidul Ahmed, Tahmeed Chisti, Mohammod Jobayer |
author_sort | Afroze, Farzana |
collection | PubMed |
description | Background: Antibiotic exposure in the pediatric intensive care unit (PICU) is very high, although 50% of all antibiotics may be unnecessary. We aimed to determine the utility of simple bedside screening tools and predicting factors to avoid antibiotic overuse in the ICU among children with diarrhea and critical illness. Methods: We conducted a retrospective, single-center, case-control study that included children aged 2–59 months who were admitted to PICU with diarrhea and critical illness between 2017 and 2020. Results: We compared young children who did not receive antibiotics (cases, n = 164) during ICU stay to those treated with antibiotics (controls, n = 346). For predicting the ‘no antibiotic approach’, the sensitivity of a negative quick Sequential Organ Failure Assessment (qSOFA) was similar to quick Pediatric Logistic Organ Dysfunction-2 (qPELOD-2) and higher than Systemic Inflammatory Response Syndrome (SIRS). A negative qSOFA or qPELOD-2 score calculated during PICU admission is superior to SIRS to avoid antibiotic overuse in under-five children. The logistic regression analysis revealed that cases were more often older and independently associated with hypernatremia. Cases less often had severe underweight, altered mentation, age-specific fast breathing, lower chest wall in-drawing, adventitious sound on lung auscultation, abdominal distension, developmental delay, hyponatremia, hypocalcemia, and microscopic evidence of invasive diarrhea (for all, p < 0.05). Conclusion: Antibiotic overuse could be evaded in PICU using simple bedside screening tools and clinical characteristics, particularly in poor resource settings among children with diarrhea. |
format | Online Article Text |
id | pubmed-8532929 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-85329292021-10-23 The Utility of Bedside Assessment Tools and Associated Factors to Avoid Antibiotic Overuse in an Urban PICU of a Diarrheal Disease Hospital in Bangladesh Afroze, Farzana Faruk, Md. Tanveer Kamal, Mehnaz Kabir, Farhad Sarmin, Monira Sharifuzzaman, Chakraborty, Mithun Hossain, Md. Rezaul Shikha, Shamima Sharmin Chowdhury, Visnu Pritom Islam, Md. Zahidul Ahmed, Tahmeed Chisti, Mohammod Jobayer Antibiotics (Basel) Article Background: Antibiotic exposure in the pediatric intensive care unit (PICU) is very high, although 50% of all antibiotics may be unnecessary. We aimed to determine the utility of simple bedside screening tools and predicting factors to avoid antibiotic overuse in the ICU among children with diarrhea and critical illness. Methods: We conducted a retrospective, single-center, case-control study that included children aged 2–59 months who were admitted to PICU with diarrhea and critical illness between 2017 and 2020. Results: We compared young children who did not receive antibiotics (cases, n = 164) during ICU stay to those treated with antibiotics (controls, n = 346). For predicting the ‘no antibiotic approach’, the sensitivity of a negative quick Sequential Organ Failure Assessment (qSOFA) was similar to quick Pediatric Logistic Organ Dysfunction-2 (qPELOD-2) and higher than Systemic Inflammatory Response Syndrome (SIRS). A negative qSOFA or qPELOD-2 score calculated during PICU admission is superior to SIRS to avoid antibiotic overuse in under-five children. The logistic regression analysis revealed that cases were more often older and independently associated with hypernatremia. Cases less often had severe underweight, altered mentation, age-specific fast breathing, lower chest wall in-drawing, adventitious sound on lung auscultation, abdominal distension, developmental delay, hyponatremia, hypocalcemia, and microscopic evidence of invasive diarrhea (for all, p < 0.05). Conclusion: Antibiotic overuse could be evaded in PICU using simple bedside screening tools and clinical characteristics, particularly in poor resource settings among children with diarrhea. MDPI 2021-10-15 /pmc/articles/PMC8532929/ /pubmed/34680835 http://dx.doi.org/10.3390/antibiotics10101255 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Afroze, Farzana Faruk, Md. Tanveer Kamal, Mehnaz Kabir, Farhad Sarmin, Monira Sharifuzzaman, Chakraborty, Mithun Hossain, Md. Rezaul Shikha, Shamima Sharmin Chowdhury, Visnu Pritom Islam, Md. Zahidul Ahmed, Tahmeed Chisti, Mohammod Jobayer The Utility of Bedside Assessment Tools and Associated Factors to Avoid Antibiotic Overuse in an Urban PICU of a Diarrheal Disease Hospital in Bangladesh |
title | The Utility of Bedside Assessment Tools and Associated Factors to Avoid Antibiotic Overuse in an Urban PICU of a Diarrheal Disease Hospital in Bangladesh |
title_full | The Utility of Bedside Assessment Tools and Associated Factors to Avoid Antibiotic Overuse in an Urban PICU of a Diarrheal Disease Hospital in Bangladesh |
title_fullStr | The Utility of Bedside Assessment Tools and Associated Factors to Avoid Antibiotic Overuse in an Urban PICU of a Diarrheal Disease Hospital in Bangladesh |
title_full_unstemmed | The Utility of Bedside Assessment Tools and Associated Factors to Avoid Antibiotic Overuse in an Urban PICU of a Diarrheal Disease Hospital in Bangladesh |
title_short | The Utility of Bedside Assessment Tools and Associated Factors to Avoid Antibiotic Overuse in an Urban PICU of a Diarrheal Disease Hospital in Bangladesh |
title_sort | utility of bedside assessment tools and associated factors to avoid antibiotic overuse in an urban picu of a diarrheal disease hospital in bangladesh |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8532929/ https://www.ncbi.nlm.nih.gov/pubmed/34680835 http://dx.doi.org/10.3390/antibiotics10101255 |
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