No clinical benefit of empirical antimicrobial therapy for pediatric diarrhea in a high usage, high resistance setting
| العنوان: | No clinical benefit of empirical antimicrobial therapy for pediatric diarrhea in a high usage, high resistance setting |
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| المؤلفون: | Stephen Baker, Ha Thanh Tuyen, James Campbell, Ruklanthi de Alwis, Tran Thi Hong Chau, Nguyen Thanh Hung, Pham Van Minh, Nguyen Thi Thanh Huong, Le Thi Phuong Tu, Tran Do Hoang Nhu, Hoang Le Phuc, Vu Thuy Duong, Guy E. Thwaites, Le Thi Quynh Nhi, Nguyen Minh Ngoc, Corinne N. Thompson, Lu Lan Vi |
| المساهمون: | Baker, Stephen [0000-0003-1308-5755], Apollo - University of Cambridge Repository |
| المصدر: | Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America |
| سنة النشر: | 2017 |
| مصطلحات موضوعية: | Male, 0301 basic medicine, medicine.disease_cause, law.invention, Feces, 0302 clinical medicine, Anti-Infective Agents, Randomized controlled trial, Salmonella, law, Drug Resistance, Multiple, Bacterial, Prevalence, Shigella, Prospective Studies, 030212 general & internal medicine, fluoroquinolones, Child, Articles and Commentaries, pediatric diarrhea, Campylobacter, Antimicrobial, Anti-Bacterial Agents, 3. Good health, Diarrhea, Treatment Outcome, Infectious Diseases, Vietnam, Child, Preschool, Female, Bloody diarrhea, medicine.symptom, nontyphoidal Salmonella, Microbiology (medical), medicine.medical_specialty, Adolescent, 030106 microbiology, Microbial Sensitivity Tests, 03 medical and health sciences, Antibiotic resistance, multidrug resistance, Internal medicine, medicine, Humans, antimicrobial resistance, Intensive care medicine, disease outcome, business.industry, Infant, Multiple drug resistance, Cross-Sectional Studies, business |
| الوصف: | We identified high antimicrobial usage and high antimicrobial resistance in children hospitalized with bloody and/or mucoid bacteria-associated diarrhea. There was no clinical benefit of antimicrobial therapy in children with diarrhea; adequately powered randomized controlled trials are required. Background Pediatric diarrheal disease presents a major public health burden in low- to middle-income countries. The clinical benefits of empirical antimicrobial treatment for diarrhea are unclear in settings that lack reliable diagnostics and have high antimicrobial resistance (AMR). Methods We conducted a prospective multicenter cross-sectional study of pediatric patients hospitalized with diarrhea containing blood and/or mucus in Ho Chi Minh City, Vietnam. Clinical parameters, including disease outcome and treatment, were measured. Shigella, nontyphoidal Salmonella (NTS), and Campylobacter were isolated from fecal samples, and their antimicrobial susceptibility profiles were determined. Statistical analyses, comprising log-rank tests and accelerated failure time models, were performed to assess the effect of antimicrobials on disease outcome. Results Among 3166 recruited participants (median age 10 months; interquartile range, 6.5–16.7 months), one-third (1096 of 3166) had bloody diarrhea, and 25% (793 of 3166) were culture positive for Shigella, NTS, or Campylobacter. More than 85% of patients (2697 of 3166) were treated with antimicrobials; fluoroquinolones were the most commonly administered antimicrobials. AMR was highly prevalent among the isolated bacteria, including resistance against fluoroquinolones and third-generation cephalosporins. Antimicrobial treatment and multidrug resistance status of the infecting pathogens were found to have no significant effect on outcome. Antimicrobial treatment was significantly associated with an increase in the duration of hospitalization with particular groups of diarrheal diseases. Conclusions In a setting with high antimicrobial usage and high AMR, our results imply a lack of clinical benefit for treating diarrhea with antimicrobials; adequately powered randomized controlled trials are required to assess the role of antimicrobials for diarrhea. |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 1537-6591 1058-4838 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b50838cef3b49c845f24abc091b29d5bTest http://ora.ox.ac.uk/objects/uuidTest: |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....b50838cef3b49c845f24abc091b29d5b |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15376591 10584838 |
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