ANTIMICROBIAL RESISTANCE PATTERNS IN PEDIATRIC RESPIRATORY TRACT INFECTIONS – A PROSPECTIVE HOSPITAL-BASED STUDY.
Main Article Content
Keywords
Antimicrobial resistance, Pediatric, Respiratory infections, Antibiotics
Abstract
Respiratory tract infections (RTIs) are a major cause of morbidity and mortality across the globe in children. These infections are harder to treat with the emergence of antimicrobial resistance (AMR). The knowledge of the local antimicrobial resistance trends in pediatric RTIs is essential to successful treatment, particularly in hospital care, such as Pediatric Intensive Care Unit (PICU).
Objectives
To determine the pattern of antimicrobial resistance against pediatric respiratory tract infections; and to determine the efficacy of commonly used antibiotics in treating the illness in Pediatric Intensive Care Unit (PICU).
Methods
This is a prospective hospital-based Study conducted in Khyber Teaching Hospital, Peshawar. RTI patients (pediatric) were enrolled. Isolated pathogens were subjected to antimicrobial susceptibility testing and microbiological cultures were obtained. Demographic, clinical presentation and resistance data were gathered. We performed statistical analysis using the relevant parametric and non-parametric tests with p less than 0.05 as statistically significant.
Results
200 pediatric patients and the mean age of the patients was 5.1 years (SD +- 3.4). Most of the patients were confirmed with upper respiratory tract infection (60%), and lower respiratory tract infection (40%). Streptococcus pneumoniae (25%), Haemophilus influenzae (18%), and Moraxella catarrhalis (15%) were the most common pathogens to be identified. The level of resistance against amoxicillin and ceftriaxone was also high, especially with S. pneumoniae (40) and H. influenzae (25). TXA group exhibited a large decrease in blood loss relative to the control group, whereby the mean blood loss was 480 mL and 740 mL respectively (p < 0.001).
Conclusion
The increasing rates of antimicrobial resistance to infections of the respiratory tract among children. The high resistance rates to most popular antibiotic drugs, e.g. amoxicillin and ceftriaxone, require continuous monitoring and the implementation of more specific antibiotic treatment. Antimicrobial stewardship and culture-based sensitivity testing should be strengthened to enhance patient outcomes and workload reduction of AMR in the pediatric contexts.
Objectives
To determine the pattern of antimicrobial resistance against pediatric respiratory tract infections; and to determine the efficacy of commonly used antibiotics in treating the illness in Pediatric Intensive Care Unit (PICU).
Methods
This is a prospective hospital-based Study conducted in Khyber Teaching Hospital, Peshawar. RTI patients (pediatric) were enrolled. Isolated pathogens were subjected to antimicrobial susceptibility testing and microbiological cultures were obtained. Demographic, clinical presentation and resistance data were gathered. We performed statistical analysis using the relevant parametric and non-parametric tests with p less than 0.05 as statistically significant.
Results
200 pediatric patients and the mean age of the patients was 5.1 years (SD +- 3.4). Most of the patients were confirmed with upper respiratory tract infection (60%), and lower respiratory tract infection (40%). Streptococcus pneumoniae (25%), Haemophilus influenzae (18%), and Moraxella catarrhalis (15%) were the most common pathogens to be identified. The level of resistance against amoxicillin and ceftriaxone was also high, especially with S. pneumoniae (40) and H. influenzae (25). TXA group exhibited a large decrease in blood loss relative to the control group, whereby the mean blood loss was 480 mL and 740 mL respectively (p < 0.001).
Conclusion
The increasing rates of antimicrobial resistance to infections of the respiratory tract among children. The high resistance rates to most popular antibiotic drugs, e.g. amoxicillin and ceftriaxone, require continuous monitoring and the implementation of more specific antibiotic treatment. Antimicrobial stewardship and culture-based sensitivity testing should be strengthened to enhance patient outcomes and workload reduction of AMR in the pediatric contexts.
References
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18. Uda K, Okubo Y, Kinoshita N, Morisaki N, Kasai M, Horikoshi Y, et al. Nationwide survey of indications for oral antimicrobial prescription for pediatric patients from 2013 to 2016 in Japan. Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy. 2019;25(10):758-63.
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21. Yahiaoui RY, Bootsma HJ, den Heijer CDJ, Pluister GN, John Paget W, Spreeuwenberg P, et al. Distribution of serotypes and patterns of antimicrobial resistance among commensal Streptococcus pneumoniae in nine European countries. BMC infectious diseases. 2018;18(1):440.
22. Yonts AB, Kronman MP, Hamdy RF. The Burden and Impact of Antibiotic Prescribing in Ambulatory Pediatrics. Current problems in pediatric and adolescent health care. 2018;48(11):272-88.
2. Bakhit M, Baillie E, Krzyzaniak N, van Driel M, Clark J, Glasziou P, et al. Antibiotic prescribing for acute infections in synchronous telehealth consultations: a systematic review and meta-analysis. BJGP open. 2021;5(6).
3. Cao B, Huang Y, She DY, Cheng QJ, Fan H, Tian XL, et al. Diagnosis and treatment of community-acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association. The clinical respiratory journal. 2018;12(4):1320-60.
4. Keohavong B, Vonglokham M, Phoummalaysith B, Louangpradith V, Inthaphatha S, Kariya T, et al. Antibiotic prescription for under-fives with common cold or upper respiratory tract infection in Savannakhet Province, Lao PDR. Tropical medicine and health. 2019;47:16.
5. Korinteli IG, McHedlishvili I, Javakhadze M, Versporten A, Goossens H, Phagava H, et al. the global point prevalence survey (pps) of antimicrobial use and antimicrobial resistance among hospitalized children in georgia. georgian medical news. 2019(292-293):72-5.
6. Li Z, Lu G, Meng G. Pathogenic Fungal Infection in the Lung. Frontiers in immunology. 2019;10:1524.
7. Lohiya A, Suliankatchi Abdulkader R, Rath RS, Jacob O, Chinnakali P, Goel AD, et al. Prevalence and patterns of drug resistant pulmonary tuberculosis in India-A systematic review and meta-analysis. Journal of global antimicrobial resistance. 2020;22:308-16.
8. Lucien MAB, Canarie MF, Kilgore PE, Jean-Denis G, Fénélon N, Pierre M, et al. Antibiotics and antimicrobial resistance in the COVID-19 era: Perspective from resource-limited settings. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2021;104:250-4.
9. McKay R, Patrick DM, McGrail K, Law MR. Antibiotic prescribing for pediatric respiratory infections: What explains a large variation among physicians? Canadian family physician Medecin de famille canadien. 2019;65(6):e278-e91.
10. Mesman AW, Rodriguez C, Ager E, Coit J, Trevisi L, Franke MF. Diagnostic accuracy of molecular detection of Mycobacterium tuberculosis in pediatric stool samples: A systematic review and meta-analysis. Tuberculosis (Edinburgh, Scotland). 2019;119:101878.
11. Muraki Y, Kusama Y, Tanabe M, Hayakawa K, Gu Y, Ishikane M, et al. Impact of antimicrobial stewardship fee on prescribing for Japanese pediatric patients with upper respiratory infections. BMC health services research. 2020;20(1):399.
12. Nguyen PT, Tran HT, Fitzgerald DA, Graham SM, Marais BJ. Antibiotic use in children hospitalised with pneumonia in Central Vietnam. Archives of disease in childhood. 2020;105(8):713-9.
13. Rivaya B, Jordana-Lluch E, Fernández-Rivas G, Molinos S, Campos R, Méndez-Hernández M, et al. Macrolide resistance and molecular typing of Mycoplasma pneumoniae infections during a 4 year period in Spain. The Journal of antimicrobial chemotherapy. 2020;75(10):2752-9.
14. Schneider A, Cabral C, Herd N, Hay A, Kesten JM, Anderson E, et al. Reducing Primary Care Attendance Intentions for Pediatric Respiratory Tract Infections. Annals of family medicine. 2019;17(3):239-49.
15. Shakur SM, Whitehall J, Mudgil P. Pediatric bloodstream infections in metropolitan Australia. World journal of pediatrics : WJP. 2019;15(2):161-7.
16. Thaulow CM, Blix HS, Eriksen BH, Ask I, Myklebust T, Berild D. Using a period incidence survey to compare antibiotic use in children between a university hospital and a district hospital in a country with low antimicrobial resistance: a prospective observational study. BMJ open. 2019;9(5):e027836.
17. Tramper-Stranders GA. Childhood community-acquired pneumonia: A review of etiology- and antimicrobial treatment studies. Paediatric respiratory reviews. 2018;26:41-8.
18. Uda K, Okubo Y, Kinoshita N, Morisaki N, Kasai M, Horikoshi Y, et al. Nationwide survey of indications for oral antimicrobial prescription for pediatric patients from 2013 to 2016 in Japan. Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy. 2019;25(10):758-63.
19. Verma S, Mathew JL, Ray P. Comparison of respiratory pathogen colonization and antimicrobial susceptibility in people with cystic fibrosis bronchiectasis versus non-cystic fibrosis bronchiectasis: a protocol for a systematic review. Systematic reviews. 2021;10(1):7.
20. Weiner-Lastinger LM, Abner S, Benin AL, Edwards JR, Kallen AJ, Karlsson M, et al. Antimicrobial-resistant pathogens associated with pediatric healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015-2017. Infection control and hospital epidemiology. 2020;41(1):19-30.
21. Yahiaoui RY, Bootsma HJ, den Heijer CDJ, Pluister GN, John Paget W, Spreeuwenberg P, et al. Distribution of serotypes and patterns of antimicrobial resistance among commensal Streptococcus pneumoniae in nine European countries. BMC infectious diseases. 2018;18(1):440.
22. Yonts AB, Kronman MP, Hamdy RF. The Burden and Impact of Antibiotic Prescribing in Ambulatory Pediatrics. Current problems in pediatric and adolescent health care. 2018;48(11):272-88.
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Published
Oct 20, 2022
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How to Cite
Ijaz Ahmad, Misbah ullah khan, & Afzal Ahmad. (2022). ANTIMICROBIAL RESISTANCE PATTERNS IN PEDIATRIC RESPIRATORY TRACT INFECTIONS – A PROSPECTIVE HOSPITAL-BASED STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 5313-5319. https://doi.org/10.53555/bzgh0a14
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Author Biographies
Ijaz Ahmad
Experiential registrar Peads icu Khyber teaching hospital Peshawar
Misbah ullah khan
Experiential registrar pediatrics Khyber teaching hospital Peshawar
Afzal Ahmad
Registrar nursery Khyber teaching hospital Peshawar
How to Cite
Ijaz Ahmad, Misbah ullah khan, & Afzal Ahmad. (2022). ANTIMICROBIAL RESISTANCE PATTERNS IN PEDIATRIC RESPIRATORY TRACT INFECTIONS – A PROSPECTIVE HOSPITAL-BASED STUDY. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 5313-5319. https://doi.org/10.53555/bzgh0a14