Assuntos
Anemia Sideroblástica/diagnóstico , Artrite Juvenil/diagnóstico , Deficiências do Desenvolvimento/diagnóstico , Febre/diagnóstico , Síndromes de Imunodeficiência/diagnóstico , Anemia Sideroblástica/tratamento farmacológico , Anemia Sideroblástica/genética , Antirreumáticos/uso terapêutico , Linfócitos B , Pré-Escolar , Colchicina/uso terapêutico , Deficiências do Desenvolvimento/tratamento farmacológico , Deficiências do Desenvolvimento/genética , Diagnóstico Diferencial , Etanercepte/uso terapêutico , Febre/tratamento farmacológico , Febre/genética , Humanos , Imunoglobulinas/uso terapêutico , Síndromes de Imunodeficiência/tratamento farmacológico , Síndromes de Imunodeficiência/genética , Lactente , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Linfopenia/diagnóstico , Linfopenia/tratamento farmacológico , Linfopenia/genética , Masculino , Nucleotidiltransferases/genética , Síndrome , Moduladores de Tubulina/uso terapêuticoRESUMO
A survey was conducted in UK regional children's hospitals with paediatric intensive care and paediatric infectious disease (PID) departments to describe the characteristics of paediatric antimicrobial stewardship (PAS) programmes. A structured questionnaire was sent to PAS coordinators. 'Audit and feedback' was implemented in 13 out of 17 centres. Microbiology-led services were more likely to implement antimicrobial restriction (75% vs 33% in PID-led services), to focus on broad-spectrum antibiotics, and to review patients with positive blood cultures. PID-led services were more likely to identify patients from e-prescribing or drug charts and review all antimicrobials. A PAS network has been established.
Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , Implementação de Plano de Saúde , Hospitais Pediátricos , Padrões de Prática Médica , Criança , Doenças Transmissíveis/tratamento farmacológico , Humanos , Unidades de Terapia Intensiva Neonatal , Inquéritos e Questionários , Reino UnidoRESUMO
Concern about Pseudomonas infection in neonatal units has focused on outbreaks. This study analysed cases of invasive Pseudomonas infection in 18 UK neonatal units participating in the NeonIN Neonatal Infection Surveillance Network from January 2005 to December 2011. Forty-two cases were reported. The majority (35/42, 93%) of cases were late-onset (median 14 days, range 2-262 days), the highest incidence was seen in extremely-low-birthweight infants and all cases were sporadic. One-third of cases were known to be colonized prior to invasive disease. Attributable mortality was 18%. Opportunities for preventing invasive disease due to this important pathogen should be prioritized.
Assuntos
Recém-Nascido de Peso Extremamente Baixo ao Nascer , Doenças do Prematuro/epidemiologia , Unidades de Terapia Intensiva Neonatal , Infecções por Pseudomonas/epidemiologia , Pseudomonas/isolamento & purificação , Efeitos Psicossociais da Doença , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/microbiologia , Doenças do Prematuro/mortalidade , Masculino , Pseudomonas/classificação , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/mortalidade , Fatores de Risco , Reino Unido/epidemiologiaRESUMO
Rates of invasive fungal infection are highest among neonates, especially those of low birthweight. This study aimed to describe the current epidemiology of invasive neonatal fungal infections in a UK neonatal infection surveillance network. From 2004 to 2010 prospective multicentre surveillance was conducted by 14 neonatal units using a web-based database. Clinicians then completed a standardized pro forma for each positive fungal blood and/or cerebrospinal fluid culture. The overall incidence was 2.4/1000 neonatal unit admissions and was highest among babies <1000 g (extreme low birthweight, 18.8/1000). Only five infants (6%) were >1500 g. The majority of infections were caused by Candida albicans (59; 69%) and Candida parapsilosis (17; 20%); 33% of infants had received antifungal prophylaxis. Known risk factors (use of central venous catheter, parenteral nutrition, previous antibiotic use) were common among cases. The attributable case fatality rate was 21% (18/84). Extreme low birthweight infants remain at highest risk of invasive fungal infection and prophylaxis should be particularly considered for this group. The number needing to receive prophylaxis to prevent one case varies significantly among units, hence unit-specific decisions are required. Further research is still needed into the optimal empiric and therapeutic strategies.
Assuntos
Infecções Fúngicas do Sistema Nervoso Central/epidemiologia , Micoses/epidemiologia , Sepse/epidemiologia , Fatores Etários , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Inglaterra/epidemiologia , Monitoramento Epidemiológico , Feminino , Fungos/classificação , Fungos/isolamento & purificação , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Mortalidade , Micoses/microbiologia , Estudos Prospectivos , Fatores de Risco , Sepse/microbiologiaRESUMO
BACKGROUND: Group B streptococcus (GBS) is the most common cause of early onset (EO) neonatal infection in the UK. National guidelines for its prevention were introduced in 2003. We assessed the opportunities for prevention amongst cases of EO GBS using the electronic Neonatal Infection Surveillance Network (NeonIN). METHODS: Culture proven EO GBS cases occurring between 2004 and 2007 were identified prospectively in eight neonatal units participating in NeonIN. Data concerning risk factors, intrapartum antibiotic (IAP) use and infant outcome were collected retrospectively. RESULTS: There were 48 cases of GBS over the 4 years (0.52/1000 live-births); 22 male, median gestation 38 weeks. The most common clinical presentation was sepsis and the GBS-attributable mortality was 6%. Risk factors were present in 67% (32) and adequate IAP was given to six of these mothers (19%). If all women with risk factors received prophylaxis, 23 cases (48%) may have been prevented. CONCLUSIONS: Better GBS prevention strategies are required in the UK.
Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Complicações Infecciosas na Gravidez/tratamento farmacológico , Infecções Estreptocócicas/prevenção & controle , Streptococcus agalactiae , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Masculino , Guias de Prática Clínica como Assunto , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro , Estudos Prospectivos , Fatores de Risco , Sepse/tratamento farmacológico , Sepse/prevenção & controle , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/transmissão , Streptococcus agalactiae/isolamento & purificação , Resultado do Tratamento , Reino UnidoRESUMO
Neonatal infections currently cause about 1.6 million deaths annually in developing countries. Sepsis and meningitis are responsible for most of these deaths. Resistance to commonly used antibiotics is emerging and constitutes an important problem world wide. To reduce global neonatal mortality, strategies of proven efficacy, such as hand washing, barrier nursing, restriction of antibiotic use, and rationalisation of admission to neonatal units, need to be implemented. Different approaches require further research.