Measuring Gastric pH in Tube-fed Children With Neurologic Impairments and Gastroesophageal Disease.

OBJECTIVES: The aim of the study was to determine the extent of agreement between pH paper and handheld pH meter with a laboratory pH meter for gastric pH measurement in children with neurologic impairments and gastrostomy tubes who have gastroesophageal reflux disease (GERD). METHODS: In this prospective observational study, gastric contents were aspirated from gastric or nasogastric tubes and the pH measured using 3 techniques: pH paper, handheld pH meter, and laboratory pH meter (the gold standard). Agreement between techniques was assessed with intraclass correlation coefficient (ICC), Bland-Altman analysis, and kappa statistic. RESULTS: Among 43 patients contributing 67 gastric samples, the ICC was 0.75 (95% confidence interval [CI]: 0.69-0.97) between the handheld and laboratory meters, 0.69 (95% CI: 0.63--0.94) between the pH paper and laboratory meter and 0.69 (95% CI: 0.63-0.94) between the handheld meter and paper. The Bland-Altman analysis between the handheld and lab meters showed a mean difference of -0.03 pH units (limits of agreement: -0.52 to 0.47 pH units) and 0.17 pH units (limits of agreement: -0.99 to 1.33 pH units) between the paper and lab meter. The kappa coefficients for a pH ≥4 were 1.0 (95% CI: 1.0--1.0) between the handheld and lab meters and 0.9 (95% CI: 0.77--1.0) between the paper and lab meter. CONCLUSIONS: The findings suggest that both point-of-care tests, the pH meter and pH paper, correlate well with the gold standard for testing pH with a laboratory pH meter, indicating usefulness in point-of-care testing for monitoring gastric pH in tube-fed children with neurologic impairments and GERD.

Drug use evaluation (DUE) of ceftriaxone: A quality metric in a pediatric hospital.

Background: Ceftriaxone is frequently used as empiric therapy because of its broad spectrum and dosing characteristics. The purpose of this study was to evaluate the appropriateness of ceftriaxone therapy among hospitalized children using drug use evaluation (DUE) methodology. Methods: Hospitalized patients who received one or fewer dose of intravenous ceftriaxone at Children's Hospital of Eastern Ontario between January 1, 2018, and June 30, 2018, were identified. Duration was defined as empiric if 72 or less and definitive if more than 72 hours. Two infectious disease physicians reviewed the charts and rated appropriateness using a previously developed scale. Results: A total of 276 ceftriaxone courses in 248 patients (mean age 6.0 y) were reviewed. Of these, 153 (55.4%) were assessed as definitively or possibly indicated. The most common reason for inappropriate empiric use was an overly broad spectrum. Of the 120 courses given empirically for which there was no indication, the three most common reasons were lower respiratory infections (51; 42.5%), head and neck infections (18; 15.0%), and intra-abdominal infections (15; 12.5%). Of the 39 (14.1%) courses of ceftriaxone that were given for more than 72 hours, 14 (35.9%) met criteria for a definitive or possible indication. Conclusion: Ceftriaxone is still overused as empiric therapy. Although 85% of courses were discontinued after three doses, 14% were continued for longer than 72 hours, with approximately one-third ultimately meeting an indication. DUE using Canadian pediatric and local guidelines criteria is useful to identify clinical presentations for which narrower spectrum antimicrobials should be used.

Historique: La ceftriaxone est souvent utilisée comme traitement empirique en raison de son large spectre et de ses caractéristiques posologiques. La présente étude visait à évaluer la pertinence d'un traitement à la ceftriaxone chez les enfants hospitalisés, à l'aide de la méthodologie d'évaluation de la consommation des médicaments (ÉCM). Méthodologie: Les chercheurs ont recensé les patients hospitalisés qui ont reçu un maximum d'une dose de ceftriaxone par voie intraveineuse au Centre hospitalier pour enfants de l'est de l'Ontario entre le 1er janvier 2018 et le 30 juin 2018. La durée était définie comme empirique si elle était de 72 heures ou moins et comme décisive si elle était supérieure à 72 heures. Deux infectiologues ont examiné les dossiers et classé la pertinence au moyen d'une échelle déjà existante. Résultats: Au total, les chercheurs ont examiné 276 traitements de ceftriaxone chez 248 patients (d'un âge moyen de 6,0 ans). De ce nombre, 153 (55,4 %) ont été évalués comme définitifs ou possibles. Un trop large spectre était la principale raison d'en faire un usage empirique inapproprié. Les trois principales raisons d'administrer les 120 traitements empiriques sans indication étaient les infections des voies respiratoires inférieures (51; 42,5 %), les infections de la tête et du cou (18; 15,0 %) et les infections intra-abdominales (15; 12,5 %). Des 39 traitements de ceftriaxone (14,1 %) administrés pendant plus de 72 heures, 14 (35,9 %) avaient respecté les critères d'une indication définitive ou possible. Conclusion: La ceftriaxone demeure surutilisée comme traitement empirique. Même si 85 % des traitements ont été abandonnés après trois doses, 14 % se sont poursuivis plus de 72 heures, et au bout du compte, environ le tiers répondait à une indication. L'ÉCM faisant appel aux critères des directives canadiennes locales en pédiatrie est utile pour déterminer les présentations cliniques qui justifient l'utilisation d'antimicrobiens à spectre plus étroit.