A worrying trend in weight-adjusted paediatric antibiotic use in a Norwegian tertiary care hospital.

AIM: The World Health Organization recommends the defined daily dose (DDD) as the standard unit of measurement for antibiotic use, but this is not applicable in children. We aimed to assess paediatric antibiotic use in a Norwegian tertiary care hospital using a novel weight-adjusted method. METHODS: We obtained antibiotic purchase data from the hospital pharmacy and administrative data for all admissions from 2002 to 2009 to the paediatric wards at Oslo University Hospital, Rikshospitalet. Recommended daily doses per 100 kg days (RDDs/kg days) were calculated based on national guidelines for paediatric antibiotic use, length of stay and estimated weight for sex and age using national growth references. RESULTS: Total antibiotic use increased significantly from 51.8 to 65.5 RDDs/100 kg days. We found statistically significant annual increases in the consumption of carbapenems (18.0%), third-generation cephalosporins (6.0%) and imidazole derivatives (6.6%) and a considerable difference between total antibiotic use measured in RDDs/100 kg days and DDDs/100 bed days for neonates. CONCLUSION: Weight-adjusted antibiotic use provided a more meaningful description of the quantities of antibiotics consumed than DDDs/100 bed days, particularly for neonates. Total antibiotic use, use of meropenem, third-generation cephalosporins and imidazole derivatives increased significantly despite low prevalence of antibiotic-resistant pathogens.

Antibiotic resistance in hospitals: a ward-specific random effect model in a low antibiotic consumption environment.

Association between previous antibiotic use and emergence of antibiotic resistance has been reported for several microorganisms. The relationship has been extensively studied, and although the causes of antibiotic resistance are multi-factorial, clear evidence of antibiotic use as a major risk factor exists. Most studies are carried out in countries with high consumption of antibiotics and corresponding high levels of antibiotic resistance, and currently, little is known whether and at what level the associations are detectable in a low antibiotic consumption environment. We conduct an ecological, retrospective study aimed at determining the impact of antibiotic consumption on antibiotic-resistant Pseudomonas aeruginosa in three hospitals in Norway, a country with low levels of antibiotic use. We construct a sophisticated statistical model to capture such low signals. To reduce noise, we conduct our study at hospital ward level. We propose a random effect Poisson or binomial regression model, with a reparametrisation that allows us to reduce the number of parameters. Inference is likelihood based. Through scenario simulation, we study the potential effects of reduced or increased antibiotic use. Results clearly indicate that the effects of consumption on resistance are present under conditions with relatively low use of antibiotic agents. This strengthens the recommendation on prudent use of antibiotics, even when consumption is relatively low.

["Look to Norway"--but for how long?]. / "Look to Norway"--men hvor lenge?

Internationally, Norway receives positive attention mainly in the context of Winter Olympics or peace initiatives. However, an Associated Press article recently suggested that the Norwegian health care system had "found the Solution to Killer Superbug". Furthermore, Norway was proclaimed "The Most Infection Free Country in the World". What my be the reality behind such headlines, and how shall we as a nation maintain a favourable situation? Physicians in Scandinavian countries and the Netherlands have a long tradition for modest prescription of antibiotics, and are trained to use agents with a narrow antimicrobial spectre whenever possible. This is probably the main reason why these countries have had less antibiotic resistance than others. The number of antibiotics marketed in a country correlates positively with total drug consumption. Until 1992, Norwegian authorities could reject marketing of new compounds if national experts found no medical need for them. The foresight of senior colleagues has led to the number of marketed antibiotics in Norway, even today, being 10-fold lower than in some other European countries. The national surveillance programme, NORM, reports antimicrobial resistance in human pathogens on an annual basis. For example, national levels of MRSA and ESBL-producing Enterobacteriaceae are still very low whereas ampicillin and ciprofloxacin resistance in E coli and high- level gentamicin resistance in enterococci cause some concern. Norway has well-established epidemiological surveillance systems in the fields of microbiology and infectious diseases. Nevertheless, more knowledge is needed on how antibiotics are used in hospitals. Two national strategic plans (since 2003) have emphasized the explicit importance of antibiotic surveillance to counteract future antibiotic resistance problems. To fulfil national ambitions, there is an urgent need for economic grants to this field; the human resources are there and as eager to start as Olympic performers!

Can a galacto-oligosaccharide reduce the risk of traveller's diarrhoea? A placebo-controlled, randomized, double-blind study.

BACKGROUND: Diarrhoea is a common medical problem affecting travellers to Asia, Africa and Latin America. The use of prophylactic antimicrobial agents may increase the risk of contracting resistant bacteria. Findings indicate that oligosaccharides, i.e. carbohydrate chains of 3-10 monosaccharides, reduce the risk of diarrhoea. METHODS: We performed a placebo-controlled, double-blind study of a galacto-oligosaccharide, B-GOS (Bimuno®, Clasado Ltd, Milton Keynes UK), vs placebo for participants travelling to countries with a high/intermediate risk of diarrhoea for 7-15 days. The participants ingested 2.7g of B-GOS daily from 5 days prior to departure throughout the travel period, and returned a questionnaire, with a diarrhoea log, after their return. The case definition of diarrhoea was three or more loose stools per day. RESULTS: Of 523 enrolled subjects, 334 travellers managed to comply per protocol (PP), 349 followed the protocol at least until the onset of diarrhoea (conditionally evaluable, CE), and 408 followed the protocol with fewer than 5 days of deviance from the protocol (intention to treat, ITT). There was a significant reduction of diarrhoea incidence in the PP group (odds ratio = 0.56, P = 0.03), while the effect in the CE group was non-significant (OR = 0.65, P = 0.08). No significant effect was found during the first 7 days after starting with B-GOS, but from day 8 there was a significant effect in both the PP and CE groups (OR = 0.47, P = 0.02 and OR = 0.53, P = 0.03, respectively). The entire effect was seen in 1-day (i.e. self-limiting) diarrhoea (PP: OR = 0.25, P = 0.004). There was no effect on duration or the number of bowel movements during diarrhoea. The severity of diarrhoea was not affected. CONCLUSIONS: B-GOS reduces the risk of diarrhoea lasting 1 day. The protection seemed to start after a week of treatment with B-GOS. Strict compliance is crucial. The treatment is environmentally friendly and without adverse effects.