Use of Ceftazidime-Avibactam in Children Admitted to Pediatric Intensive Care Units.

BACKGROUND: Ceftazidime-Avibactam (CAZ-AVI) is one of the new antibiotics available to treat infections due to carbapenem-resistant gram-negative bacteria (CRB). Our aim was to describe the use of CAZ-AVI in children admitted to pediatric intensive care units (PICUs), with suspected or proven CRB infections. METHODS: A retrospective descriptive study was conducted in two PICUs of Rio de Janeiro, Brazil, between January 2020 and January 2024. Children aged 0 to 18 years who received CAZ-AVI for more than 24 h were included. RESULTS: CAZ-AVI was used in 37 patients. The median age was 28 months (range 1-215), 17 (45.9%) being male. The median time from the patient admission to the initial prescription of CAZ-AVI was 39.9 days (range 1-138). Thirty-four (91.9%) children had at least one comorbidity at admission and (91.9%) used at least one invasive device prior to the CAZ-AVI prescription, and 89.2% had received carbapenem before; and fifteen (40.5%) had healthcare-associated infection (HAI) prior to CAZ-AVI use. The mean time of CAZ-AVI use was 11 days (range 1-22). Gram-negative bacteria were isolated in cultures from 12 (32.4%) patients in the 24 h prior to prescription or on the day of prescription. In five patients, CRB was confirmed in cultures, and in four (80%) of them, microbiological clearance was verified after 7 days of treatment. The 30-day mortality rate was 37.8%. CONCLUSION: Almost all patients who used CAZ-AVI were critically ill children with multiple comorbidities and previous use of carbapenems. Among CRB confirmed infections, microbiology clearance in 7 days was high.

Availability of complementary resources and equipment for use in the prevention of healthcare-associated infections / Disponibilidade de recursos e equipamentos complementares para uso na prevenção de infecções relacionadas à assistência à saúde / Disponibilidad de recursos y equipos complementarios para prevenir las infecciones asociadas a la atención de la salud

Background and Objectives: Recently, complementary resources and equipment have emerged to improve prevention of healthcare-associated infections (HAIs). Our aim is to verify availability and use of different resources/ equipment by infection controllers. Methods: We conducted a survey with infection controllers from the State of Rio de Janeiro, Brazil, by invitation using a social media group, in August 2022. Nine different resources and equipment were evaluated. Categorical and continuous variables were evaluated by the chi-square test and Mann­Whitney U test, respectively. A p value of less than 0.05 was considered statistically significant. Results: One hundred and eight persons answered the questionnaire. The mean age was 42.8 years (SD +/- 8.5 years) and 53 (49.1%) reported most of their workload in public hospitals, 45 (41.7%) in private hospitals and 10 (9.2%) reported the same workload in public and private hospitals. Sixty-there percent reported teaching activities in their institutions. There was no correlation between the existence of teaching activities and hospital profile (p=0.42). The most common resource available was molecular biology (PCR) for microbiological samples research for 73 (67.6%) participants. The second resource most available was applications (Apps) for HAIs prevention and control for 33 (30.6%), 19 (17.6%) reported no availability of resource/equipment technology. Conclusion: Molecular biology (PCR) for microbiological samples research was the most common resource available for infection controllers of an important state of Brazil.(AU)

Justificativas e Objetivos: Recentemente, recursos e equipamentos complementares têm surgido para melhorar a prevenção de infecções relacionadas à assistência à saúde. O objetivo deste artigo é verificar a disponibilidade e o uso de diferentes recursos e equipamentos pelos controladores de infecção. Métodos: Realizamos uma pesquisa do tipo survey com controladores de infecção do estado do Rio de Janeiro, por meio de convite pela mídia social, em agosto de 2022. Nove diferentes recursos e equipamentos foram avaliados quanto à disponibilidade e ao uso. Variáveis categóricas e contínuas foram avaliadas pelo teste qui-quadrado e Mann-Whitney, respectivamente. Um valor de p menor que 0,05 foi considerado estatisticamente significativo. Resultados: Cento e oito pessoas responderam ao questionário. A média de idade foi de 42,8 anos (DP +/- 8,5 anos), e 53(49,1%) relataram maior carga de trabalho em hospitais públicos, 45 (41,7%) em hospitais privados e 10(9,2%) carga horária similar nos dois tipos de hospitais. Dos 108, 63% relataram a existência de atividades de ensino nas instituições. Não houve correlação entre existência de atividades de ensino e tipo de hospital (p=0,42). O recurso mais disponível foi o uso de biologia molecular (reação em cadeia de polimerase) por 73 (67,6%) participantes. A segunda ferramenta mais encontrada foi o uso de aplicativos para prevenção e controle de infecção para 33 (30,6%) desses participantes. Dezenove deles (17,6%) relataram ausência de todos os recursos/equipamentos. Conclusão: O uso de biologia molecular para pesquisa de amostras biológicas foi o recurso mais disponível para controladores de infecção de um importante estado brasileiro.(AU)

Antecedentes y objetivos: Recientemente han surgido recursos y equipos complementarios para mejorar la prevención de las infecciones asociadas a la atención de la salud. El objetivo es verificar la disponibilidad y el uso de diferentes recursos/equipos por los controladores de infecciones. Métodos: Realizamos una encuesta entre los controladores de infecciones del estado de Rio de Janeiro, Brasil, por invitación en redes sociales, en agosto de 2022. Se evaluó la disponibilidad y uso de nueve recursos y equipos diferentes. Las variables categóricas y continuas se evaluaron mediante las pruebas de chi-cuadrado y Mann-Whitney, respectivamente. Se consideró estadísticamente significativo un valor de p < 0.05. Resultados: Ciento ocho personas respondieron al cuestionario. La edad media fue de 42,8 años (DE +/- 8,5 años) y 53 (49,1%) reportaron mayor carga de trabajo en hospitales públicos, 45 (41,7%) en privados y 10 (9,2%) reportaron la misma carga en hospitales públicos y privados. De los 108, el 63% reportó actividades docentes en sus instituciones. No hubo correlación entre la existencia de actividades docentes y el tipo de hospital (p=0,42). El recurso más disponible fue el uso de la biología molecular (reacción en cadena de la polimerasa) por 73 (67,6%) participantes. El segundo más común fue el uso de aplicaciones de prevención y control de infecciones por 33 (30,6%) participantes. Diecinueve participantes (17,6%) señalaron la ausencia de todos los recursos/equipos. Conclusiones: El uso de la biología molecular para investigar muestras microbiológicas fue el recurso/equipo más disponible para los controladores de infecciones de un importante estado brasileño.(AU)

Efficiency of Experimental Formulation Containing Duddingtonia flagrans and Pochonia chlamydosporia against Moniezia expansa Eggs.

This study aimed to evaluate the effectiveness of the experimental formulation containing chlamydospores of Duddingtonia flagrans and Pochonia chlamydosporia fungi, against Moniezia expansa. Two experiments were carried out. The first experiment evaluated the in vitro efficacy using 1 g of the experimental formulation (V1) added to 100 M. expansa eggs and the control (V2) (without the fungal formulation). Intact eggs or eggs with alterations were counted in order to evaluate their effectiveness. The second experiment evaluated the action of the fungal formulation on M. expansa eggs after passing through the gastrointestinal tract of goats. Three groups were identified as B1, B2, and B3, which received 1.0, 1.5 g of experimental fungal formulation, and placebo, respectively. In experiment 1, all the eggs in V1 were subjected to the predatory action of fungi, while in V2, the eggs remained intact. In experiment 2, the reduction of eggs in groups B1 and B2 were 49% and 57% 24 h after ingestion, 60% and 63% 48 h after, and 48% and 58% 72 h after. The predatory capacity against M. expansa eggs shown in the tests demonstrated that experimental fungal formulation has the potential to be used on integrated helminth control programs.

Prevalência e Autoconhecimento de Indicadores de Inflamação Sugestivos de Doença Periodontal em Militares / Prevalence And Self-Knowledge Of Indicators Of Inflammation Suggestive of Periodontal Disease In Military Personne

O objetivo deste estudo foi identificar a prevalência e o autoconhecimento para indicadores de inflamação sugestivos de doença periodontal em militares de ambos os sexos. Os militares foram recrutados para realização de um censo odontológico para toda a população do Centro de Instrução Almirante Wandenkolk (CIAW) da Marinha do Brasil, totalizando 409 voluntários. Foram formados dois grupos para posterior análise: Grupo 1- contendo exclusivamente mulheres e Grupo 2- contendo exclusivamente homens. Foram realizados 409 exames clínicos e analisados 409 questionários. Os resultados demonstraram que, quanto aos participantes militares, 40,1% foram do sexo feminino e 59,9%, do sexo masculino; 87% faziam uso do fio dental, desses 56% usavam diariamente; 77% apresentaram frequência de escovação de três vezes ao dia ou mais; 74,3% relataram que visitam regularmente o dentista, e a proporção de mulheres que frequenta regularmente o dentista superou significativamente a proporção de homens que o fizeram (I.C. 95%; p < 0,001); 61,6% afirmaram conhecer a doença periodontal. A avaliação profissional verificou a presença de indicadores de inflamação sugestivos de doença periodontal em 45,2% participantes, desses 37% eram do gênero feminino e 63%, do gênero masculino, não sendo observada diferença estatística entre os gêneros (I.C. 95%; p = 0,2248). Concluiu-se que a prevalência de indicadores de inflamação sugestivos de doença periodontal encontrada foi de 45,2%; o autoconhecimento dos militares sobre doença periodontal foi baixo, apenas 19%; dessa forma foi verificada diferença estatística entre o conhecimento das mulheres e dos homens; e observou-se que a maioria dos participantes estava dentro da frequência correta para consulta de retorno ao dentista.

The objective of this study was to identify the prevalence and self-recognition for indicators of inflammation suggestive of periodontal disease in military personnel of both genders. The military personnel was recruited to conduct a dental census for the entire population of the Admiral Wandenkolk Training Center of the Brazilian Navy, totaling 409 volunteers. Two groups were formed for further analysis: Group 1- containing exclusively women and Group 2- containing exclusively men. A total of 409 clinical examinations were performed and the questionnaires were analyzed. The results showed that, regarding the military participants, 40.1% were female and 59.9% were male; 87% used dental floss, of which 56% used it daily; 77% brushed three times a day or more; 74.3% reported that they visited the dentist regularly, and the proportion of women who regularly visited the dentist significantly exceeded the proportion of men who did (C.I. 95%; p<0.001); 61.6% said they knew about periodontal disease. The professional evaluation verified the presence of inflammation indicators suggestive of periodontal disease in 45.2% of the participants, of which 37% were female and 63% were male, with no statistical difference between genders (95% CI, p=0.2248). The prevalence of inflammation indicators suggestive of periodontal disease was 45.2%; the self-knowledge of the military about the periodontal disease was low, only 19%; thus a statistical difference was found between the knowledge of females and males; and it was observed that most participants were within the correct frequency for return visits to the dentist.

Pediatric Emergency Care for Children and Adolescents with Cancer: Causes of Consultation and Factors Associated with Hospitalization / Atendimento de Emergência Pediátrica a Crianças e Adolescentes com Câncer: Causas de Consultas e Fatores associados à Internação / Atención de Emergencia Pediátrica al Niño y Adolescente con Cáncer: Causas de Consultas y Factores Asociados a la Hospitalización

Introduction: Pediatric emergency care is essential for adequate medical treatment of pediatric cancer-associated complications and for increasing the chances of cure. Objective: This study aimed to describe pediatric cancer-associated emergencies and outcomes, and to analyze the factors associated with hospitalization. Method: A retrospective observational cohort study was conducted including patients aged ≤19 years who attended the pediatric emergency of a general cancer hospital from April 17 to October 17, 2019. The variables analyzed were demographics, socioeconomic status, disease and treatment factors, reasons for seeking emergency care, and associated outcomes. Results: This study included 309 patients who required 994 emergency consultations, with a total of 766 reasons for seeking care. The median age was 4.86 years; 50.8% were female and 51.5% were white. The patients had solid tumors (49.8%), central nervous system tumors (27.5%), and hematological neoplasms (15.5%). Most of the patients were home discharged (72.2%) or to support houses (6.7%). Fever was the most frequent symptom (30.8%) and the most common reason for admission. 19.2% of the patients were admitted to the ward and 2.0% to the pediatric intensive care unit (2.0%). Only two of the 309 patients (0.6%) seeking care in the pediatric emergency died in the emergency room, and these patients were in end-of-life care. Conclusion: The availability of a pediatric emergency room with skilled professionals in supportive care of pediatric patients with cancer was essential for the management of disease and treatment-related complications

Introdução: O atendimento de emergência pediátrica é essencial para o tratamento adequado das complicações associadas ao câncer pediátrico e para aumentar as chances de cura. Objetivo: Descrever as emergências associadas ao câncer pediátrico e seus desfechos, e analisar os fatores associados à hospitalização. Método: Estudo de coorte observacional retrospectivo incluindo pacientes com idade ≤ 19 anos que foram atendidos na emergência pediátrica de um hospital oncológico geral no período de 17 de abril a 17 de outubro de 2019. As variáveis analisadas foram demográficas, socioeconômicas, fatores relacionados à doença e ao tratamento, razões para procurar atendimento de emergência e resultados associados. Resultados: Foram incluídos 309 pacientes que necessitaram de 994 consultas de emergência, totalizando 766 causas de atendimento. A idade mediana foi de 4,86 anos; 50,8% eram do sexo feminino e 51,5% afirmaram ser da raça branca. Os pacientes apresentavam tumores sólidos (49,8%), tumores do sistema nervoso central (27,5%) e neoplasias hematológicas (15,5%). A maioria dos pacientes foi liberada para a residência (72,2%) ou casa de apoio (6,7%). A febre foi o sintoma mais frequente (30,8%) e o motivo mais comum de admissão. Os pacientes foram internados em enfermaria (19,2%), ou em unidade de terapia intensiva pediátrica (2,0%). Somente dois dos 309 (0,6%) pacientes atendidos na emergência pediátrica morreram nesse setor, estando estes em cuidados de fim de vida. Conclusão: A disponibilidade de um departamento de emergência pediátrica com profissionais especializados e treinados em cuidados de suporte a pacientes pediátricos com câncer foi essencial para o manejo das complicações relacionadas à doença e ao tratamento

Introducción: La atención de emergencias pediátricas es fundamental para el adecuado tratamiento médico de las complicaciones asociadas al cáncer pediátrico y para aumentar las posibilidades de cura. Objetivo: Describir las emergencias asociadas al cáncer pediátrico y sus desenlaces, y analizar los factores asociados a la hospitalización. Método: Estudio de cohorte observacional retrospectivo que incluyó pacientes con edad ≤ 19 años que fueron atendidos en el servicio de emergencias pediátricas de un hospital general de oncología del 17 de abril al 17 de octubre de 2019. Las variables analizadas fueron demográficas, socioeconómicas, factores relacionados con la enfermedad y tratamiento, razones para buscar atención de emergencia y resultados asociados. Resultados: Se incluyeron 309 pacientes que requirieron 994 consultas de urgencia, totalizando 766 causas de atención. La mediana de edad fue de 4,86 años; el 50,8% eran mujeres y el 51,5% eran personas blancas. Los pacientes tenían tumores sólidos (49,8%), tumores del sistema nervioso central (27,5%) y neoplasias hematológicas (15,5%). La mayoría de los pacientes fueron dados de alta a su hogar (72,2%) o casa de apoyo (6,7%). La fiebre fue el síntoma más frecuente (30,8%) y el motivo de ingreso más frecuente. Los pacientes fueron admitidos en una sala (19,2%) o en una unidad de cuidados intensivos pediátricos (2,0%). Solo 2 de 309 (0,6%) pacientes atendidos en el servicio de emergencias pediátricas fallecieron en este sector, estando estos en cuidados al final de la vida. Conclusión: La disponibilidad de un servicio de emergencias pediátricas con profesionales especializados y capacitados en el cuidado de apoyo al paciente oncológico pediátrico fue fundamental para el manejo de las complicaciones relacionadas con la enfermedad y el tratamiento

Pain Assessment in Pediatric Patients with Primary Bone Cancer in a Single Site Cohort / Avaliação da Dor em Pacientes Pediátricos com Câncer Ósseo Primário em uma Coorte de um Centro Único / Evaluación del Dolor en Pacientes Pediátricos con Cáncer Óseo Primario en una Cohorte de un Solo Centro

Introduction: Pain is the main symptom described in cancer patients. Objective: To assess pain classification and management in pediatric patients with primary bone cancer over time: admission, during treatment and follow-up, and to investigate factors associated with pain classification at the last assessment. Method: Retrospective cohort study of osteosarcoma and Ewing's sarcoma cases in individuals <19 years old treated at a single cancer referral site and followed up by a multidisciplinary team. The primary endpoint was pain score at the last assessment. Secondary outcome: evolution of pharmacological treatment. Results: 142 patients were included. The frequency of pain assessment increased during the study period from 53.5% at admission to 68.3% during treatment and 85.9% in follow-up. Of the patients who had pain assessed, 65.8% had pain at admission and 26.2% at the end of the study. There was an increase in the use of strong opioids and antidepressants. In the last evaluation, 56 patients (39.4%) were at the end-of-life and this was not associated with more pain (p=0.68). Meanwhile, those who had more pain used strong opioids (p=0.01) or steroids (p=0.03). Conclusion: Pain management during treatment resulted in increased use of strong opioids and antidepressants with pain reduction, revealing that pain control is possible. In the last assessment, end-of-life patients no longer had pain and patients with pain were the ones who used strong opioids and steroids at the most, showing the difficulty of pain control in some patients.

Introdução: A dor é o principal sintoma descrito em pacientes com câncer. Objetivo: Avaliar a classificação e o manejo da dor em pacientes pediátricos com câncer ósseo primário ao longo do tempo: admissão, durante o tratamento e acompanhamento, e investigar fatores associados à classificação da dor na última avaliação. Método: Estudo de coorte retrospectivo de casos de osteossarcoma e sarcoma de Ewing em indivíduos <19 anos, atendidos em único centro de referência de câncer e acompanhados por equipe multidisciplinar. Desfecho primário: classificação da dor na última avaliação. Desfecho secundário: evolução do tratamento farmacológico. Resultados: Foram incluídos 142 pacientes. A frequência de avaliação da dor aumentou durante o período do estudo de 53,5% na admissão para 68,3% durante o tratamento, chegando a 85,9% no acompanhamento. Dos pacientes cuja dor foi avaliada, 65,8% tiveram dor no recrutamento e 26,2% ao final do estudo. Houve aumento no uso de opioides fortes e antidepressivos. Na última avaliação, 56 pacientes (39,4%) estavam no fim da vida sem associação com mais dor (p=0,68), enquanto os que apresentaram mais dor foram aqueles que usavam opioides fortes (p=0,01) ou esteroides (p=0,03). Conclusão: O manejo da dor durante o tratamento resultou em aumento do uso de opioides fortes e antidepressivos com redução da dor, revelando que o controle da dor é possível. Na última avaliação, os pacientes em fim de vida não apresentavam mais dor, e os pacientes com dor foram os que mais utilizaram opioides fortes e esteroides, evidenciando a dificuldade no controle da dor em alguns pacientes.

Introducción: El dolor es el principal síntoma descrito en pacientes oncológicos. Objetivo: Evaluar la clasificación y el manejo del dolor en pacientes pediátricos con cáncer óseo primario a lo largo del tiempo: registro, durante el tratamiento y seguimiento, e investigar los factores asociados entre la clasificación del dolor y última evaluación. Método: Estudio cohortes retrospectiva de casos de osteosarcoma y sarcoma de Ewing <19 años, tratados en único centro de referencia oncológica y seguidos por equipo multidisciplinar. Desenlace primario: calificación del dolor en la última evaluación. Desenlace secundario: evolución del tratamiento farmacológico. Resultados: Se incluyeron 142 pacientes. La frecuencia de evaluación del dolor aumentó durante el período de estudio del 53,5% al 68,3% y 85,9%. Los pacientes evaluados por dolor, el 65,8% tenía dolor al registro y 26,2% al final del estudio. Hubo aumento en el uso de opioides fuertes y antidepresivos. En la última evaluación, 56 pacientes (39,4%) estaban al final de su vida y esto no se asoció con más dolor (p=0,68), mientras que, quienes presentaron más dolor fueron quienes usaban opioides fuertes (p=0,01) o esteroides (p=0,03). Conclusión: Manejo del dolor durante el tratamiento resultó en un mayor uso de opioides fuertes y antidepresivos con reducción del dolor, revelando que es posible controlar el dolor. La última evaluación, pacientes al final de la vida ya no tenían dolor y pacientes con dolor eran los que más usaban opioides fuertes y esteroides, evidenciando la dificultad en el control del dolor en algunos pacientes.

A influência da pandemia de Covid-19 em crianças e adolescentes com Transtorno do Espectro Autista / The influence of the Covid-19 pandemic on children and adolescents with autism spectrum disorder / Influencia de la pandemia de Covid-19 en niños y adolescentes con trastorno del espectro autista

O objetivo do estudo foi avaliar a influência do isolamento social causado pela pandemia da COVID-19 em pacientes com Transtorno do Espectro Autista (TEA), atendidos em um serviço especializado. Foi realizado um estudo transversal do tipo observacional e descritivo por meio da aplicação de um formulário de 51 perguntas. Participaram do estudo 45 responsáveis por crianças e adolescentes com TEA, acompanhados na Policlínica Naval de São Pedro da Aldeia (PNSPA), no período de julho a novembro de 2021. Foram abordados aspectos demográficos, sociais, clínicos e comportamentais dos pacientes e familiares. Os resultados indicaram que a maioria dos pacientes era do sexo masculino (86,7%) com média de idade de 10,4 anos, sendo 57,8% TEA nível 1. Observou-se alterações comportamentais em 88,9% dos pacientes, sendo essas alterações consideradas como negativas por 57% dos responsáveis. Foi necessário o ajuste nas medicações em 51,1% dos pacientes que já usavam medicações no período, a maioria deles por causa de modificações no comportamento. Não houve diferença estatisticamente significativa quando avaliamos as modificações comportamentais por sexo (p-valor 0,471), nível do TEA (p-valor 0,128), idade (p-valor 0,460), número de irmãos (p-valor 0,903), modificações medicamentosas (p-valor 0,280) e isolamento social (p-valor 0,553). Observou-se que a manutenção das terapias e a participação nas atividades escolares foi fator protetor quando analisamos as modificações de comportamento (RP para ambos = 0,86). Em conclusão, o estudo mostrou o impacto da pandemia de COVID-19 em pacientes com TEA, pelo elevado percentual de mudanças comportamentais, especialmente aquelas consideradas negativas, independentemente de os pacientes terem permanecido ou não em isolamento social.

The aim of the study was to assess the influence of social distancing caused by the COVID-19 pandemic in patients with Autistic Spectrum Disorder (ASD), treated at a specialized unit. It was performed a cross-sectional observational and descriptive study with 45 guardians of children and adolescents with ASD, treated at an outpatient clinic, from July to November 2021. Guardians were asked to fill out a 51-question form that addressed demographic, social, clinical, and behavioral aspects of patients and family members. The results showed that the most patients are male (86.7%) with a mean age of 10.4 years; 57.8% had level 1 ASD. There were behavioral changes in 88.9% of patients; such changes were considered negative by 57% of the guardians. Medication adjustment was necessary for 51.1% of the patients who were already using medications in the period, most of them because of changes in behavior. There was no statistically significant difference when behavioral changes were evaluated by gender (p-value 0.471), ASD level (p-value 0.128), age (p-value 0.460), number of siblings (p-value 0.903), changes in medication (p-value 0.280) and social distancing (p-value 0.553). The continuation of therapies and participation in school activities was a protective factor when we analyzed changes in behavior (PR for both = 0.86). In conclusion, the research indicates that the COVID-19 pandemic had an impact on ASD patients, which could be noticed by the high percentage of occurrence of behavioral changes, especially those considered negative, regardless of whether the patients practiced social distancing or not.

El objetivo del estudio fue evaluar la influencia del distanciamiento social causado por la pandemia de COVID-19 en pacientes con Trastorno del Espectro Autista (TEA), atendidos en una unidad especializada. Se realizó un estudio transversal observacional y descriptivo con 45 tutores de niños y adolescentes con TEA, atendidos en una consulta externa, de julio a noviembre de 2021. Se pidió a los tutores que rellenaran un formulario de 51 preguntas que abordaba aspectos demográficos, sociales, clínicos y conductuales de los pacientes y sus familiares. Los resultados mostraron que la mayoría de los pacientes son varones (86,7%) con una edad media de 10,4 años; el 57,8% presentaba un TEA de nivel 1. Hubo cambios conductuales en el 88,9% de los pacientes; dichos cambios fueron considerados negativos por el 57% de los tutores. Fue necesario ajustar la medicación en el 51,1% de los pacientes que ya la utilizaban en ese periodo, la mayoría de ellos debido a cambios en el comportamiento. No hubo diferencias estadísticamente significativas cuando se evaluaron los cambios de comportamiento en función del sexo (p-valor 0,471), el nivel de TEA (p-valor 0,128), la edad (p-valor 0,460), el número de hermanos (p-valor 0,903), los cambios de medicación (p-valor 0,280) y el distanciamiento social (p-valor 0,553). La continuación de las terapias y la participación en actividades escolares fue un factor protector cuando analizamos los cambios en el comportamiento (PR para ambos = 0,86). En conclusión, la investigación indica que la pandemia de COVID-19 tuvo un impacto en los pacientes con TEA, que pudo ser notado por el alto porcentaje de ocurrencia de cambios de comportamiento, especialmente los considerados negativos, independientemente de que los pacientes practicaran o no el distanciamiento social.

The Role of COVID-19 Vaccinal Status in Admitted Children during OMICRON Variant Circulation in Rio de Janeiro, City-Preliminary Report.

Objective: To evaluate COVID-19 vaccination status in admitted children in 2020−2021 and during the OMICRON variant circulation (2022), a period when children older than 12 years of age had received two doses of COVID-19 vaccines. Design: An observational retrospective study. Patients with confirmed COVID-19 were compared in two different periods: 2020−2021 when adolescents aged 12−18 years had not received the complete COVID-19 vaccine, and 2022 when children older than 12 years had received the complete Pfizer-BioNTech vaccine scheme. Setting: Two pediatric hospitals in Rio de Janeiro city. Patients: Children aged < 18 years with confirmed COVID-19. Intervention: None. Main outcome: Vaccination status for COVID-19 on admission. Results: In total, 300 patients were admitted with confirmed COVID-19 (240 in 2020−2021 and 60 in 2022). The distribution of patients according to the age-groups was: 0−2 years (33.3% in 2020−2021 and 53.4% in 2022), 2−5 years (21.7% in 2020−2021 and 10% in 2022), 5−11 years (29.2% in 2020−2021 and 28.3% in 2022), and 12−18 years (15.8% in 2020−2021 and 8.3% in 2022) (p = 0.076). The median length of stay was six days in 2020−2021 and six days in 2022 (p = 0.423). We verified six deaths in the first analysis period and one death in the second one (p = 0.894). Of the 60 children admitted in 2022, 58 (96.7%) did not receive the complete COVID-19 vaccine scheme available. Conclusions: We verified in a "real-world condition" the ability of the Pfizer-BioNTech vaccine to prevent hospitalization in children over 12 years of age.

The Impact of Interventions to Prevent Neonatal Healthcare-associated Infections in Low- and Middle-income Countries: A Systematic Review.

BACKGROUND: Clinically suspected and laboratory-confirmed bloodstream infections are frequent causes of morbidity and mortality during neonatal care. The most effective infection prevention and control interventions for neonates in low- and middle-income countries (LMIC) are unknown. AIM: To identify effective interventions in the prevention of hospital-acquired bloodstream infections in LMIC neonatal units. METHODS: Medline, PUBMED, the Cochrane Database of Systematic Reviews, EMBASE and PsychInfo (January 2003 to October 2020) were searched to identify studies reporting single or bundled interventions for prevention of bloodstream infections in LMIC neonatal units. RESULTS: Our initial search identified 5206 articles; following application of filters, 27 publications met the inclusion and Integrated Quality Criteria for the Review of Multiple Study Designs assessment criteria and were summarized in the final analysis. No studies were carried out in low-income countries, only 1 in Sub-Saharan Africa and just 2 in multiple countries. Of the 18 single-intervention studies, most targeted skin (n = 4) and gastrointestinal mucosal integrity (n = 5). Whereas emollient therapy and lactoferrin achieved significant reductions in proven neonatal infection, glutamine and mixed probiotics showed no benefit. Chlorhexidine gluconate for cord care and kangaroo mother care reduced infection in individual single-center studies. Of the 9 studies evaluating bundles, most focused on prevention of device-associated infections and achieved significant reductions in catheter- and ventilator-associated infections. CONCLUSIONS: There is a limited evidence base for the effectiveness of infection prevention and control interventions in LMIC neonatal units; bundled interventions targeting device-associated infections were most effective. More multisite studies with robust study designs are needed to inform infection prevention and control intervention strategies in low-resource neonatal units.

Keeping It Real: Infection Prevention and Control Problems and Solutions in Low- and Middle-income Countries.

Infection prevention challenges are ubiquitous in healthcare, but some are unique to or more prevalent in low-and middle-income country settings. Despite limited resources, innovative and committed paediatric healthcare providers and infection preventionists have found creative solutions to address the very real and pressing risks their patients face every day. We gathered examples of infection prevention and control challenges faced by clinicians in resource-limited healthcare facilities, and the real-world infection prevention and control solutions they implemented, with the goal of learning broader lessons applicable to low-and middle-income countrie.

Evaluation of risk stratification strategies in pediatric patients with febrile neutropenia

Abstract Objective To evaluate the performance of risk stratification protocols for febrile neutropenia specific to the pediatric population. Methods Retrospective study of a cohort of pediatric patients undergoing cancer treatment with episodes of neutropenia due to chemotherapy and fever, treated at the emergency department of a tertiary cancer hospital from January 2015 to June 2017. Patients who were bone marrow transplant recipients and patients with neutropenia due to causes other than chemotherapy were excluded. Six protocols were applied to all patients: Rackoff, Alexander, Santolaya, Rondinelli, Ammann 2003, and Ammann 2010. The following outcomes were assessed: microbiological infection, death, ICU admission, and need for more than two antibiotics. The performance of each protocol was analyzed for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operator characteristic (ROC) curve. Results This study evaluated 199 episodes of febrile neutropenia in 118 patients. Microbiological infection was identified in 70 samples from 45 distinct episodes (22.6%), 30 patients used more than two antibiotics during treatment (15%), eight required ICU admission (4%), and one patient died (0.8%). Three protocols achieved high sensitivity indices and NPV regarding the outcomes of death and ICU admission: Alexander, Rackoff, and Ammann 2010; however, Rackoff showed higher sensitivity (0.82) and NPV (0.9) in relation to the microbiological infection outcome. Conclusion The Rackoff risk rating showed the best performance in relation to microbiological infection, death, and ICU admission, making it eligible for prospective evaluation.

A living WHO guideline on drugs to prevent covid-19.

CLINICAL QUESTION: What is the role of drugs in preventing covid-19? WHY DOES THIS MATTER?: There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19. RECOMMENDATION: The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty). HOW THIS GUIDELINE WAS CREATED: This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. UNDERSTANDING THE NEW RECOMMENDATION: The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19. UPDATES: This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. READERS NOTE: This is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity.

Evaluation of risk stratification strategies in pediatric patients with febrile neutropenia.

OBJECTIVE: To evaluate the performance of risk stratification protocols for febrile neutropenia specific to the pediatric population. METHODS: Retrospective study of a cohort of pediatric patients undergoing cancer treatment with episodes of neutropenia due to chemotherapy and fever, treated at the emergency department of a tertiary cancer hospital from January 2015 to June 2017. Patients who were bone marrow transplant recipients and patients with neutropenia due to causes other than chemotherapy were excluded. Six protocols were applied to all patients: Rackoff, Alexander, Santolaya, Rondinelli, Ammann 2003, and Ammann 2010. The following outcomes were assessed: microbiological infection, death, ICU admission, and need for more than two antibiotics. The performance of each protocol was analyzed for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operator characteristic (ROC) curve. RESULTS: This study evaluated 199 episodes of febrile neutropenia in 118 patients. Microbiological infection was identified in 70 samples from 45 distinct episodes (22.6%), 30 patients used more than two antibiotics during treatment (15%), eight required ICU admission (4%), and one patient died (0.8%). Three protocols achieved high sensitivity indices and NPV regarding the outcomes of death and ICU admission: Alexander, Rackoff, and Ammann 2010; however, Rackoff showed higher sensitivity (0.82) and NPV (0.9) in relation to the microbiological infection outcome. CONCLUSION: The Rackoff risk rating showed the best performance in relation to microbiological infection, death, and ICU admission, making it eligible for prospective evaluation.

A living WHO guideline on drugs for covid-19

Updates: This is the fourteenth version (thirteenth update) of the living guideline, replacing earlier versions (available as data supplements). New recommendations will be published as updates to this guideline. Clinical question: What is the role of drugs in the treatment of patients with covid-19? Context: The evidence base for therapeutics for covid-19 is evolving with numerous randomised controlled trials (RCTs) recently completed and underway. Emerging SARS-CoV-2 variants and subvariants are changing the role of therapeutics. What is new?: The guideline development group (GDG) defined 1.5% as a new threshold for an important reduction in risk of hospitalisation in patients with non-severe covid-19. Combined with updated baseline risk estimates, this resulted in stratification into patients at low, moderate, and high risk for hospitalisation. New recommendations were added for moderate risk of hospitalisation for nirmatrelvir/ritonavir, and for moderate and low risk of hospitalisation for molnupiravir and remdesivir. New pharmacokinetic evidence was included for nirmatrelvir/ritonavir and molnupiravir, supporting existing recommendations for patients at high risk of hospitalisation. The recommendation for ivermectin in patients with non-severe illness was updated in light of additional trial evidence which reduced the high degree of uncertainty informing previous guidance. A new recommendation was made against the antiviral agent VV116 for patients with non-severe and with severe or critical illness outside of randomised clinical trials based on one RCT comparing the drug with nirmatrelvir/ritonavir. The structure of the guideline publication has also been changed; recommendations are now ordered by severity of covid-19. About this guideline: This living guideline from the World Health Organization (WHO) incorporates new evidence to dynamically update recommendations for covid-19 therapeutics. The GDG typically evaluates a therapy when the WHO judges sufficient evidence is available to make a recommendation. While the GDG takes an individual patient perspective in making recommendations, it also considers resource implications, acceptability, feasibility, equity, and human rights. This guideline was developed according to standards and methods for trustworthy guidelines, making use of an innovative process to achieve efficiency in dynamic updating of recommendations. The methods are aligned with the WHO Handbook for Guideline Development and according to a pre-approved protocol (planning proposal) by the Guideline Review Committee (GRC). A box at the end of the article outlines key methodological aspects of the guideline process. MAGIC Evidence Ecosystem Foundation provides methodological support, including the coordination of living systematic reviews with network meta-analyses to inform the recommendations. The full version of the guideline is available online in MAGICapp and in PDF on the WHO website, with a summary version here in The BMJ. These formats should facilitate adaptation, which is strongly encouraged by WHO to contextualise recommendations in a healthcare system to maximise impact. Future recommendations: Recommendations on anticoagulation are planned for the next update to this guideline. Updated data regarding systemic corticosteroids, azithromycin, favipiravir and umefenovir for non-severe illness, and convalescent plasma and statin therapy for severe or critical illness, are planned for review in upcoming guideline iterations.

Análise do consumo de antimicrobianos e infecções relacionadas à assistência à saúde após implantação de um programa de gestão de antimicrobianos em unidade de tratamento intensivo neonatal do Rio de Janeiro / Analysis of antimicrobial consumption and healthcare-associated infections after an antimicrobial stewardship program implantation in neonatal intensive care of Rio de Janeiro / Análisis del consumo de antimicrobianos y las infecciones asociadas a la atención de la salud después de la implantación de un programa de administración de antimicrobianos en cuidados intensivos neonatales de Río de Janeiro

Justificativa e objetivos. Programas de gestão de antimicrobianos (PGA) podem contribuir para otimizar o uso de antimicrobianos em unidades de tratamento intensivo neonatais (UTINEO). O objetivo deste estudo foi mensurar o consumo de antimicrobianos, dentre eles os carbapenêmicos e infecções relacionadas à assistência à saúde (IRAS), especificamente as causadas por bactérias Gram-negativas resistentes a carbapenêmicos (BGN-CR) em neonatos após a implantação de um PGA. Métodos: Estudo prospectivo descritivo do consumo de antimicrobianos, dentre eles os carbapenêmicos; e das taxas de IRAS em uma UTINEO, durante 1 ano de seguimento. O consumo fo i medido em dias de terapia/1000 pacientes-dia (DOT/1000PD). Resultados: Em setembro de 2017 o PGA foi implementado com os seguintes elementos-chave: auditoria de antibióticos/feedback, restrição de antimicrobianos-alvo, medida do consumo de antimicrobianos e maior rapidez na liberação de resultados de culturas. Entre setembro de 2017 e setembro de 2018 admitimos 308 pacientes, totalizando 2223 pacientes-dia. A mediana de consumo total de antimicrobianos foi de 1580 DOT/1000PD (variação de 1180,7 a 2336,6/mês) sem tendência de aumento e a de carbapenêmicos 12 DOT/1000PD (variação de 0 a 163,2/mês). O consumo de carbapenêmicos foi reduzido entre abril a setembro de 2018 (valor de p =0,07) quando comparado com os primeiros seis meses. Oito IRAS foram registradas, correspondendo a uma densidade de incidência de 3,6/1000 pacientes-dia. Não foram reportadas BGN-CR causando IRAS. Conclusões: O consumo total de antimicrobianos não apresentou aumento ao longo do ano após implantação do PGA. No entanto, houve redução significativa do consumo de carbapenêmicos. Não foram verificadas IRAS por BGN-CR no período do estudo.(AU)

Background and objectives: Antimicrobial stewardship programs (ASPs) could contribute to optimize antimicrobial use within neonatal intensive care units (NICUs). The aim of this study was to measure the antimicrobial consumption, including carbapenems and healthcare-associated infections (HAI), specifically infections caused by carbapenem-resistant Gram-negative bacteria (CR-GNB) in neonates, after implementation of an ASP. Methods: A prospective descriptive study of antimicrobial and carbapenem consumption; and healthcare-associated rate in a NICU, during a one-year follow-up. The consumption was measured in days of therapy /1000 patients-days(DOT/1000PD). Results: In September 2017, the ASP was implemented, with the following core components: antibiotic audit and feedback, restriction of target antimicrobials, measure of antimicrobial consumption and improvement of results from microbiologic laboratory. Between September 2017 and September 2018, we admitted 308 patients, totalizing 2223 patient-days. The median of total antimicrobial consumption was 1580 DOT/1000PD (range from 1180.7 to 2336.6/month and of carbapenems 12 DOT/1000PD (range from 0 to 162.3/month). The carbapenem consumption was reduced between April and September of 2018 (p value=0.07) when we compared the first six months of the study. Eight HAI were detected, corresponding to density of incidence of 3.6/1000 patient-days. No HAI due to CR-GNB was reported. Conclusion: The total antimicrobial consumption did not increase during all the year after the ASP implantation. Although there was a significant reduction of carbapenem consumption. Carbapenem-resistant bacteria was not found in NICU causing HAI.(AU)

Justificación y objetivos: Los programas de optimizatión de uso de antimicrobianos (POA) podrían contribuir a optimizar el uso de antimicrobianos dentro de las unidades de cuidados intensivos neonatales (UCIN). El objetivo de este estudio fue medir el consumo de antimicrobianos incluidos los carbapenems y las infecciones asociadas a la atención de la salud (IAAs), especificamente las infecciones causadas por bacterias Gram negativas resistentes a carbapenems (CR-GNB) en neonatos, después de la implementación de un POA. Métodos: Un estudio descriptivo prospectivo del consumo de antimicrobianos y carbapenems; y la tasa de IAAs en una UCIN durante un año de seguimiento. El consumo se midió en días de terapia (DOT) / 1000 pacientes-días. Resultados: En septiembre de 2017, se implementó el POA con los siguientes componentes principales: auditoría y retroalimentación de antibióticos, restricción de antimicrobianos objetivo, medición del consumo de antimicrobianos y mejora de los resultados del laboratorio microbiológico. Entre septiembre de 2017 y septiembre de 2018, admitimos 308 pacientes, totalizando 2223 días-paciente. La mediana del consumo total de antimicrobianos fue de 1580 DOT / 1000PD (rango de 1180.7 a 2336.6 / mes y de carbapenems 12 (rango de 0 a 162.3 / mes). El consumo de carbapenem se redujo entre abril y septiembre de 2018 (valor p = 0.07) cuando comparamos los primeros seis meses del estudio, se detectaron ocho IAAs, lo que corresponde a la densidad de incidencia de 3.6 / 1000 días-paciente No se informó ningún IAA debido a CR-GNB. Conclusiones: El consumo total de antimicrobianos no aumentó durante todo el año posterior a la implantación de POA. Aunque hubo una reducción significativa del consumo de carbapenem. No se encontraron bacterias resistentes a carbapenem en la UCIN que causa IAA.(AU)

Blood culture sampling rate in hospitalised children as a quality indicator for diagnostic stewardship.

PURPOSE: Recommendations regarding the optimal number of blood cultures in children are not available. The aim of this article is to describe the correlation between blood culture (BC) rates and laboratory-confirmed bloodstream infection (LCBSI) rates, on different paediatric wards of a tertiary-care centre in Germany. METHODS: We conducted a retrospective cohort study in a paediatric university hospital, from 1st January to 31st December 2018. All blood cultures collected from neonatal (NICU) and paediatric intensive-care units (PICU), haematology/oncology, and general paediatric wards were included. There were no exclusion criteria. BC taken/1000 patients-days (BC rates/BCR) and LCBSI/1000 patient-days at risk (LCBSI rates) were calculated for each unit. RESULTS: A total of 6040 patients were admitted to the hospital with 3114 of them into wards studied. Of the 3072 BCs collected, 200 (6.5%) were positive. Collection of BCs was performed in 51/77 (66.2%) of admitted patients on NICU, in 151/399 (37.8%) of PICU patients, in 163/755 (21.6%) of haematology/oncology patients, and in 281/1883 (14.9%) of children on general paediatric wards. Gram-positive bacteria were the most commonly detected organisms in blood cultures from all wards with exception of NICU. The BCR in NICU, PICU, haematology/oncology wards, and general wards were 61.6, 196.2, 358.4, and 52.3, respectively. Excluding commensal pathogens and possible contaminations, the LCBSI rates in the same units were 2.4, 5.6, 4.4, and 1.0, respectively. CONCLUSION: We found different BCR values according the ward studied, being higher in patients with high risk of bloodstream infection such as haematology/oncology patients.

INFLUENCE OF SOCIAL DISTANCING DUE TO COVID-19 PANDEMIC IN EMERGENCY ATTENDANCE AND HOSPITALIZATIONS IN PEDIATRICS / INFLUÊNCIA DO DISTANCIAMENTO SOCIAL CAUSADO PELA PANDEMIA DA COVID-19 NOS ATENDIMENTOS DE EMERGÊNCIA E INTERNAÇÕES EM PEDIATRIA

The aim of this article is to compare number of attendances to pediatric emergencies and hospital admissions, considering a period time in which measures of social distancing and restriction or urban mobility were in course, with the same period in previous years to the pandemic. We performed a case-series study in two pediatric emergencies and hospital admission between 16th March and 16th April 2020 (first month of social distancing in Rio de Janeiro State, Brazil). Data were compared with the same period, in the two previous years, using Analysis of variance (ANOVA). A p value <0.05 was considered as statistically significant.  The number of attendances in the Unit A and B, respectively, were 6.579 and 1.538 in 2018; 5.750 and 1.430 in 2019 and 1.762 and 375 in 2020. The number of hospital admissions in the Unit A and B, respectively, were 823 and 199 in 2018; of 721 and 188 in 2019; and 325 and 135 in 2020. In both units, there was a statistically significant reduction of attendances and hospitals admissions when 2020 year was compared with the two previous years (p>0.0001). Relative percentage of acute respiratory diseases and influenza-like illness was 36.7%, 36.5% and 29.2%, respectively in 2018, 2019 and 2020 in the Unit A; and 25.9%, 24.2% and 24.5%, respectively for the same years, in the Unit B. We concluded that there was a statistically significant reduction of attendances and hospitals admissions in the pediatric emergencies evaluated, being the results attributed to social distancing and restriction of urban mobility during the period studied.

O objetivo deste artigo foi comparar o número de atendimentos em emergências pediátricas e internações hospitalares, considerando um período de tempo no qual vigoravam medidas de distanciamento social e restrição de mobilidade urbana, com o mesmo período em anos anteriores à pandemia da COVID-19. Realizamos um estudo de uma série de casos de atendimentos em duas emergências pediátricas e internações hospitalares entre 16 de março e 16 de abril de 2020 (primeiro mês de distanciamento social no Estado do Rio de Janeiro). Os dados foram comparados com o mesmo período dos dois anos anteriores, através de análise de variância (ANOVA). Um valor de p <0.05 foi considerado estatisticamente significativo. O número de atendimentos nas unidades A e B, respectivamente, foi de 6.579 e 1.538 em 2018; de 5.750 e 1.430 em 2019 e 1.762 e 375 em 2020. O número de internações nas unidades A e B, respectivamente, foi de 823 e 199 em 2018; de 721 e 188 em 2019; e 325 e 135 em 2020. Houve redução estatisticamente significativa de atendimentos e internações quando o ano de 2020 foi comparado com os anos anteriores nas duas unidades (p<0.0001). O percentual relativo de atendimentos de doenças respiratórias agudas e síndromes gripais foi de 36,7%, 36,5% e 29,2%, respectivamente em 2018, 2019 e 2020 na Unidade A; e 25,9%, 24,2% e 24,5%, respectivamente aos mesmos anos na Unidade B. Concluímos que houve redução estatisticamente significativa no número de atendimentos e internações nas emergências pediátricas avaliadas, sendo o resultado atribuído ao distanciamento social e restrição de mobilidade urbana no período avaliado.

Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review.

INTRODUCTION: Antimicrobial stewardship programmes (ASPs) are recommended to improve antibiotic use in healthcare and reduce antimicrobial resistance (AMR). Our aim was to investigate the effectiveness of ASPs in reducing antibiotic consumption, use of broad-spectrum/restricted antibiotics, antibiotic resistance and healthcare-associated infections (HAIs) in neonates. METHODS: We searched PUBMED, SCIELO, EMBASE and the Cochrane Database (January 2000-April 2019) to identify studies on the effectiveness of ASPs in neonatal wards and/or neonatal intensive care units (NICUs). Outcomes were as follows: reduction of antibiotic consumption overall and of broad-spectrum/target antibiotics, inappropriate antibiotic use, antibiotic resistance and HAIs. ASPs conducted in settings other than acute care hospitals, for children older than 1 month, and ASPs addressing antifungal and antiviral agents, were excluded. RESULTS: The initial search identified 53 173 titles and abstracts; following the application of filters and inclusion criteria, a total of six publications were included in the final analysis. All studies, of which one was multi-centre study, were published after 2010. Five studies were conducted exclusively in NICUs. Four articles applied multimodal interventions. Reduction of antibiotic consumption overall and/or inappropriate antibiotic use were reported by four articles; reduction of broad-spectrum/targeted antibiotics were reported by four studies; No article evaluated the impact of ASPs on AMR or the incidence of HAI in neonates. CONCLUSION: ASPs can be effectively applied in neonatal settings. Limiting the use of broad-spectrum antibiotics and shorting the duration of antibiotic treatment are the most promising approaches. The impact of ASPs on AMR and HAI needs to be evaluated in long-term studies.

Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network.

OBJECTIVE: To gain an understanding of the variation in available resources and clinical practices between neonatal units (NNUs) in the low-income and middle-income country (LMIC) setting to inform the design of an observational study on the burden of unit-level antimicrobial resistance (AMR). DESIGN: A web-based survey using a REDCap database was circulated to NNUs participating in the Neonatal AMR research network. The survey included questions about NNU funding structure, size, admission rates, access to supportive therapies, empirical antimicrobial guidelines and period prevalence of neonatal blood culture isolates and their resistance patterns. SETTING: 39 NNUs from 12 countries. PATIENTS: Any neonate admitted to one of the participating NNUs. INTERVENTIONS: This was an observational cohort study. RESULTS: The number of live births per unit ranged from 513 to 27 700 over the 12-month study period, with the number of neonatal cots ranging from 12 to 110. The proportion of preterm admissions <32 weeks ranged from 0% to 19%, and the majority of units (26/39, 66%) use Essential Medicines List 'Access' antimicrobials as their first-line treatment in neonatal sepsis. Cephalosporin resistance rates in Gram-negative isolates ranged from 26% to 84%, and carbapenem resistance rates ranged from 0% to 81%. Glycopeptide resistance rates among Gram-positive isolates ranged from 0% to 45%. CONCLUSION: AMR is already a significant issue in NNUs worldwide. The apparent burden of AMR in a given NNU in the LMIC setting can be influenced by a range of factors which will vary substantially between NNUs. These variations must be considered when designing interventions to improve neonatal mortality globally.

Patterns of antimicrobial consumption in neonatal and pediatric intensive care units in Germany and Brazil.

Antibiotic consumption (AC) is a key component of antimicrobial stewardship programs to recognize local patterns of antibiotic use. Our aim was to measure AC in neonatal units, including neonatal (NICU)/paediatric (PICU) intensive care units in different countries. We conducted a multicenter, retrospective, cohort study in three NICUs, one neonatal ward, and three PICUs with a total of 84 beds. Global and individual AC in days of therapy (DOT) and DOT per 1000 patient-days were assessed. During the study period, 2567 patients were admitted, corresponding to 4961 patient-days in neonatal units and 9243 patient-days in PICUs. Multidrug-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus were more frequent in Brazil than in Germany. Average AC was 386.5 and 1335.5 DOT/1000PD in German and Brazilian neonatal units, respectively. Aminopenicillins plus 3rd generation cephalosporins were the most commonly prescribed antibiotics in German neonatal units, while aminopenicillins plus aminoglycosides were the class most commonly used in Brazilian NICU. Average AC was 888.1 and 1440.7 DOT/1000PD in German and Brazilian PICUs, respectively. Antipseudomonal penicillins were most commonly used in the German PICU, and glycopeptides were the most frequently prescribed in Brazilian PICUs. Carbapenems represented 2.3-14% of total DOTs in German neonatal units and 4% in the Brazilian NICU and 13.0% in the German PICU and 6-12.2% in Brazilian PICUs. We concluded that different patterns of most commonly prescribed antibiotics were observed in neonatal units and PICUs in these two countries, probably related to different local patterns of antibiotic resistance, with a higher antibiotic consumption in Brazilian study units.