Factors Influencing Inappropriate Use of Antibiotics in Infants under 3 Years of Age in Primary Care: A Qualitative Study of the Paediatricians' Perceptions.

Antibiotic consumption in infants of less than three years is higher than average the average consumption for general population. The aim of this study was to explore paediatricians' opinions regarding factors influencing inappropriate use of antibiotics in early infancy in primary care. A qualitative study based on the grounded theory using convenience sampling was conducted in Murcia Region, Spain. Three focal discussion groups were developed with 25 participants from 9 health areas (HA) of Murcia Region. Paediatricians perceived that health care pressure was an influential factor in the prescribing behaviour, forcing them to prescribe antibiotics for a rapid cure in unjustified circumstances. Participants believed that antibiotic consuming was related to parents' self-medication due to their perceptions about the curative potential of antibiotics together with facilities to obtain these agents from pharmacies without prescription. The misuse of antibiotics by paediatricians was associated to the lack of education on antibiotic prescription and the limited use of clinical guidelines. Not prescribing an antibiotic in the presence of a potentially severe disease generated more fear than an unnecessary prescription. The clinical interaction asymmetry was more evident, when paediatricians use trapping risk strategies as a mechanism to justify a restrictive prescribing behaviour. The rational model of clinical decision-making in antibiotic prescribing among paediatricians was determined by factors associated with health care management, social awareness and knowledge of the population and pressure of families' demands. The present findings have contributed to the design and implementation of health interventions in the community for improving awareness of the appropriate use of antibiotics, as well as for a better quality of prescription by peadiatricians.

Impact of Pneumococcal Vaccination in the Nasopharyngeal Carriage of Streptococcus pneumoniae in Healthy Children of the Murcia Region in Spain.

BACKGROUND: An epidemiological study of Streptococcus pneumoniae nasopharyngeal carriage in healthy children was carried out five years after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13). OBJECTIVES: Study the impact of pediatric vaccination with PCV13, and other associated epidemiological factors on the status of nasopharyngeal carriage, the circulating pneumococcal serotypes, and the antibiotic susceptibility to more frequently used antibiotics. METHODS: A multi-center study was carried out in Primary Health Care, which included 1821 healthy children aged 1 to 4 years old. All isolates were sent to the Spanish Pneumococcal Reference Laboratory for serotyping and antimicrobial susceptibility testing. RESULTS: At least one dose of PCV13 had been received by 71.9% of children and carriage pneumococcal prevalence was 19.7%. The proportion of PCV13 serotypes was low (14.4%), with an observed predominance of non-vaccine serotypes, 23B, 11A, 10A, 35B/F, and 23A were the five most frequent. A high rate of resistance to penicillin, erythromycin, and trimethoprim sulfamethoxazole was found. CONCLUSIONS: A low proportion of PCV13 serotypes were detected, confirming the impact of pediatric vaccination for reducing the serotypes vaccine carriage. High resistance rates to clinically important antibiotics were observed.

Estudio epidemiológico de portadores nasofaríngeos de Streptococcus pneumoniae en niños en la comunidad autónoma de Murcia / Epidemiological study of nasopharyngeal carriers of Streptococcus pneumoniae in children in Murcia region

INTRODUCCIÓN Y OBJETIVOS: Streptococcus pneumoniae es un patógeno para el ser humano que precisa de colonización nasofaríngea previa para causar enfermedad. Realizamos un estudio epidemiológico de portadores nasofaríngeos de neumococo en niños sanos en Murcia, tras la introducción de la vacuna neumocócica conjugada heptavalente (VCN7) y ante la inmediata comercialización de las nuevas vacunas con el objetivo de conocer, en nuestro ámbito geográfico, la influencia de la vacunación y de otros factores sobre el estado de portador y los diferentes serotipos circulantes. MÉTODOS: En verano de 2009 e invierno de 2010 realizamos un estudio multicéntrico en 60 consultas de atención primaria, recogiéndose una muestra nasofaríngea y cumplimentándose una encuesta epidemiológica en 1.562 niños de 1 y 4años. De las 1.562 muestras nasofaríngeas se obtuvieron 489 neumococos, habiéndose podido serotipar 343 (72% de los aislados). RESULTADOS: El 31,3% (489/1.562) de los niños eran portadores. El 61,7% (964/1.562) de los pacientes incluidos habían recibido al menos una dosis de la VCN7. El 12,8% (44/343) de los serotipos identificados eran serotipos vacunales. Fueron factores protectores independientes de colonización: el periodo de verano en todas las edades, la vacunación en el total de los niños (OR: 0,73; IC 95%: 0,56-0,93; p = 0,010) y en niños de 1año (OR: 0,6; IC 95%: 0,42-0,84; p = 0,002) y haber tomado antibióticos en el último mes en el total de la población (OR: 0,69; IC95%: 0,50-0,96). Por el contrario, para todo el grupo, la escolarización (OR: 1,85; IC95%: 1,27-2,18; p = 0,001), el número de hermanos (OR: 1,31; IC 95%: 1,01-0,91) y la exposición al tabaco (OR: 1,33; IC 95%: 1,02-1,73) fueron factores de riesgo. Los serotipos 6A, 19A, 23B, 15A/B, 11A, 14, 23A/F, 3 y 19F fueron los más prevalentes. CONCLUSIONES: La proporción de serotipos vacunales encontrados fue baja, persistiendo el 14, el 23F y el 19F. Hallamos una alta prevalencia de serotipos 6A y 19A. El periodo estival, la vacunación y la administración previa de antibióticos demostraron ser protectores de la colonización; y la escolarización, el hábito tabáquico y el número de hermanos, facilitadores de la misma

BACKGROUND AND OBJECTIVES: Streptococcus pneumoniae is a human pathogen that requires prior nasopharyngeal colonization to cause disease. An epidemiological study was conducted on nasopharyngeal carriers of pneumococci in healthy children in Murcia after the introduction of the VCN7, and immediately before the marketing of new vaccines, with the aim of determining the influence of vaccination in our geographic area, and other factors in relation to the state of being a carrier, and the different circulating serotypes. METHODS: A multicentre study was conducted in in 60 primary care health centres in summer 2009 and winter of 2010. A nasopharyngeal swab was collected, and an epidemiological study was carried out on 1562 children aged 1 and 4 years. Of the 1562 nasopharyngeal samples, pneumococci were found in 489 of them, with 343 of them able to be serotyped (70.2%). RESULTS: The prevalence of carriers was 31.3%. Of the patients included, 61.7% (964/1562) had received at least one dose of VCN7. Only 12.8% of the identified serotypes were vaccine serotypes. The independent protective factors against colonization were; Summer time in all age groups, previous vaccination in all the children (OR: 0.75; 95%CI: 0.56-0.93]; P = .01, and in 1-year-olds (OR: 0.6; 95% CI: 0.42-0.84; P =.002), and had taken antibiotics in the last month in the total cohort [OR: 0.69; 95% CI: 0.50-0.96). On the other hand, attendance at school or day-care centre (OR: 1.85; 95% CI: 1.27-2.18; P=.001), number of siblings (OR: 1.3; 95% CI: 1.01-1.91), and passive tobacco smoke exposure (OR: 1.33; 95%CI: 1.02-1.73), were colonization risk factors. The serotypes 6A, 19A, 23B, 15A/B, 11A, 14, 23A/F, 3 y 19F were the most prevalent. CONCLUSIONS: A low proportion of SV was found, with 14, 23F and 19F are persisting. A high prevalence of serotypes 6A and 19A was found. Summer time, vaccination, and the prior administration of antibiotics proved to be protective against colonization, whereas schooling, smoking, and siblings contributed to it

[Epidemiological study of nasopharyngeal carriers of Streptococcus pneumoniae in children in Murcia region]. / Estudio epidemiológico de portadores nasofaríngeos de Streptococcus pneumoniae en niños en la comunidad autónoma de Murcia.

BACKGROUND AND OBJECTIVES: Streptococcus pneumoniae is a human pathogen that requires prior nasopharyngeal colonization to cause disease. An epidemiological study was conducted on nasopharyngeal carriers of pneumococci in healthy children in Murcia after the introduction of the VCN7, and immediately before the marketing of new vaccines, with the aim of determining the influence of vaccination in our geographic area, and other factors in relation to the state of being a carrier, and the different circulating serotypes. METHODS: A multicentre study was conducted in in 60 primary care health centres in summer 2009 and winter of 2010. A nasopharyngeal swab was collected, and an epidemiological study was carried out on 1562 children aged 1 and 4 years. Of the 1562 nasopharyngeal samples, pneumococci were found in 489 of them, with 343 of them able to be serotyped (70.2%). RESULTS: The prevalence of carriers was 31.3%. Of the patients included, 61.7% (964/1562) had received at least one dose of VCN7. Only 12.8% of the identified serotypes were vaccine serotypes. The independent protective factors against colonization were; Summer time in all age groups, previous vaccination in all the children (OR: 0.75; 95%CI: 0.56-0.93]; P=.01, and in 1-year-olds (OR: 0.6; 95%CI: 0.42-0.84; P=.002), and had taken antibiotics in the last month in the total cohort [OR: 0.69; 95%CI: 0.50-0.96). On the other hand, attendance at school or day-care centre (OR: 1.85; 95%CI: 1.27-2.18; P=.001), number of siblings (OR: 1.3; 95%CI: 1.01-1.91), and passive tobacco smoke exposure (OR: 1.33; 95%CI: 1.02-1.73), were colonization risk factors. The serotypes 6A, 19A, 23B, 15A/B, 11A, 14, 23A/F, 3 y 19F were the most prevalent. CONCLUSIONS: A low proportion of SV was found, with 14, 23F and 19F are persisting. A high prevalence of serotypes 6A and 19A was found. Summer time, vaccination, and the prior administration of antibiotics proved to be protective against colonization, whereas schooling, smoking, and siblings contributed to it.