Antimicrobial use for treatment of healthcare-associated infections and bacterial resistance in a reference neonatal unit

Abstract Objective The use of broad-spectrum antimicrobials, such as third and fourth-generation, are responsible for emergence of multidrug-resistant microorganisms in neonatal units. Furthermore, antimicrobial daily doses are not standardized in neonatology. This study aimed to investigate the association between the use of antimicrobial broad spectrum to bacterial sensitivity profile in a referral unit of neonatal progressive care. Methods This is a cohort study conducted in a referral neonatal progressive care unit from January 2008 to December 2016. The data of all hospitalized neonates was collected daily. The infection criteria used were the standardized national criteria, based on definitions of Center for Diseases Control and Prevention. In this study, the use of antimicrobials was evaluated as antimicrobial-day (ATM-day) and the ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was also calculated. The study was approved by the Institutional Review Board of the Universidade Federal de Minas Gerais (ETIC 312/08 e CAAE 58973616.2.0000.5149). Results From 2008 to 2016, 2751 neonates were hospitalized, corresponding to 60,656 patient-days. The ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was 1,3 in the first period and 4,3 in the second period (p = 0,005). Conclusion It was observed that use of broad-spectrum antimicrobials, especially those with coverage for Gram-negative bacteria, was associated with an increase of multidrug-resistant bacteria.

Risk factors associated with the outcomes of pediatric bacterial meningitis: a systematic review / Fatores de risco associados aos desfechos da meningite bacteriana pediátrica: uma revisão sistemática

Abstract Objective: The aim of this study was to systematically review the literature and answer the following central question: "What are the risk factors associated with worse clinical outcomes of pediatric bacterial meningitis patients?" Methods: The articles were obtained through literary search using electronic bibliographic databases: Web of Science, Scopus, MEDLINE, and LILACS; they were selected using the international guideline outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols. Results: The literature search identified 1,244 articles. After methodological screening, 17 studies were eligible for this systematic review. A total of 9,581 patients aged between 0 days and 18 years were evaluated in the included studies, and several plausible and important prognostic factors are proposed for prediction of poor outcomes after bacterial meningitis in childhood. Late diagnosis reduces the chances for a better evolution and reinforces the importance of a high diagnostic suspicion of meningitis, especially in febrile pictures with nonspecific symptomatology. S. pneumoniae as a causative pathogen was demonstrated to be related to clinical severity. Conclusions: Early prediction of an adverse outcome may help determine which children require more intensive or longer follow-up and may provide the physician with rationale for parental counseling about their child's prognosis in an early phase of the disease.

Resumo Objetivo O objetivo deste estudo é revisar sistematicamente a literatura e responder à seguinte questão central: "Quais são os fatores de risco associados a piores desfechos clínicos de pacientes pediátricos com meningite bacteriana?". Métodos Os artigos foram obtidos através de pesquisa bibliográfica, nas bases de dados eletrônicas Web of Science, Scopus, Medline e Lilacs, e selecionados com diretriz internacional delineada pela abordagem Prisma (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Resultados A pesquisa bibliográfica identificou 1.244 artigos. Após a triagem metodológica, 17 estudos foram considerados elegíveis para esta revisão sistemática. Foram avaliados 9.581 pacientes até 18 anos nos estudos incluídos e vários fatores prognósticos plausíveis e importantes são propostos para a previsão de desfechos piores após meningite bacteriana na infância. O diagnóstico tardio reduz as chances de uma melhor evolução e reforça a importância de uma alta suspeita diagnóstica de meningite, especialmente em quadros febris com sintomatologia inespecífica. S. pneumoniae como patógeno causador demonstrou estar relacionado à gravidade clínica. Conclusões A previsão precoce de um desfecho clínico desfavorável pode ajudar a determinar quais crianças necessitam de uma abordagem mais invasiva ou seguimento mais prolongado e pode fornecer ao médico a justificativa para o aconselhamento dos pais sobre o prognóstico de seu filho em uma fase inicial da doença.