Stewardship / Resistance Scan for Aug 21, 2018

Antibiotics for kids' UTIs
;
Drug-resistant TB surveillance model

Study supports oral antibiotic monotherapy for most kids with UTIs

A study today in Pediatrics suggests that a dose of parenteral antibiotics prior to discharge from the emergency department (ED) is likely not necessary for most young children with urinary tract infections (UTIs).

In the study, researchers conducted a retrospective analysis of administrative data from 26 hospitals from 2010 through 2016 to better understand the value of a single dose of parenteral antibiotics in children with UTIs who are well enough to be discharged from the ED. While oral antibiotics are as effective as parenteral antibiotics in the treatment of UTIs in young children, and the American Academy of Pediatrics UTI guidelines recommend oral antibiotics alone for children with UTIs who are able to tolerate oral intake and are not ill-appearing, the administration of parenteral antibiotics before ED discharge remains a common practice.

The primary outcome of the study was an ED revisit within 3 days requiring admission. All ED revisits served as a secondary outcome.

Overall, 29,919 children with a median age of 8.6 months were included in the analysis; 36% (10,849) of those children received parenteral antibiotics before ED discharge, 4.0% (1,199) had a 3-day ED revisit, and 1.1% (336) had a 3-day revisit with admission. After adjusting for demographic factors, clinical severity, and hospital-level factors, the researchers found that ED revisit rates with admission were similar among patients who received parenteral antibiotics and those who did not (1.3% vs. 1.0%; risk difference, 0.3%). Overall ED revisit rates were higher among patients who received parenteral antibiotics (4.8% vs. 3.3%; risk difference, 1.5%).

The authors of the study say the findings support the goal of using oral antibiotics as monotherapy for most children who are discharged with UTIs.
Aug 21 Pediatrics study

 

Researchers develop method for real-time surveillance of drug-resistant TB

A study today in PLoS Medicine by US and South African researchers describes a method to monitor drug-resistant tuberculosis (TB) by identifying high-burden communities using routinely collected laboratory data.

South Africa has one of the highest TB incidence rates globally (781 per 100,000 inhabitants), yet little is known about the spatial heterogeneity of TB or drug-resistant TB within the country. This kind of spatial information is required to understand where drug-resistant TB exists, to determine why it persists in those communities, and to create appropriate control and elimination strategies.  

To derive spatial estimates of drug-resistant TB in the country, the researchers retrospectively identified cases of TB and rifampicin-resistant TB (RR-TB) from all biological samples submitted for testing to the Western Cape National Health Laboratory Services (NHLS) from 2008 through June 2013. Because the NHLS database lacks unique patient identifiers, the researchers created a person-matching algorithm to match specimen records to individual patients. Cases were then aggregated by clinic location to estimate the percentage of RR-TB cases per clinic.

Of the 799,779 individuals who were mappable to clinic locations, 27.8% (222,735) had microbiologically confirmed TB, and, of these, 4.6% (10,255) had RR-TB. Mapping of cases at the clinic level showed that while the median percentage of RR-TB diagnosed at clinics was 4.3%, the percentage of diagnosed RR-TB cases ranged from 0% to 25% across Western Cape province, with significant yearly fluctuations in RR-TB percentages at several locations.

"Maps such as the ones we have created can be the platform for this next generation of disease surveillance," the authors of the study conclude. "Improved knowledge of subnational geographic variability of RR-tuberculosis is essential for the improved design and implementation of national and local responses to reduce drug-resistant tuberculosis transmission and for timely context-specific resource allocation."
Aug 21 PLoS Med study

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