Outbreak of severe acute respiratory infection in Southern Province, Sri Lanka in 2018: a cross-sectional study

Vanderburg, Sky; Wijayaratne, Weerasinghe Mudiyanselage Dilip Gaya Bandara; Danthanarayana, Nayomi; Jayamaha, Jude; Piyasiri, Bhagya; Halloluwa, Chathurangi; Sheng, Tianchen; Amarasena, Sujeewa; Kurukulasooriya, Ruvini; Nicholson, Bradly P.; Peiris, J. S. Malik; Gray, Gregory C.; Gunasena, Sunethra; Nagahawatte, Ajith; Bodinayake, Champica K; Woods, Christopher W.; Devasiri, Vasantha; Tillekeratne, L. Gayani

doi:10.1136/bmjopen-2020-040612

Cited by 2 publications

(2 citation statements)

References 34 publications

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“…In Sri Lanka, a LMIC in South Asia, LRTI is a common reason for hospitalization among both children and adults. Distinguishing viral and bacterial LRTI can be difficult due to insufficient resources and diagnostics [ 9 , 15 , 16 ]. In 2018, a Sri Lankan study reported that 30.1% of hospitalized patients were potentially inappropriately prescribed antibiotics, for which LRTI was the most common indication for prescription [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of antibiotic prescription among patients hospitalized with viral lower respiratory tract infections in Southern Province, Sri Lanka

Medrano,

Weerasinghe,

Nagahawatte

et al. 2024

PLoS ONE

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Background Antimicrobial overprescription is common for lower respiratory tract infections (LRTI), as viral and bacterial infections generally present with similar clinical features. Overprescription is associated with downstream antimicrobial resistance. This study aims to identify the prevalence and predictors of antibiotic prescription among patients hospitalized with viral LRTI. Methods A prospective cohort study was conducted among patients aged ≥1 year hospitalized with viral LRTI in a tertiary care hospital in Southern Province, Sri Lanka from 2018–2021. Demographic, clinical, and laboratory data were recorded. Nasopharyngeal and blood samples were collected for multiplex polymerase chain reaction testing for 21 respiratory pathogens and procalcitonin (PCT) detection, respectively. Demographic and clinical features associated with antibiotic prescription were identified using Chi Square and t-tests; significant variables (p<0.05) were further included in multivariable logistic regression models. The potential impact of biomarker testing on antibiotic prescription was simulated using standard c-reactive protein (CRP) and PCT cut-offs. Results Of 1217 patients enrolled, 438 (36.0%) had ≥1 respiratory virus detected, with 48.4% of these patients being male and 30.8% children. Influenza A (39.3%) and human rhinovirus/ enterovirus (28.3%) were most commonly detected. A total of 114 (84.4%) children and 266 (87.8%) adults with respiratory viruses were treated with antibiotics. Among children, neutrophil percentage (median 63.6% vs 47.6%, p = 0.04) was positively associated with antibiotic prescription. Among adults, headache (60.6% vs 35.1%, p = 0.003), crepitations/crackles (55.3% vs 21.6%, p<0.001), rhonchi/wheezing (42.9% vs 18.9%, p = 0.005), and chest x-ray opacities (27.4% vs 8.1%, p = 0.01) were associated with antibiotic prescription. Access to CRP and procalcitonin test results could have potentially decreased inappropriate antibiotic prescription in this study by 89.5% and 83.3%, respectively. Conclusions High proportions of viral detection and antibiotic prescription were observed among a large inpatient cohort with LRTI. Increased access to point-of-care biomarker testing may improve antimicrobial prescription.

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Section: Introductionmentioning

confidence: 99%

Prevalence and predictors of antibiotic prescription among patients hospitalized with viral lower respiratory tract infections in Southern Province, Sri Lanka

Medrano,

Weerasinghe,

Nagahawatte

et al. 2024

PLoS ONE

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“…According to this surveillance report Inf-V circulate throughout the year with peaks in April-June and November to February [5]. Despite the increase in global influenza surveillance and improved understanding of Inf-V, longitudinal data on seasonality, epidemiology and estimates of influenza-associated disease burden are limited in tropical countries like Sri Lanka [5,6]. However, it appears that the distribution and mortality from influenza in tropical countries are comparable to those seen in temperate high-income countries [7].…”

Section: Introductionmentioning

confidence: 99%

Clinical and epidemiological characteristics of influenza virus infection in hospitalized children with acute respiratory infections in Sri Lanka

Rafeek

Divarathna

Morel³

et al. 2022

PLoS ONE

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Influenza viruses (Inf-V) are an important cause of acute respiratory infection (ARI) in children. This study was undertaken to describe the clinical and epidemiological characteristics of Inf-V infections in a sample of hospitalized children with ARI. Nasopharyngeal aspirates (NPA) from 500 children between 1 month to 5 years old with symptoms of ARI were collected at the Teaching Hospital Kegalle Sri Lanka From May 2016 to June 2018, NPAs were tested for influenza A (Inf-A) and B (Inf-B) viruses, human respiratory syncytial virus (hRSV), human parainfluenza virus (hPIV) 1–3 using an immunofluorescence assay. The Inf-V were then subtyped using a multiplex RT-PCR. Inf-V were detected in 10.75% (54/502) of the hospitalized children with ARI and in that 5.57% (28/502) were positive for Inf-A and 5.17% (26/502) were positive for Inf-B. Of the 54 Inf-V positive children, 33 were aged between 6 and 20 months. Of the 28 children infected with Inf-A, 15 had uncharacterized lower respiratory infection, 7 had bronchopneumonia and 6 had bronchiolitis. Of the 26 children infected with Inf-B, 11 had uncharacterized lower respiratory infection, 10 had bronchiolitis, and 4 had bronchopneumonia. Inf-B circulated throughout the year with a few peaks, one in June and then in August followed by November to December in 2016 and one in April 2017 and January 2018. Inf-A circulated throughout the year with a major peak in March to April 2017 and July 2018. ARI was more common in boys compared to girls. Majority of the children infected with Inf-V were diagnosed with uncharacterized lower respiratory infection and mild to moderate bronchiolitis. Inf-V infections were prevalent throughout the year in the study area of Sri Lanka with variations in the type of the circulating virus.

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Outbreak of severe acute respiratory infection in Southern Province, Sri Lanka in 2018: a cross-sectional study

Cited by 2 publications

References 34 publications

Prevalence and predictors of antibiotic prescription among patients hospitalized with viral lower respiratory tract infections in Southern Province, Sri Lanka

Prevalence and predictors of antibiotic prescription among patients hospitalized with viral lower respiratory tract infections in Southern Province, Sri Lanka

Clinical and epidemiological characteristics of influenza virus infection in hospitalized children with acute respiratory infections in Sri Lanka

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