Penicillin Resistance is Not Extrapolable to Amoxicillin Resistance in <i>Streptococcus Pneumoniae</i> Isolated from Middle Ear Fluid in Children with Acute Otitis Media

Rosenblüt, Andrés; Santolaya, Marı́a Elena; González, Patricia; Borel, Cecilia; Cofré, José

doi:10.1177/000348940611500305

Cited by 18 publications

(9 citation statements)

References 25 publications

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“…Narrow-spectrum monotherapy (amoxicillin) is the first option for mild CAP in fully immunized children, as S . pneumoniae accounts for 21–44% of disease [ 23 – 28 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of clinical pathway implementation on antibiotic prescriptions for pediatric community-acquired pneumonia

et al. 2018

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BackgroundItalian pediatric antimicrobial prescription rates are among the highest in Europe. As a first step in an Antimicrobial Stewardship Program, we implemented a Clinical Pathway (CP) for Community Acquired Pneumonia with the aim of decreasing overall prescription of antibiotics, especially broad-spectrum.Materials and methodsThe CP was implemented on 10/01/2015. We collected antibiotic prescribing and outcomes data from children aged 3 months-15 years diagnosed with CAP from 10/15/2014 to 04/15/2015 (pre-intervention period) and from 10/15/2015 to 04/15/2016 (post-intervention period). We assessed antibiotic prescription differences pre- and post-CP, including rates, breadth of spectrum, and duration of therapy. We also compared length of hospital stay for inpatients and treatment failure for inpatients and outpatients. Chi-square and Fisher’s exact test were used to compare categorical variables and Wilcoxon rank sum test was used to compare quantitative outcomes.Results120 pre- and 86 post-intervention clinic visits were identified with a diagnosis of CAP. In outpatients, we observed a decrease in broad-spectrum regimens (50% pre-CP vs. 26.8% post-CP, p = 0.02), in particular macrolides, and an increase in narrow-spectrum (amoxicillin) post-CP. Post-CP children received fewer antibiotic courses (median DOT from 10 pre-CP to 8 post-CP, p<0.0001) for fewer days (median LOT from 10 pre-CP to 8 post-CP, p<0.0001) than their pre-CP counterparts. Physicians prescribed narrow-spectrum monotherapy more frequently than broad-spectrum combination therapy (DOT/LOT ratio 1.157 pre-CP vs. 1.065 post-CP). No difference in treatment failure was reported before and after implementation (2.3% pre-CP vs. 11.8% post-CP, p = 0.29). Among inpatients we also noted a decrease in broad-spectrum regimens (100% pre-CP vs. 66.7% post-CP, p = 0.02) and the introduction of narrow-spectrum regimens (0% pre-CP vs. 33.3% post-CP, p = 0.02) post-CP. Hospitalized patients received fewer antibiotic courses post-CP (median DOT from 18.5 pre-CP to 10 post-CP, p = 0.004), while there was no statistical difference in length of therapy (median LOT from 11 pre-CP to 10 post-CP, p = 0.06). Days of broad spectrum therapy were notably lower post-CP (median bsDOT from 17 pre-CP to 4.5 post-CP, p <0.0001). No difference in treatment failure was reported before and after CP implementation (16.7% pre-CP vs. 15.4% post-CP, p = 1).ConclusionsIntroduction of a CP for CAP in a Pediatric Emergency Department led to reduction of broad-spectrum antibiotic prescriptions, of combination therapy and of duration of treatment both for outpatients and inpatients.

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“…Narrow-spectrum monotherapy (amoxicillin) is the first option for mild CAP in fully immunized children, as S . pneumoniae accounts for 21–44% of disease [ 23 – 28 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of clinical pathway implementation on antibiotic prescriptions for pediatric community-acquired pneumonia

et al. 2018

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“…Commisso et al published in 2000 a cross-sectional study, but etiology percentages refer to middle ear samples and not patients with AOM [51], and thus selection bias could not be discarded. Rosenblut et al [52] published an extension of a 2001 paper [29] but did not include raw serotype data.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of acute otitis media in children of Latin America and the Caribbean: A systematic review and meta-analysis

Bardach

Ciapponi

García-Martí

et al. 2011

International Journal of Pediatric Otorhinolaryngology

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“…Other regularly reported bacterial pathogens include Moraxella catarrhalis ( M. catarrhalis ) and Streptococcus pyogenes ( S. pyogenes ) [11]. S. pneumoniae has been shown to be responsible for 43.8%-61.4% of all bacterial AOM cases in Latin America [12-14]. H. influenzae has, however, emerged as the most frequently recovered bacterial pathogen in recent studies [13,15].…”

Section: Introductionmentioning

confidence: 99%

Non-capsulated and capsulated Haemophilus influenzaein children with acute otitis media in Venezuela: a prospective epidemiological study

et al. 2012

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BackgroundNon-typeable Haemophilus influenzae (NTHi) and Streptococcus pneumoniae are major causes of bacterial acute otitis media (AOM). Data regarding AOM are limited in Latin America. This is the first active surveillance in a private setting in Venezuela to characterize the bacterial etiology of AOM in children < 5 years of age.MethodsBetween December 2008 and December 2009, 91 AOM episodes (including sporadic, recurrent and treatment failures) were studied in 87 children enrolled into a medical center in Caracas, Venezuela. Middle ear fluid samples were collected either by tympanocentesis or spontaneous otorrhea swab sampling method. Standard laboratory and microbiological techniques were used to identify bacteria and test for antimicrobial resistance. The results were interpreted according to Clinical Laboratory Standards Institute (CLSI) 2009 for non-meningitis isolates. All statistical analyses were performed using SAS 9.1 and Microsoft Excel (for graphical purposes).ResultsOverall, bacteria were cultured from 69.2% (63 of the 91 episodes); at least one pathogen (S. pneumoniae, H. influenzae, S. pyogenes or M. catarrhalis) was cultured from 65.9% (60/91) of episodes. H. influenzae (55.5%; 35/63 episodes) and S. pneumoniae (34.9%; 22/63 episodes) were the most frequently reported bacteria. Among H. influenzae isolates, 62.9% (22/35 episodes) were non-capsulated (NTHi) and 31.4% (11/35 episodes) were capsulated including types d, a, c and f, across all age groups. Low antibiotic resistance for H. influenzae was observed to amoxicillin/ampicillin (5.7%; 2/35 samples). NTHi was isolated in four of the six H. influenzae positive samples (66.7%) from recurrent episodes.ConclusionsWe found H. influenzae and S. pneumoniae to be the main pathogens causing AOM in Venezuela. Pneumococcal conjugate vaccines with efficacy against these bacterial pathogens may have the potential to maximize protection against AOM.

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Penicillin Resistance is Not Extrapolable to Amoxicillin Resistance in Streptococcus Pneumoniae Isolated from Middle Ear Fluid in Children with Acute Otitis Media

Cited by 18 publications

References 25 publications

Effects of clinical pathway implementation on antibiotic prescriptions for pediatric community-acquired pneumonia

Effects of clinical pathway implementation on antibiotic prescriptions for pediatric community-acquired pneumonia

Epidemiology of acute otitis media in children of Latin America and the Caribbean: A systematic review and meta-analysis

Non-capsulated and capsulated Haemophilus influenzaein children with acute otitis media in Venezuela: a prospective epidemiological study

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