Burden, spectrum and outcome of community-acquired infections among paediatric ward admissions to Tygerberg Hospital
Date
2020-12
Authors
Journal Title
Journal ISSN
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Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH ABSTRACT: Introduction: Community acquired infections (CAIs), both bacterial and viral in origin,
are the most common reason for hospitalization in general paediatric wards. Data from
South Africa on the burden, pathogen spectrum, antimicrobial therapy and outcome of
paediatric CAIs is limited.
Methods: We conducted secondary analysis of data from a prospective cohort of
consecutive paediatric admissions to a general ward at Tygerberg Hospital (May -
November 2015). Demographics, admission history, laboratory investigations,
antimicrobial prescription and hospital outcome data were collected.
Results: Of 451 admissions, 364 (81%) were for CAI episodes. Median age and weight
of patients with CAI was 4.8 months (IQR 1.5-17.5) and 5.4 kg (IQR 3.6-9.0)
respectively. Male gender predominated (210/364; 58%), and HIV-infection prevalence
was 6.0% (22/364). Sources of referral were: home (139/364, 38%), other hospitals
(113/364, 31%) and clinics (112/364, 31%). Pre-hospital antibiotics (commonly
ceftriaxone) were given to 152/364 (42%) of patients. The most prevalent CAI types
(n=364) were: respiratory tract infections (197; 54%), gastroenteritis (51; 14%),
bloodstream/serious bacterial infections (33; 9%), meningitis (17; 5%) and urinary tract
infections (8; 2%). Of 274 blood cultures submitted, 5% yielded a pathogen and 8%
were contaminated. Of 140 cerebrospinal fluid samples sent, only 2% yielded a
pathogen. Of investigations for respiratory infection, respiratory syncytial virus (RSV),
adenovirus (AV) and parainfluenza virus predominated from shell vial culture, whereas
RSV, cytomegalovirus and rhinovirus were most frequently identified on polymerase
chain reaction testing. Most frequent CAI antibiotic treatment regimens included:
ampicillin alone (53%); ampicillin plus gentamicin (25%) and ampicillin plus cefotaxime
(20%). Unfavourable outcomes were uncommon (1% died; 4% required re-admission
within 30 days of discharge). The majority of antibiotic prescriptions for CAI (323/364;
89%) were compliant with the Essential Drug List (EDL) guidelines. The overall
estimated cost of CAI episode management was R 8.2 million or R22,527 per CAI
admission episode.
Conclusion: CAI's are the most frequent reason for hospitalization and a major driver
of antimicrobial use and hospital costs in general paediatric wards. Improved diagnostic
stewardship should be implemented in South African paediatric wards to reduce culture
contamination, improve pathogen yield, minimize use of unnecessary investigations and
reduce inappropriate antimicrobial prescriptions. Despite a high burden and hospital
cost of CAI admissions, paediatric clinical outcomes were generally favourable.
"Geen opsomming biskikbaar"
"Geen opsomming biskikbaar"
Description
Thesis (MMed)--Stellenbosch University, 2020.
Keywords
Community-acquired infections, Pediatricians, Paediatric ward admissions, Pediatrics, Laboratory investigations, Anti-infective agents, Anti-infective agents, UCTD