Retrospective review of antimicrobial use for gastroschisis patients in Kigali, Rwanda: can improved stewardship reduce late inpatient deaths?
Gastroschisis mortality is 75–100% in low-resource settings. In Rwanda, late deaths are often due to sepsis. We aimed to understand the effect of antimicrobial use on survival. We conducted a retrospective review of gastroschisis patients at a tertiary hospital in Kigali, Rwanda between January 2016...
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| Veröffentlicht in: | European journal of pediatrics 2023-07, Vol.182 (7), p.3203-3209 |
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| creator | Diehl, Thomas M. Davis, James R. Nsengiyumva, Alice Igiraneza, Deborah Hong, Philip Umutoni, Rosine Neal, Dan Ndibanje, Alain Jules Bunogerane, Gisèle Juru Petroze, Robin T. Ntaganda, Edmond |
| description | Gastroschisis mortality is 75–100% in low-resource settings. In Rwanda, late deaths are often due to sepsis. We aimed to understand the effect of antimicrobial use on survival. We conducted a retrospective review of gastroschisis patients at a tertiary hospital in Kigali, Rwanda between January 2016–June 2019. Demographics, antimicrobial use, microbiology, and outcomes were abstracted. Descriptive and univariate analyses were conducted to assess factors associated with improved survival. Among 92 gastroschisis patients, mortality was 77%(n = 71); 23%(n = 21) died within 48 h. 98%(n = 90) of patients received antibiotics on arrival. Positive blood cultures were obtained in 41%(n = 38). Patients spent 86%(SD = 20%) of their hospital stay on antibiotics and 38%(n = 35) received second-line agents. There was no difference in age at arrival, birth weight, gestational age, silo complications, or antimicrobial selection between survivors and non-survivors. Late death patients spent more total hospital days and post-abdominal closure days on antibiotics (p |
| doi_str_mv | 10.1007/s00431-023-04955-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2808588207</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2838875568</sourcerecordid><originalsourceid>FETCH-LOGICAL-c419t-3045e59891f80666ba0b74c6015be50d112923f02c88eefeede9e9fee4082d373</originalsourceid><addsrcrecordid>eNp9kU2LFDEQhoMo7rr6BzxIwIsHWyudTnfiZZHFL1wQFj2HdKd6Jkt_mUrP4J_wN5txxg88eKqCet63KnkZeyzghQBoXhJAJUUBpSygMkoV5g47F5UsCwFNffev_ow9ILqFLDJC32dnshGlqYU6Z99vMMWZFuxS2CGPuAu453PP3ZTCGLo4t8ENfCXk_Rz5xtEB77aBAvHFpYBTIh4m_jFs3BCe85u9m7x7xTs38TAucd6h55Rw76KnbVjyCr92yAeXMOtOFtyjS1u6fMju9W4gfHSqF-zL2zefr94X15_efbh6fV10lTCpkFApVEYb0Wuo67p10DZVV4NQLSrwIj-vlD2UndaIPaJHgybXCnTpZSMv2LOjbz7w64qU7Biow2FwE84r2VKDVlqXcECf_oPezmuc8nWZklo3StU6U-WRyj9GFLG3Swyji9-sAHtIyx7Tsjkt-zMta7Loycl6bUf0vyW_4smAPAKUR9MG45_d_7H9AQJoogU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2838875568</pqid></control><display><type>article</type><title>Retrospective review of antimicrobial use for gastroschisis patients in Kigali, Rwanda: can improved stewardship reduce late inpatient deaths?</title><source>SpringerLink Journals - AutoHoldings</source><creator>Diehl, Thomas M. ; Davis, James R. ; Nsengiyumva, Alice ; Igiraneza, Deborah ; Hong, Philip ; Umutoni, Rosine ; Neal, Dan ; Ndibanje, Alain Jules ; Bunogerane, Gisèle Juru ; Petroze, Robin T. ; Ntaganda, Edmond</creator><creatorcontrib>Diehl, Thomas M. ; Davis, James R. ; Nsengiyumva, Alice ; Igiraneza, Deborah ; Hong, Philip ; Umutoni, Rosine ; Neal, Dan ; Ndibanje, Alain Jules ; Bunogerane, Gisèle Juru ; Petroze, Robin T. ; Ntaganda, Edmond</creatorcontrib><description>Gastroschisis mortality is 75–100% in low-resource settings. In Rwanda, late deaths are often due to sepsis. We aimed to understand the effect of antimicrobial use on survival. We conducted a retrospective review of gastroschisis patients at a tertiary hospital in Kigali, Rwanda between January 2016–June 2019. Demographics, antimicrobial use, microbiology, and outcomes were abstracted. Descriptive and univariate analyses were conducted to assess factors associated with improved survival. Among 92 gastroschisis patients, mortality was 77%(n = 71); 23%(n = 21) died within 48 h. 98%(n = 90) of patients received antibiotics on arrival. Positive blood cultures were obtained in 41%(n = 38). Patients spent 86%(SD = 20%) of their hospital stay on antibiotics and 38%(n = 35) received second-line agents. There was no difference in age at arrival, birth weight, gestational age, silo complications, or antimicrobial selection between survivors and non-survivors. Late death patients spent more total hospital days and post-abdominal closure days on antibiotics (p < 0.001) compared to survivors. There was no difference in the proportion of hospital stay on second-line antibiotics (p = 0.1).
Conclusion
: We identified frequent late deaths, prolonged antibiotic courses, and regular use of second-line antibiotic agents in this retrospective cohort of Rwandan gastroschisis patients. Future studies are needed to evaluate antimicrobial resistance in pediatric surgical patients in Rwanda.
What is Known:
• Global disparities in gastroschisis outcomes are extreme, with <4% mortality in high-income settings and 75-100% mortality in low-income settings.
• Antimicrobial surveillance data is sparse across Africa, but existing evidence suggests high levels of resistance to first-line antibiotics in Rwanda.
What is New:
• In-hospital survival for gastroschisis was 23% from 2016-2019 and most deaths occurred late (>48hrs after admission) due to sepsis.
• Rwandan gastroschisis patients received prolonged courses of antibiotics and second-line antibiotics were frequently used without culture data, raising concern for antimicrobial resistance.</description><identifier>ISSN: 1432-1076</identifier><identifier>ISSN: 0340-6199</identifier><identifier>EISSN: 1432-1076</identifier><identifier>DOI: 10.1007/s00431-023-04955-9</identifier><identifier>PMID: 37129615</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Antibiotics ; Antimicrobial agents ; Antimicrobial resistance ; Birth weight ; Drug resistance ; Gestational age ; Medicine ; Medicine & Public Health ; Mortality ; Patients ; Pediatrics ; Sepsis ; Survival</subject><ispartof>European journal of pediatrics, 2023-07, Vol.182 (7), p.3203-3209</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-3045e59891f80666ba0b74c6015be50d112923f02c88eefeede9e9fee4082d373</citedby><cites>FETCH-LOGICAL-c419t-3045e59891f80666ba0b74c6015be50d112923f02c88eefeede9e9fee4082d373</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00431-023-04955-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00431-023-04955-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37129615$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Diehl, Thomas M.</creatorcontrib><creatorcontrib>Davis, James R.</creatorcontrib><creatorcontrib>Nsengiyumva, Alice</creatorcontrib><creatorcontrib>Igiraneza, Deborah</creatorcontrib><creatorcontrib>Hong, Philip</creatorcontrib><creatorcontrib>Umutoni, Rosine</creatorcontrib><creatorcontrib>Neal, Dan</creatorcontrib><creatorcontrib>Ndibanje, Alain Jules</creatorcontrib><creatorcontrib>Bunogerane, Gisèle Juru</creatorcontrib><creatorcontrib>Petroze, Robin T.</creatorcontrib><creatorcontrib>Ntaganda, Edmond</creatorcontrib><title>Retrospective review of antimicrobial use for gastroschisis patients in Kigali, Rwanda: can improved stewardship reduce late inpatient deaths?</title><title>European journal of pediatrics</title><addtitle>Eur J Pediatr</addtitle><addtitle>Eur J Pediatr</addtitle><description>Gastroschisis mortality is 75–100% in low-resource settings. In Rwanda, late deaths are often due to sepsis. We aimed to understand the effect of antimicrobial use on survival. We conducted a retrospective review of gastroschisis patients at a tertiary hospital in Kigali, Rwanda between January 2016–June 2019. Demographics, antimicrobial use, microbiology, and outcomes were abstracted. Descriptive and univariate analyses were conducted to assess factors associated with improved survival. Among 92 gastroschisis patients, mortality was 77%(n = 71); 23%(n = 21) died within 48 h. 98%(n = 90) of patients received antibiotics on arrival. Positive blood cultures were obtained in 41%(n = 38). Patients spent 86%(SD = 20%) of their hospital stay on antibiotics and 38%(n = 35) received second-line agents. There was no difference in age at arrival, birth weight, gestational age, silo complications, or antimicrobial selection between survivors and non-survivors. Late death patients spent more total hospital days and post-abdominal closure days on antibiotics (p < 0.001) compared to survivors. There was no difference in the proportion of hospital stay on second-line antibiotics (p = 0.1).
Conclusion
: We identified frequent late deaths, prolonged antibiotic courses, and regular use of second-line antibiotic agents in this retrospective cohort of Rwandan gastroschisis patients. Future studies are needed to evaluate antimicrobial resistance in pediatric surgical patients in Rwanda.
What is Known:
• Global disparities in gastroschisis outcomes are extreme, with <4% mortality in high-income settings and 75-100% mortality in low-income settings.
• Antimicrobial surveillance data is sparse across Africa, but existing evidence suggests high levels of resistance to first-line antibiotics in Rwanda.
What is New:
• In-hospital survival for gastroschisis was 23% from 2016-2019 and most deaths occurred late (>48hrs after admission) due to sepsis.
• Rwandan gastroschisis patients received prolonged courses of antibiotics and second-line antibiotics were frequently used without culture data, raising concern for antimicrobial resistance.</description><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>Antimicrobial resistance</subject><subject>Birth weight</subject><subject>Drug resistance</subject><subject>Gestational age</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Sepsis</subject><subject>Survival</subject><issn>1432-1076</issn><issn>0340-6199</issn><issn>1432-1076</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kU2LFDEQhoMo7rr6BzxIwIsHWyudTnfiZZHFL1wQFj2HdKd6Jkt_mUrP4J_wN5txxg88eKqCet63KnkZeyzghQBoXhJAJUUBpSygMkoV5g47F5UsCwFNffev_ow9ILqFLDJC32dnshGlqYU6Z99vMMWZFuxS2CGPuAu453PP3ZTCGLo4t8ENfCXk_Rz5xtEB77aBAvHFpYBTIh4m_jFs3BCe85u9m7x7xTs38TAucd6h55Rw76KnbVjyCr92yAeXMOtOFtyjS1u6fMju9W4gfHSqF-zL2zefr94X15_efbh6fV10lTCpkFApVEYb0Wuo67p10DZVV4NQLSrwIj-vlD2UndaIPaJHgybXCnTpZSMv2LOjbz7w64qU7Biow2FwE84r2VKDVlqXcECf_oPezmuc8nWZklo3StU6U-WRyj9GFLG3Swyji9-sAHtIyx7Tsjkt-zMta7Loycl6bUf0vyW_4smAPAKUR9MG45_d_7H9AQJoogU</recordid><startdate>20230701</startdate><enddate>20230701</enddate><creator>Diehl, Thomas M.</creator><creator>Davis, James R.</creator><creator>Nsengiyumva, Alice</creator><creator>Igiraneza, Deborah</creator><creator>Hong, Philip</creator><creator>Umutoni, Rosine</creator><creator>Neal, Dan</creator><creator>Ndibanje, Alain Jules</creator><creator>Bunogerane, Gisèle Juru</creator><creator>Petroze, Robin T.</creator><creator>Ntaganda, Edmond</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20230701</creationdate><title>Retrospective review of antimicrobial use for gastroschisis patients in Kigali, Rwanda: can improved stewardship reduce late inpatient deaths?</title><author>Diehl, Thomas M. ; Davis, James R. ; Nsengiyumva, Alice ; Igiraneza, Deborah ; Hong, Philip ; Umutoni, Rosine ; Neal, Dan ; Ndibanje, Alain Jules ; Bunogerane, Gisèle Juru ; Petroze, Robin T. ; Ntaganda, Edmond</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-3045e59891f80666ba0b74c6015be50d112923f02c88eefeede9e9fee4082d373</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Antibiotics</topic><topic>Antimicrobial agents</topic><topic>Antimicrobial resistance</topic><topic>Birth weight</topic><topic>Drug resistance</topic><topic>Gestational age</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Sepsis</topic><topic>Survival</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Diehl, Thomas M.</creatorcontrib><creatorcontrib>Davis, James R.</creatorcontrib><creatorcontrib>Nsengiyumva, Alice</creatorcontrib><creatorcontrib>Igiraneza, Deborah</creatorcontrib><creatorcontrib>Hong, Philip</creatorcontrib><creatorcontrib>Umutoni, Rosine</creatorcontrib><creatorcontrib>Neal, Dan</creatorcontrib><creatorcontrib>Ndibanje, Alain Jules</creatorcontrib><creatorcontrib>Bunogerane, Gisèle Juru</creatorcontrib><creatorcontrib>Petroze, Robin T.</creatorcontrib><creatorcontrib>Ntaganda, Edmond</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Diehl, Thomas M.</au><au>Davis, James R.</au><au>Nsengiyumva, Alice</au><au>Igiraneza, Deborah</au><au>Hong, Philip</au><au>Umutoni, Rosine</au><au>Neal, Dan</au><au>Ndibanje, Alain Jules</au><au>Bunogerane, Gisèle Juru</au><au>Petroze, Robin T.</au><au>Ntaganda, Edmond</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Retrospective review of antimicrobial use for gastroschisis patients in Kigali, Rwanda: can improved stewardship reduce late inpatient deaths?</atitle><jtitle>European journal of pediatrics</jtitle><stitle>Eur J Pediatr</stitle><addtitle>Eur J Pediatr</addtitle><date>2023-07-01</date><risdate>2023</risdate><volume>182</volume><issue>7</issue><spage>3203</spage><epage>3209</epage><pages>3203-3209</pages><issn>1432-1076</issn><issn>0340-6199</issn><eissn>1432-1076</eissn><abstract>Gastroschisis mortality is 75–100% in low-resource settings. In Rwanda, late deaths are often due to sepsis. We aimed to understand the effect of antimicrobial use on survival. We conducted a retrospective review of gastroschisis patients at a tertiary hospital in Kigali, Rwanda between January 2016–June 2019. Demographics, antimicrobial use, microbiology, and outcomes were abstracted. Descriptive and univariate analyses were conducted to assess factors associated with improved survival. Among 92 gastroschisis patients, mortality was 77%(n = 71); 23%(n = 21) died within 48 h. 98%(n = 90) of patients received antibiotics on arrival. Positive blood cultures were obtained in 41%(n = 38). Patients spent 86%(SD = 20%) of their hospital stay on antibiotics and 38%(n = 35) received second-line agents. There was no difference in age at arrival, birth weight, gestational age, silo complications, or antimicrobial selection between survivors and non-survivors. Late death patients spent more total hospital days and post-abdominal closure days on antibiotics (p < 0.001) compared to survivors. There was no difference in the proportion of hospital stay on second-line antibiotics (p = 0.1).
Conclusion
: We identified frequent late deaths, prolonged antibiotic courses, and regular use of second-line antibiotic agents in this retrospective cohort of Rwandan gastroschisis patients. Future studies are needed to evaluate antimicrobial resistance in pediatric surgical patients in Rwanda.
What is Known:
• Global disparities in gastroschisis outcomes are extreme, with <4% mortality in high-income settings and 75-100% mortality in low-income settings.
• Antimicrobial surveillance data is sparse across Africa, but existing evidence suggests high levels of resistance to first-line antibiotics in Rwanda.
What is New:
• In-hospital survival for gastroschisis was 23% from 2016-2019 and most deaths occurred late (>48hrs after admission) due to sepsis.
• Rwandan gastroschisis patients received prolonged courses of antibiotics and second-line antibiotics were frequently used without culture data, raising concern for antimicrobial resistance.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37129615</pmid><doi>10.1007/s00431-023-04955-9</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | Antibiotics Antimicrobial agents Antimicrobial resistance Birth weight Drug resistance Gestational age Medicine Medicine & Public Health Mortality Patients Pediatrics Sepsis Survival |
| title | Retrospective review of antimicrobial use for gastroschisis patients in Kigali, Rwanda: can improved stewardship reduce late inpatient deaths? |
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