No Clinical Benefit of Empirical Antimicrobial Therapy for Pediatric Diarrhea in a High-Usage, High-Resistance Setting
Pediatric diarrheal disease presents a major public health burden in low- to middle-income countries. The clinical benefits of empirical antimicrobial treatment for diarrhea are unclear in settings that lack reliable diagnostics and have high antimicrobial resistance (AMR). We conducted a prospectiv...
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| Veröffentlicht in: | Clinical infectious diseases 2018-02, Vol.66 (4), p.504-511 |
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| creator | Duong, Vu Thuy Tuyen, Ha Thanh Van Minh, Pham Campbell, James I Phuc, Hoang Le Nhu, Tran Do Hoang Tu, Le Thi Phuong Chau, Tran Thi Hong Nhi, Le Thi Quynh Hung, Nguyen Thanh Ngoc, Nguyen Minh Huong, Nguyen Thi Thanh Vi, Lu Lan Thompson, Corinne N Thwaites, Guy E de Alwis, Ruklanthi Baker, Stephen |
| description | Pediatric diarrheal disease presents a major public health burden in low- to middle-income countries. The clinical benefits of empirical antimicrobial treatment for diarrhea are unclear in settings that lack reliable diagnostics and have high antimicrobial resistance (AMR).
We conducted a prospective multicenter cross-sectional study of pediatric patients hospitalized with diarrhea containing blood and/or mucus in Ho Chi Minh City, Vietnam. Clinical parameters, including disease outcome and treatment, were measured. Shigella, nontyphoidal Salmonella (NTS), and Campylobacter were isolated from fecal samples, and their antimicrobial susceptibility profiles were determined. Statistical analyses, comprising log-rank tests and accelerated failure time models, were performed to assess the effect of antimicrobials on disease outcome.
Among 3166 recruited participants (median age 10 months; interquartile range, 6.5-16.7 months), one-third (1096 of 3166) had bloody diarrhea, and 25% (793 of 3166) were culture positive for Shigella, NTS, or Campylobacter. More than 85% of patients (2697 of 3166) were treated with antimicrobials; fluoroquinolones were the most commonly administered antimicrobials. AMR was highly prevalent among the isolated bacteria, including resistance against fluoroquinolones and third-generation cephalosporins. Antimicrobial treatment and multidrug resistance status of the infecting pathogens were found to have no significant effect on outcome. Antimicrobial treatment was significantly associated with an increase in the duration of hospitalization with particular groups of diarrheal diseases.
In a setting with high antimicrobial usage and high AMR, our results imply a lack of clinical benefit for treating diarrhea with antimicrobials; adequately powered randomized controlled trials are required to assess the role of antimicrobials for diarrhea. |
| doi_str_mv | 10.1093/cid/cix844 |
| format | Article |
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We conducted a prospective multicenter cross-sectional study of pediatric patients hospitalized with diarrhea containing blood and/or mucus in Ho Chi Minh City, Vietnam. Clinical parameters, including disease outcome and treatment, were measured. Shigella, nontyphoidal Salmonella (NTS), and Campylobacter were isolated from fecal samples, and their antimicrobial susceptibility profiles were determined. Statistical analyses, comprising log-rank tests and accelerated failure time models, were performed to assess the effect of antimicrobials on disease outcome.
Among 3166 recruited participants (median age 10 months; interquartile range, 6.5-16.7 months), one-third (1096 of 3166) had bloody diarrhea, and 25% (793 of 3166) were culture positive for Shigella, NTS, or Campylobacter. More than 85% of patients (2697 of 3166) were treated with antimicrobials; fluoroquinolones were the most commonly administered antimicrobials. AMR was highly prevalent among the isolated bacteria, including resistance against fluoroquinolones and third-generation cephalosporins. Antimicrobial treatment and multidrug resistance status of the infecting pathogens were found to have no significant effect on outcome. Antimicrobial treatment was significantly associated with an increase in the duration of hospitalization with particular groups of diarrheal diseases.
In a setting with high antimicrobial usage and high AMR, our results imply a lack of clinical benefit for treating diarrhea with antimicrobials; adequately powered randomized controlled trials are required to assess the role of antimicrobials for diarrhea.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/cix844</identifier><identifier>PMID: 29029149</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Accelerated tests ; Adolescent ; and Commentaries ; Anti-Bacterial Agents - therapeutic use ; Antiinfectives and antibacterials ; Antimicrobial agents ; Antimicrobial resistance ; Bacteria ; Campylobacter ; Campylobacter - drug effects ; Cephalosporins ; Child ; Child, Preschool ; Clinical trials ; Cross-Sectional Studies ; Diarrhea ; Diarrhea - drug therapy ; Diarrhea - microbiology ; Drug resistance ; Drug Resistance, Multiple, Bacterial ; Empirical analysis ; Failure analysis ; Feces - microbiology ; Female ; Fluoroquinolones ; Humans ; Infant ; Male ; Medical treatment ; Microbial Sensitivity Tests ; Mucus ; Multidrug resistance ; Patients ; Pediatrics ; Prevalence ; Prospective Studies ; Public health ; Rank tests ; Salmonella ; Salmonella - drug effects ; Shigella ; Shigella - drug effects ; Statistical analysis ; Statistical methods ; Treatment Outcome ; Vietnam</subject><ispartof>Clinical infectious diseases, 2018-02, Vol.66 (4), p.504-511</ispartof><rights>The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.</rights><rights>Copyright Oxford University Press, UK Feb 15, 2018</rights><rights>The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c406t-9f141381cc478ce255572ccb8d2bd8ba1eab5eed6549d4fbb1a50a62bcbe56fd3</citedby><cites>FETCH-LOGICAL-c406t-9f141381cc478ce255572ccb8d2bd8ba1eab5eed6549d4fbb1a50a62bcbe56fd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29029149$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Duong, Vu Thuy</creatorcontrib><creatorcontrib>Tuyen, Ha Thanh</creatorcontrib><creatorcontrib>Van Minh, Pham</creatorcontrib><creatorcontrib>Campbell, James I</creatorcontrib><creatorcontrib>Phuc, Hoang Le</creatorcontrib><creatorcontrib>Nhu, Tran Do Hoang</creatorcontrib><creatorcontrib>Tu, Le Thi Phuong</creatorcontrib><creatorcontrib>Chau, Tran Thi Hong</creatorcontrib><creatorcontrib>Nhi, Le Thi Quynh</creatorcontrib><creatorcontrib>Hung, Nguyen Thanh</creatorcontrib><creatorcontrib>Ngoc, Nguyen Minh</creatorcontrib><creatorcontrib>Huong, Nguyen Thi Thanh</creatorcontrib><creatorcontrib>Vi, Lu Lan</creatorcontrib><creatorcontrib>Thompson, Corinne N</creatorcontrib><creatorcontrib>Thwaites, Guy E</creatorcontrib><creatorcontrib>de Alwis, Ruklanthi</creatorcontrib><creatorcontrib>Baker, Stephen</creatorcontrib><title>No Clinical Benefit of Empirical Antimicrobial Therapy for Pediatric Diarrhea in a High-Usage, High-Resistance Setting</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Pediatric diarrheal disease presents a major public health burden in low- to middle-income countries. The clinical benefits of empirical antimicrobial treatment for diarrhea are unclear in settings that lack reliable diagnostics and have high antimicrobial resistance (AMR).
We conducted a prospective multicenter cross-sectional study of pediatric patients hospitalized with diarrhea containing blood and/or mucus in Ho Chi Minh City, Vietnam. Clinical parameters, including disease outcome and treatment, were measured. Shigella, nontyphoidal Salmonella (NTS), and Campylobacter were isolated from fecal samples, and their antimicrobial susceptibility profiles were determined. Statistical analyses, comprising log-rank tests and accelerated failure time models, were performed to assess the effect of antimicrobials on disease outcome.
Among 3166 recruited participants (median age 10 months; interquartile range, 6.5-16.7 months), one-third (1096 of 3166) had bloody diarrhea, and 25% (793 of 3166) were culture positive for Shigella, NTS, or Campylobacter. More than 85% of patients (2697 of 3166) were treated with antimicrobials; fluoroquinolones were the most commonly administered antimicrobials. AMR was highly prevalent among the isolated bacteria, including resistance against fluoroquinolones and third-generation cephalosporins. Antimicrobial treatment and multidrug resistance status of the infecting pathogens were found to have no significant effect on outcome. Antimicrobial treatment was significantly associated with an increase in the duration of hospitalization with particular groups of diarrheal diseases.
In a setting with high antimicrobial usage and high AMR, our results imply a lack of clinical benefit for treating diarrhea with antimicrobials; adequately powered randomized controlled trials are required to assess the role of antimicrobials for diarrhea.</description><subject>Accelerated tests</subject><subject>Adolescent</subject><subject>and Commentaries</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antiinfectives and antibacterials</subject><subject>Antimicrobial agents</subject><subject>Antimicrobial resistance</subject><subject>Bacteria</subject><subject>Campylobacter</subject><subject>Campylobacter - drug effects</subject><subject>Cephalosporins</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical trials</subject><subject>Cross-Sectional Studies</subject><subject>Diarrhea</subject><subject>Diarrhea - drug therapy</subject><subject>Diarrhea - microbiology</subject><subject>Drug resistance</subject><subject>Drug Resistance, Multiple, Bacterial</subject><subject>Empirical analysis</subject><subject>Failure analysis</subject><subject>Feces - microbiology</subject><subject>Female</subject><subject>Fluoroquinolones</subject><subject>Humans</subject><subject>Infant</subject><subject>Male</subject><subject>Medical treatment</subject><subject>Microbial Sensitivity Tests</subject><subject>Mucus</subject><subject>Multidrug resistance</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Public health</subject><subject>Rank tests</subject><subject>Salmonella</subject><subject>Salmonella - drug effects</subject><subject>Shigella</subject><subject>Shigella - drug effects</subject><subject>Statistical analysis</subject><subject>Statistical methods</subject><subject>Treatment Outcome</subject><subject>Vietnam</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkVFvFCEQx4nR2Pb0xQ9gSHwxjauwC7vwYlLP1jZp1Gj7TICdvZtmlz2Ba-y3l_baRn2YMMP8MvOHPyGvOHvPmW4-eOxL_FZCPCH7XDZd1UrNn5acSVUJ1ag9cpDSFWOcKyafk71as1pzoffJ9deZLkcM6O1IP0GAATOdB3o8bTDeXR6FjBP6ODss1cUaot3c0GGO9Dv0aHOh6Ge0Ma7BUgzU0lNcravLZFfwbpf_gIQp2-CB_oScMaxekGeDHRO8vD8X5PLk-GJ5Wp1_-3K2PDqvvGBtrvTABW8U9150ykMtpexq753qa9crZzlYJwH6Vgrdi8E5biWzbe28A9kOfbMgH3dzN1s3Qe8h5GhHs4k42XhjZovm307AtVnN10YqyVjZvSBv7wfE-dcWUjYTJg_jaAPM22S4lkVix7Qo6Jv_0Kt5G0N5nqkZ69qOdfKWOtxR5UdTijA8iuHM3Nppip1mZ2eBX_8t_xF98K_5AwSqng0</recordid><startdate>20180215</startdate><enddate>20180215</enddate><creator>Duong, Vu Thuy</creator><creator>Tuyen, Ha Thanh</creator><creator>Van Minh, Pham</creator><creator>Campbell, James I</creator><creator>Phuc, Hoang Le</creator><creator>Nhu, Tran Do Hoang</creator><creator>Tu, Le Thi Phuong</creator><creator>Chau, Tran Thi Hong</creator><creator>Nhi, Le Thi Quynh</creator><creator>Hung, Nguyen Thanh</creator><creator>Ngoc, Nguyen Minh</creator><creator>Huong, Nguyen Thi Thanh</creator><creator>Vi, Lu Lan</creator><creator>Thompson, Corinne N</creator><creator>Thwaites, Guy E</creator><creator>de Alwis, Ruklanthi</creator><creator>Baker, Stephen</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180215</creationdate><title>No Clinical Benefit of Empirical Antimicrobial Therapy for Pediatric Diarrhea in a High-Usage, High-Resistance Setting</title><author>Duong, Vu Thuy ; Tuyen, Ha Thanh ; Van Minh, Pham ; Campbell, James I ; Phuc, Hoang Le ; Nhu, Tran Do Hoang ; Tu, Le Thi Phuong ; Chau, Tran Thi Hong ; Nhi, Le Thi Quynh ; Hung, Nguyen Thanh ; Ngoc, Nguyen Minh ; Huong, Nguyen Thi Thanh ; Vi, Lu Lan ; Thompson, Corinne N ; Thwaites, Guy E ; de Alwis, Ruklanthi ; Baker, Stephen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c406t-9f141381cc478ce255572ccb8d2bd8ba1eab5eed6549d4fbb1a50a62bcbe56fd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Accelerated tests</topic><topic>Adolescent</topic><topic>and Commentaries</topic><topic>Anti-Bacterial Agents - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Duong, Vu Thuy</au><au>Tuyen, Ha Thanh</au><au>Van Minh, Pham</au><au>Campbell, James I</au><au>Phuc, Hoang Le</au><au>Nhu, Tran Do Hoang</au><au>Tu, Le Thi Phuong</au><au>Chau, Tran Thi Hong</au><au>Nhi, Le Thi Quynh</au><au>Hung, Nguyen Thanh</au><au>Ngoc, Nguyen Minh</au><au>Huong, Nguyen Thi Thanh</au><au>Vi, Lu Lan</au><au>Thompson, Corinne N</au><au>Thwaites, Guy E</au><au>de Alwis, Ruklanthi</au><au>Baker, Stephen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>No Clinical Benefit of Empirical Antimicrobial Therapy for Pediatric Diarrhea in a High-Usage, High-Resistance Setting</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2018-02-15</date><risdate>2018</risdate><volume>66</volume><issue>4</issue><spage>504</spage><epage>511</epage><pages>504-511</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Pediatric diarrheal disease presents a major public health burden in low- to middle-income countries. The clinical benefits of empirical antimicrobial treatment for diarrhea are unclear in settings that lack reliable diagnostics and have high antimicrobial resistance (AMR).
We conducted a prospective multicenter cross-sectional study of pediatric patients hospitalized with diarrhea containing blood and/or mucus in Ho Chi Minh City, Vietnam. Clinical parameters, including disease outcome and treatment, were measured. Shigella, nontyphoidal Salmonella (NTS), and Campylobacter were isolated from fecal samples, and their antimicrobial susceptibility profiles were determined. Statistical analyses, comprising log-rank tests and accelerated failure time models, were performed to assess the effect of antimicrobials on disease outcome.
Among 3166 recruited participants (median age 10 months; interquartile range, 6.5-16.7 months), one-third (1096 of 3166) had bloody diarrhea, and 25% (793 of 3166) were culture positive for Shigella, NTS, or Campylobacter. More than 85% of patients (2697 of 3166) were treated with antimicrobials; fluoroquinolones were the most commonly administered antimicrobials. AMR was highly prevalent among the isolated bacteria, including resistance against fluoroquinolones and third-generation cephalosporins. Antimicrobial treatment and multidrug resistance status of the infecting pathogens were found to have no significant effect on outcome. Antimicrobial treatment was significantly associated with an increase in the duration of hospitalization with particular groups of diarrheal diseases.
In a setting with high antimicrobial usage and high AMR, our results imply a lack of clinical benefit for treating diarrhea with antimicrobials; adequately powered randomized controlled trials are required to assess the role of antimicrobials for diarrhea.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>29029149</pmid><doi>10.1093/cid/cix844</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical infectious diseases, 2018-02, Vol.66 (4), p.504-511 |
| issn | 1058-4838 1537-6591 |
| language | eng |
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| source | Jstor Complete Legacy; Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Accelerated tests Adolescent and Commentaries Anti-Bacterial Agents - therapeutic use Antiinfectives and antibacterials Antimicrobial agents Antimicrobial resistance Bacteria Campylobacter Campylobacter - drug effects Cephalosporins Child Child, Preschool Clinical trials Cross-Sectional Studies Diarrhea Diarrhea - drug therapy Diarrhea - microbiology Drug resistance Drug Resistance, Multiple, Bacterial Empirical analysis Failure analysis Feces - microbiology Female Fluoroquinolones Humans Infant Male Medical treatment Microbial Sensitivity Tests Mucus Multidrug resistance Patients Pediatrics Prevalence Prospective Studies Public health Rank tests Salmonella Salmonella - drug effects Shigella Shigella - drug effects Statistical analysis Statistical methods Treatment Outcome Vietnam |
| title | No Clinical Benefit of Empirical Antimicrobial Therapy for Pediatric Diarrhea in a High-Usage, High-Resistance Setting |
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