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Objectives\ud The aim of this study was to describe antibiotic prescribing patterns and resistance rates in hospitalised children with febrile and afebrile urinary tract infections (UTIs).\ud \ud Methods\ud We evaluated antibiotic prescriptions and antibiograms for neonates, infants and older children with a UTI admitted to a general district hospital in central Greece. Data was collected retrospectively from the Paediatric Department’s Electronic Clinical Archive, covering a 5-year period. Patients were included based on clinical and microbiological criteria. Sensitivity to antimicrobials was determined using the Kirby-Bauer disk diffusion method.\ud \ud Results\ud Two hundred and thirty patients were included in the study. Among 459 prescriptions identified, amikacin (31.2%) was the most common antibiotic prescribed in this population, followed by amoxicillin-clavulanic acid (17.4%) and ampicillin (13.5%). Children received prolonged intravenous treatments for febrile (mean 5.4 days; SD 1.45) and afebrile UTIs (mean 4.7 days; SD 1.34). A total of 236 pathogens were isolated. The main causative organism was Escherichia coli (79.2%) with high reported resistance rates to ampicillin (42.0%), trimethoprim-sulfamethoxazole (26.5%) and amoxicillin/clavulanic acid (12.2%). Lower resistance rates were identified for 3rd generation cephalosporins (1.7%), nitrofurantoin (2.3%), ciprofloxacin (1.3%) and amikacin (0.9%). Klebsiella sp. isolates were highly resistant to cefaclor (27.3%).\ud \ud Conclusion\ud We observed high prescribing rates for amikacin and penicillins (+/-beta lactamase inhibitors) and prolonged intravenous treatments. E.coli appeared to be highly resistant to ampicillin, whilst 3rd generation cephalosporins exhibited higher in vitro efficacy. The establishment of antimicrobial stewardship programs and regular monitoring of antimicrobial resistance could help to minimise inappropriate prescribing for UTIs.

BACKGROUND: Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions. METHODS: 1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance networks. We included hospital inpatients aged younger than 19 years receiving at least one antibiotic on the day of the survey. The WHO AWaRe classification was used to describe overall antibiotic use as assessed by the variation between use of Access, Watch, and Reserve antibiotics, for neonates and children and for the commonest clinical indications. FINDINGS: Of the 23 572 patients included from 56 countries, 18 305 were children (77·7%) and 5267 were neonates (22·3%). Access antibiotic use in children ranged from 7·8% (China) to 61·2% (Slovenia) of all antibiotic prescriptions. The use of Watch antibiotics in children was highest in Iran (77·3%) and lowest in Finland (23·0%). In neonates, Access antibiotic use was highest in Singapore (100·0%) and lowest in China (24·2%). Reserve antibiotic use was low in all countries. Major differences in clinical syndrome-specific patterns of AWaRe antibiotic use in lower respiratory tract infection and neonatal sepsis were observed between WHO regions and countries. INTERPRETATION: There is substantial global variation in the proportion of AWaRe antibiotics used in hospitalised neonates and children. The AWaRe classification could potentially be used as a simple traffic light metric of appropriate antibiotic use. Future efforts should focus on developing and evaluating paediatric antibiotic stewardship programmes on the basis of the AWaRe index. FUNDING: GARPEC was funded by the PENTA Foundation. GARPEC-China data collection was funded by the Sanming Project of Medicine in Shenzhen (SZSM2015120330). bioMérieux provided unrestricted funding support for the Global-PPS.

An AFM based measurement of the disjoining pressure ( Π ) is described. For the measurement of nano-thin fluids on hard substrates it was shown that specific experimental requirements are placed on the cantilever stiffness and probe radius. The disjoining pressure of Fomblin Z03 was then measured on a Si surface and found to be consistent with literature values. The disjoining pressures ( Π ) of 25 A Zdol on SiN x films deposited under a flowing-gas of N 2 was measured and a sharp decrease in Π was observed with increasing N 2 concentration (in the gas) that was assigned to the decrease in the polarizability and/or the density of polarizable species in the surface.