Search

Purpose: Antimicrobial agents are frequently prescribed during pregnancy. This study aims to explore the association between antimicrobial exposure and pregnancy outcomes. Patients and Methods: A multi-center retrospective cohort study of pregnant patients (n=370) was conducted in 22 tertiary hospitals in China. Adverse pregnancy outcomes and admission of neonate to neonatal intensive care unit (NICU) were considered as outcomes. The effect of antimicrobial exposure on pregnancy outcomes was assessed using a multivariate logistic regression model. Results: Use of first-generation cephalosporins during pregnancy was associated with a significantly higher risk of adverse pregnancy outcomes (odds ratio [OR]: 3.64 [95% confidence interval, CI: 1.43– 9.24], P =  0.007) and admission of neonate to the NICU (OR: 3.41, 95% CI: 1.37– 8.53, P=0.009) compared with use of third-generation cephalosporins, after adjusting for gestational age of exposure to antimicrobial agents, cesarean section, and antimicrobial dose. Similarly, a higher risk of adverse pregnancy outcomes (OR: 14.76, 95% CI: 4.43– 49.11) and neonatal NICU admission (OR: 11.74, 95% CI: 3.59– 38.35) were observed among women with first-generation cephalosporins use compared with mothers with no antimicrobial use. Conclusion: Both first- and third-generation cephalosporins use was associated with an increased risk of adverse pregnancy and neonatal outcomes. In addition, first-generation cephalosporins were associated with an increased risk of those pregnant and neonatal outcomes, when compared with third-generation cephalosporins. We should require to determine the indications and contraindications for use of cephalosporins during pregnancy. [ABSTRACT FROM AUTHOR]

Background The purpose of the study was to investigate parents’ perceptions of antibiotic use for their children, interactions between parents and physicians regarding treatment with antibiotics, and factors associated with parents self-medicating children with antibiotics. Methods A cross-sectional study was conducted in vaccination clinics in two rural Chinese counties. Primary caregivers (the child’s parents in 97% of cases) visiting these clinics for the vaccination of their young children were given a 55-item structured questionnaire to collect information on the parents’ knowledge and attitudes regarding when, why, and how to use antibiotics and on their practices of purchasing antibiotics and medicating children. Results Of the 854 participating primary caregivers, 79% thought antibiotics could cure viral infections, and half believed that antibiotics could shorten the duration of upper respiratory tract infection. Parents reported a median of two hospital visits for their children during the previous 6 months, equal to the median number of antibiotic prescriptions received from physicians. Sixty-two percent of the parents had self-medicated their children with antibiotics. Living in rural villages (Adj OR = 1.643, 95% CI: 1.108–2.436), raising more than one child (Adj OR = 2.174, 95% CI: 1.485–3.183), increasing age of child (Adj OR = 1.146, 95% CI: 1.037–1.266), purchasing antibiotics without a prescription (Adj OR = 6.264, 95% CI: 4.144–9.469), storing antibiotics at home (Adj OR = 2.792, 95% CI: 1.961–3.975) and good adherence to physicians’ advice (Adj OR = 0.639, 95% CI: 0.451–0.906) were independently associated with self-medicating behavior. Conclusions Low levels of knowledge on the use of antibiotics and a high prevalence of self-medicating children with antibiotics were observed among parents in rural China. Interventions for the rational use of antibiotics in children should focus on strengthening mass health education, improving effective communication between physicians and patients, and enforcing supervision of the sale of antibiotics in retail pharmacies. [ABSTRACT FROM AUTHOR]

Objective: To study bacterial resistance in children and newborns aged less than 14 years across China from 2014 to 2017. Methods: Bacterial resistance data on children and newborns were extracted from the national bacterial resistance surveillance reports from 2014 to 2017. Resistance trends in children and newborns were analyzed over the past four years, and compared with the adult and elderly groups. Results: Among all strains, the isolates collected from children and newborns from 2014 to 2017 accounted for 16.2%, 13.8%, 15.3% and 16.3%, respectively. The proportions of gram-positive bacteria among strains isolated from children and newborns, which were apparently higher than that of the adult and elderly groups, were 42.6%, 44.3%, 45.8% and 45.5%, respectively. The top five isolates of gram-positive bacteria were Staphylococcus aureus, Streptococcus pneumoniae, coagulase-negative staphylococci, Enterococcus faecium and E . faecalis . The top five isolates of gram-negative bacteria were Escherichia coli, Klebsiella pneumonia, Haemophilus influenzae, Pseudomonas aeruginosa and Acinetobacter baumannii . The proportion of urine-derived bacteria isolated from children and newborns (6.1%-7.1%) was apparently lower than that of the adult and elderly groups, while sputum (49.2%-52.8%) and blood-derived (11.4%-13.8%) were higher than the adult group. The prevalence of cefotaxime-resistant E . coli and K . pneumoniae decreased from 58.3% to 52.0% and 51.2% to 45.0%, respectively. The prevalence of imipenem-resistant E . coli and K . pneumoniae increased from 1.2% to 1.9% and 5.6% to 8.8%, respectively. The prevalence of imipenem-resistant P . aeruginosa increased from 11.0% to 12.4%, however, the prevalence of imipenem-resistant A . baumannii decreased from 27.2% to 24.6%. The prevalence of methicillin-resistant S . aureus increased from 27.5% to 29.5%. The prevalence of vancomycin-resistant- E . faecalis / E . faecium decreased from 0.6% to 0.2% and 0.9% to 0.3%, respectively. The proportion of non-cerebrospinal fluid-derived penicillin-resistant S . pneumoniae decresed from 5.1% to 2.7%. Conclusions: The prevalence of several drug-resistant bacteria isolated from children and newborns were decreasing, but the prevalence of imipenem-resistant E . coli, imipenem-resistant K . pneumoniae and methicillin-resistant S . aureus increased slowly. It is still necessary to strengthen antibiotics rational application management and hospital infection control, and maintain good practice in bacterial resistance surveillance work.