Mostrar el registro sencillo del ítem

dc.contributor.authorHagedoorn, N. N.
dc.contributor.authorBorensztajn, D. M.
dc.contributor.authorNijman, R.
dc.contributor.authorBalode, A.
dc.contributor.authorvon Both, U.
dc.contributor.authorCarrol, E. D.
dc.contributor.authorEleftheriou, I.
dc.contributor.authorEmonts, M.
dc.contributor.authorvan der Flier, M.
dc.contributor.authorde Groot, R.
dc.contributor.authorHerberg, J.
dc.contributor.authorKohlmaier, B.
dc.contributor.authorLim, E.
dc.contributor.authorMaconochie, I.
dc.contributor.authorMartinón Torres, Federico 
dc.contributor.authorNieboer, D.
dc.contributor.authorPokorn, M.
dc.contributor.authorStrle, F.
dc.contributor.authorTsolia, M.
dc.contributor.authorYeung, S.
dc.contributor.authorZavadska, D.
dc.contributor.authorZenz, W.
dc.contributor.authorVermont, C.
dc.contributor.authorLevin, M.
dc.contributor.authorMoll, H. A.
dc.contributor.authorConsortium, Perform
dc.date.accessioned2022-04-29T10:28:30Z
dc.date.available2022-04-29T10:28:30Z
dc.date.issued2020
dc.identifier.issn1549-1277
dc.identifier.otherhttps://www.ncbi.nlm.nih.gov/pubmed/32813708es
dc.identifier.urihttp://hdl.handle.net/20.500.11940/16637
dc.description.abstractBACKGROUND: The prescription rate of antibiotics is high for febrile children visiting the emergency department (ED), contributing to antimicrobial resistance. Large studies at European EDs covering diversity in antibiotic and broad-spectrum prescriptions in all febrile children are lacking. A better understanding of variability in antibiotic prescriptions in EDs and its relation with viral or bacterial disease is essential for the development and implementation of interventions to optimise antibiotic use. As part of the PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union) project, the MOFICHE (Management and Outcome of Fever in Children in Europe) study aims to investigate variation and appropriateness of antibiotic prescription in febrile children visiting EDs in Europe. METHODS AND FINDINGS: Between January 2017 and April 2018, data were prospectively collected on febrile children aged 0-18 years presenting to 12 EDs in 8 European countries (Austria, Germany, Greece, Latvia, the Netherlands [n = 3], Spain, Slovenia, United Kingdom [n = 3]). These EDs were based in university hospitals (n = 9) or large teaching hospitals (n = 3). Main outcomes were (1) antibiotic prescription rate; (2) the proportion of antibiotics that were broad-spectrum antibiotics; (3) the proportion of antibiotics of appropriate indication (presumed bacterial), inappropriate indication (presumed viral), or inconclusive indication (unknown bacterial/viral or other); (4) the proportion of oral antibiotics of inappropriate duration; and (5) the proportion of antibiotics that were guideline-concordant in uncomplicated urinary and upper and lower respiratory tract infections (RTIs). We determined variation of antibiotic prescription and broad-spectrum prescription by calculating standardised prescription rates using multilevel logistic regression and adjusted for general characteristics (e.g., age, sex, comorbidity, referral), disease severity (e.g., triage level, fever duration, presence of alarming signs), use and result of diagnostics, and focus and cause of infection. In this analysis of 35,650 children (median age 2.8 years, 55% male), overall antibiotic prescription rate was 31.9% (range across EDs: 22.4%-41.6%), and among those prescriptions, the broad-spectrum antibiotic prescription rate was 52.1% (range across EDs: 33.0%-90.3%). After standardisation, differences in antibiotic prescriptions ranged from 0.8 to 1.4, and the ratio between broad-spectrum and narrow-spectrum prescriptions ranged from 0.7 to 1.8 across EDs. Standardised antibiotic prescription rates varied for presumed bacterial infections (0.9 to 1.1), presumed viral infections (0.1 to 3.3), and infections of unknown cause (0.1 to 1.8). In all febrile children, antibiotic prescriptions were appropriate in 65.0% of prescriptions, inappropriate in 12.5% (range across EDs: 0.6%-29.3%), and inconclusive in 22.5% (range across EDs: 0.4%-60.8%). Prescriptions were of inappropriate duration in 20% of oral prescriptions (range across EDs: 4.4%-59.0%). Oral prescriptions were not concordant with the local guideline in 22.3% (range across EDs: 11.8%-47.3%) of prescriptions in uncomplicated RTIs and in 45.1% (range across EDs: 11.1%-100%) of prescriptions in uncomplicated urinary tract infections. A limitation of our study is that the included EDs are not representative of all febrile children attending EDs in that country. CONCLUSIONS: In this study, we observed wide variation between European EDs in prescriptions of antibiotics and broad-spectrum antibiotics in febrile children. Overall, one-third of prescriptions were inappropriate or inconclusive, with marked variation between EDs. Until better diagnostics are available to accurately differentiate between bacterial and viral aetiologies, implementation of antimicrobial stewardship guidelines across Europe is necessary to limit antimicrobial resistance.en
dc.rightsAtribución 4.0 Internacional
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subject.meshFever*
dc.subject.meshHumans*
dc.subject.meshAdolescent*
dc.subject.meshDrug Resistance*
dc.subject.meshProspective Studies*
dc.subject.meshAnti-Bacterial Agents*
dc.subject.meshBacterial Infections*
dc.subject.meshInfant*
dc.titleVariation in antibiotic prescription rates in febrile children presenting to emergency departments across Europe (MOFICHE): A multicentre observational studyen
dc.typeJournal Articlees
dc.authorsophosHagedoorn, N. N.;Borensztajn, D. M.;Nijman, R.;Balode, A.;von Both, U.;Carrol, E. D.;Eleftheriou, I.;Emonts, M.;van der Flier, M.;de Groot, R.;Herberg, J.;Kohlmaier, B.;Lim, E.;Maconochie, I.;Martinon-Torres, F.;Nieboer, D.;Pokorn, M.;Strle, F.;Tsolia, M.;Yeung, S.;Zavadska, D.;Zenz, W.;Vermont, C.;Levin, M.;Moll, H. A.;Consortium, Perform
dc.identifier.doi10.1371/journal.pmed.1003208
dc.identifier.pmid32813708
dc.identifier.sophos39739
dc.issue.number8es
dc.journal.titlePLOS MEDICINEes
dc.organizationServizo Galego de Saúde::Estrutura de Xestión Integrada (EOXI)::EOXI de Santiago de Compostela - Complexo Hospitalario Universitario de Santiago de Compostela::Pediatríaes
dc.organizationServizo Galego de Saúde::Estrutura de Xestión Integrada (EOXI)::Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS)es
dc.rights.accessRightsopenAccess
dc.subject.decsinfecciones bacterianas*
dc.subject.decsresistencia a medicamentos*
dc.subject.decsestudios prospectivos*
dc.subject.decslactante*
dc.subject.decshumanos*
dc.subject.decsfiebre*
dc.subject.decsantibacterianos*
dc.subject.decsadolescente*
dc.subject.keywordCHUSes
dc.subject.keywordIDISes
dc.typefidesArtículo Originales
dc.typesophosArtículo Originales
dc.volume.number17es


Ficheros en el ítem

Este ítem aparece en la(s) siguiente(s) colección(ones)

Mostrar el registro sencillo del ítem

Atribución 4.0 Internacional
Excepto si se señala otra cosa, la licencia del ítem se describe como Atribución 4.0 Internacional