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      Antibiotic Prescribing in Children Hospitalized With COVID-19 and Multisystem Inflammatory Syndrome in Spain: Prevalence, Trends, and Associated Factors

      brief-report
      Author(s): 1 , 2 , 3 , 4 , 5 , 6 , , 7 , 3 , 8 , 4 , 9 , 10 , 11 , 12 , 1 , 2 , 3 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 3 , 8 , 20 , 21 , 5 , 6 , 5 , 6 , 5 , 6 , 15 , 16 , 5 , 6 , 5 , 6 , 15 , 16 , 4 , 5 , 6
      Publication date (Electronic):
      Journal: Journal of the Pediatric Infectious Diseases Society
      Publisher: Oxford University Press
      Keywords: antibiotic stewardship, bacterial infections, children, COVID-19, SARS-CoV-2

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          Abstract

          The SARS-CoV-2 pandemic has caused an increase in antibiotic use in different settings. We describe the antibiotic prescribing prevalence, associated factors and trends, as well as concomitant bacterial infections in children hospitalized with COVID-19 or multisystemic inflammatory syndrome related to SARS-CoV-2 in Spain.

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          Co-infections in people with COVID-19: a systematic review and meta-analysis

          Louise Lansbury, Benjamin W.H. Lim, Vadsala Baskaran … (2020)
          Highlights • SARS-CoV-2, the cause of COVID19 disease, has spread globally since late 2019 • Bacterial coinfections associated with mortality in previous influenza pandemics • Proportion of COVID19 patients with bacterial coinfection less than in flu pandemics • Higher proportion of critically-ill with bacterial coinfections than in mixed setting • Bacterial co-pathogen profiles different to those in influenza co-infections • Fungal coinfection diagnosis difficult so high level suspicion in critically-ill
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            Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis

            Bradley Langford, Miranda So, Sumit Raybardhan … (2020)
            Background Bacterial co-pathogens are commonly identified in viral respiratory infections and are important causes of morbidity and mortality. The prevalence of bacterial infection in patients infected with SARS-CoV-2 is not well understood. Aims To determine the prevalence of bacterial co-infection (at presentation) and secondary infection (after presentation) in patients with COVID-19. Sources We performed a systematic search of MEDLINE, OVID Epub and EMBASE databases for English language literature from 2019 to April 16, 2020. Studies were included if they (a) evaluated patients with confirmed COVID-19 and (b) reported the prevalence of acute bacterial infection. Content Data were extracted by a single reviewer and cross-checked by a second reviewer. The main outcome was the proportion of COVID-19 patients with an acute bacterial infection. Any bacteria detected from non-respiratory-tract or non-bloodstream sources were excluded. Of 1308 studies screened, 24 were eligible and included in the rapid review representing 3338 patients with COVID-19 evaluated for acute bacterial infection. In the meta-analysis, bacterial co-infection (estimated on presentation) was identified in 3.5% of patients (95%CI 0.4–6.7%) and secondary bacterial infection in 14.3% of patients (95%CI 9.6–18.9%). The overall proportion of COVID-19 patients with bacterial infection was 6.9% (95%CI 4.3–9.5%). Bacterial infection was more common in critically ill patients (8.1%, 95%CI 2.3–13.8%). The majority of patients with COVID-19 received antibiotics (71.9%, 95%CI 56.1 to 87.7%). Implications Bacterial co-infection is relatively infrequent in hospitalized patients with COVID-19. The majority of these patients may not require empirical antibacterial treatment.
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              Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study

              Olivia V Swann, Karl A Holden, Lance Turtle … (2020)
              Abstract Objective To characterise the clinical features of children and young people admitted to hospital with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the UK and explore factors associated with admission to critical care, mortality, and development of multisystem inflammatory syndrome in children and adolescents temporarily related to coronavirus disease 2019 (covid-19) (MIS-C). Design Prospective observational cohort study with rapid data gathering and near real time analysis. Setting 260 hospitals in England, Wales, and Scotland between 17 January and 3 July 2020, with a minimum follow-up time of two weeks (to 17 July 2020). Participants 651 children and young people aged less than 19 years admitted to 138 hospitals and enrolled into the International Severe Acute Respiratory and emergency Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol UK study with laboratory confirmed SARS-CoV-2. Main outcome measures Admission to critical care (high dependency or intensive care), in-hospital mortality, or meeting the WHO preliminary case definition for MIS-C. Results Median age was 4.6 (interquartile range 0.3-13.7) years, 35% (225/651) were under 12 months old, and 56% (367/650) were male. 57% (330/576) were white, 12% (67/576) South Asian, and 10% (56/576) black. 42% (276/651) had at least one recorded comorbidity. A systemic mucocutaneous-enteric cluster of symptoms was identified, which encompassed the symptoms for the WHO MIS-C criteria. 18% (116/632) of children were admitted to critical care. On multivariable analysis, this was associated with age under 1 month (odds ratio 3.21, 95% confidence interval 1.36 to 7.66; P=0.008), age 10-14 years (3.23, 1.55 to 6.99; P=0.002), and black ethnicity (2.82, 1.41 to 5.57; P=0.003). Six (1%) of 627 patients died in hospital, all of whom had profound comorbidity. 11% (52/456) met the WHO MIS-C criteria, with the first patient developing symptoms in mid-March. Children meeting MIS-C criteria were older (median age 10.7 (8.3-14.1) v 1.6 (0.2-12.9) years; P<0.001) and more likely to be of non-white ethnicity (64% (29/45) v 42% (148/355); P=0.004). Children with MIS-C were five times more likely to be admitted to critical care (73% (38/52) v 15% (62/404); P<0.001). In addition to the WHO criteria, children with MIS-C were more likely to present with fatigue (51% (24/47) v 28% (86/302); P=0.004), headache (34% (16/47) v 10% (26/263); P<0.001), myalgia (34% (15/44) v 8% (21/270); P<0.001), sore throat (30% (14/47) v (12% (34/284); P=0.003), and lymphadenopathy (20% (9/46) v 3% (10/318); P<0.001) and to have a platelet count of less than 150 × 109/L (32% (16/50) v 11% (38/348); P<0.001) than children who did not have MIS-C. No deaths occurred in the MIS-C group. Conclusions Children and young people have less severe acute covid-19 than adults. A systemic mucocutaneous-enteric symptom cluster was also identified in acute cases that shares features with MIS-C. This study provides additional evidence for refining the WHO MIS-C preliminary case definition. Children meeting the MIS-C criteria have different demographic and clinical features depending on whether they have acute SARS-CoV-2 infection (polymerase chain reaction positive) or are post-acute (antibody positive). Study registration ISRCTN66726260.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Pediatric Infect Dis Soc
                Journal ID (iso-abbrev): J Pediatric Infect Dis Soc
                Journal ID (publisher-id): jpids
                Title: Journal of the Pediatric Infectious Diseases Society
                Publisher: Oxford University Press (US )
                ISSN (Print): 2048-7193
                ISSN (Electronic): 2048-7207
                Publication date (Electronic): 21 February 2022
                Publication date PMC-release: 21 February 2022
                Electronic Location Identifier: piac003
                Affiliations
                [1 ] Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón , Madrid, Spain
                [2 ] Unidad de Investigación Maternoinfantil Fundación Familia Alonso (UDIMIFFA), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) , Madrid, Spain
                [3 ] CIBER en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III , Madrid, Spain
                [4 ] Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre , Madrid, Spain
                [5 ] Pediatric Research and Clinical Trials Unit (UPIC), Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12) , Madrid, Spain
                [6 ] Fundación para la Investigación Biomédica del Hospital 12 de Octubre, RITIP (Traslational Research Network in Pediatric Infectious Diseases) , Madrid, Spain
                [7 ] Department of Pediatrics, Hospital Infantil Universitario Niño Jesús , Madrid, Spain
                [8 ] Pediatrics, Infectious and Tropical Diseases Department, Hospital Universitario La Paz, Instituto Investigación Hospital La Paz (IDIPaz), RITIP (Traslational Research Network in Pediatric Infectious Diseases) , Madrid, Spain
                [9 ] Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall dʹHebron, Vall dʹHebron Research Institute , Barcelona, Spain
                [10 ] Department of Pediatrics, Hospital Virgen de la Arrixaca , Murcia, Spain
                [11 ] Pediatrics Department, Complejo Hospitalario de Navarra , Pamplona, Spain
                [12 ] Pediatrics Department, Hospital Sant Joan de Déu (HSJD) , Barcelona, Spain
                [13 ] Pediatric Critical Care Service, Hospital Universitario Cruces , Barakaldo, Spain
                [14 ] Pediatric Critical Care Group, BioCruces Health Research Institute , Barakaldo, Spain
                [15 ] Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes , Madrid, Spain
                [16 ] Universidad Europea , Madrid, Spain
                [17 ] Department of Pediatrics, Hospital Lozano Blesa , Zaragoza, Spain
                [18 ] Department of Pediatrics, Hospital Sant Joan dʹAlacant, Alicante, Spain
                [19 ] Department of Pediatrics, Hospital Universitario Severo Ochoa , Madrid, Spain
                [20 ] Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús , Madrid, Spain
                [21 ] Department of Pharmacy, Hospital Universitario 12 de Octubre , Madrid, Spain
                Author notes
                Corresponding Author: Cristina Epalza, MD, Hospital Universitario 12 de Octubre, Servicio de Pediatría, Avenida de Córdoba s/n, 28041 Madrid, Madrid, Spain. E-mail: cristina.epalza@ 123456salud.madrid.org .

                Both the authors (D.A.-A and C.E.) contributed equally to this study.

                Both the authors (C.M. and A.T.) contributed equally to this study.

                Author information
                https://orcid.org/0000-0003-1017-2386
                https://orcid.org/0000-0002-9323-2024
                https://orcid.org/0000-0003-3747-9265
                https://orcid.org/0000-0003-2860-3455
                Article
                Publisher ID: piac003
                DOI: 10.1093/jpids/piac003
                PMC ID: 8903467
                PubMed ID: 35188190
                SO-VID: f1c04bba-dd11-4814-b53a-ea0ff8255d66
                Copyright © © The Author(s) 2022. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
                License:

                This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Date received : 15 September 2021
                Date accepted : 12 January 2022
                Date: 11 January 2022
                Page count
                Pages: 5
                Funding
                Funded by: Instituto de Salud Carlos III, DOI 10.13039/501100004587;
                Funded by: European Union–Fondos FEDER;
                Award ID: PI20/00095
                Funded by: Spanish Ministry of Health/ISCIII;
                Funded by: Fondos FEDER;
                Award ID: CM18/00100
                Categories
                Subject: Brief Report
                Subject: AcademicSubjects/MED00670
                Subject: AcademicSubjects/MED00290
                Custom metadata
                article-lifecycle PAP

                Keywords: antibiotic stewardship,bacterial infections,children,covid-19,sars-cov-2
                Data availability:
                Keywords: antibiotic stewardship, bacterial infections, children, covid-19, sars-cov-2

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