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Article ; Online: Decolonization and decontamination: what's their role in infection control?

Vergnano, Stefania

2015 Volume 28, Issue 3, Page(s) 207–214

Abstract: Purpose of review: Hospital-acquired infections cause up to 19% of infections in paediatric patients contributing to the spread of antimicrobial resistance. This review evaluates the effect of decolonization and decontamination in hospitalized children ... ...

Abstract	Purpose of review: Hospital-acquired infections cause up to 19% of infections in paediatric patients contributing to the spread of antimicrobial resistance. This review evaluates the effect of decolonization and decontamination in hospitalized children and neonates as an adjunct to standard infection control measures. Recent findings: Few studies on decolonization and decontamination are available in children. The evidence about the effectiveness of daily chlorhexidine washcloths on bacteraemia in paediatric patients relies on a single randomized controlled trial, in neonates with central venous access in a single retrospective observational study. It is uncertain whether nasal mupirocin reduces methicillin-resistant Staphylococcus aureus carriage and infections in neonates, whereas oral chlorhexidine mouthwashes have not proven effective in children in intensive care settings. Scanty evidence demonstrates a reduction in the rate of ventilation-acquired pneumonia with digestive tract decontamination in paediatric patients and no studies are available in neonates. These strategies have not been extensively tested in resource-poor countries. Summary: Strong evidence about the efficacy of decolonization and decontamination interventions exists in adult medicine but not in paediatric patients. There is an urgent need to understand how these interventions could be adapted to neonates and resource-poor settings in which the prevalence of hospital-acquired infections is higher.
MeSH term(s)	Administration, Intranasal ; Anti-Bacterial Agents/therapeutic use ; Anti-Infective Agents, Local/therapeutic use ; Chlorhexidine/therapeutic use ; Cross Infection/prevention & control ; Decontamination/methods ; Digestive System/microbiology ; Female ; Humans ; Infection Control/methods ; Male ; Methicillin-Resistant Staphylococcus aureus/drug effects ; Methicillin-Resistant Staphylococcus aureus/growth & development ; Mupirocin/therapeutic use ; Nasal Cavity/microbiology ; Staphylococcal Infections/prevention & control
Chemical Substances	Anti-Bacterial Agents ; Anti-Infective Agents, Local ; Mupirocin (D0GX863OA5) ; Chlorhexidine (R4KO0DY52L)
Language	English
Publishing date	2015-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	645085-4
ISSN	1473-6527 ; 1535-3877 ; 0951-7375 ; 1355-834X
ISSN (online)	1473-6527 ; 1535-3877
ISSN	0951-7375 ; 1355-834X
DOI	10.1097/QCO.0000000000000164
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Article ; Online: The impact of paediatric antimicrobial stewardship programmes on patient outcomes.

Patel, Sanjay V / Vergnano, Stefania

Current opinion in infectious diseases

2018 Volume 31, Issue 3, Page(s) 216–223

Abstract: Purpose of review: Although there has been an unprecedented global effort to reduce the spread of antimicrobial resistance, little emphasis has been placed on children. This review aims to evaluate the impact of paediatric antimicrobial stewardship ... ...

Abstract	Purpose of review: Although there has been an unprecedented global effort to reduce the spread of antimicrobial resistance, little emphasis has been placed on children. This review aims to evaluate the impact of paediatric antimicrobial stewardship programmes as well as providing a practical approach for effectively implementing them in community-based settings and in hospitals. Recent findings: Although rates of serious bacterial infection are low in children, the rates of antimicrobial use and resistance are comparable with adults. Different strategies are required to implement antimicrobial stewardship in community-based settings compared to in hospitals. Nationally coordinated, whole-system approaches have achieved long-term, sustainable reductions in antimicrobial prescribing, as well as reductions in resistance rates at population level, with no evidence of an increase in rate of serious infection or bacterial complications. Summary: Antimicrobial stewardship programmes in neonates and children have unique characteristics and issues. There is currently no consensus on how to measure consumption of antimicrobials in neonates and children. This is a research priority. Benchmarking and clinical networks in neonates and paediatrics are important to share practice and drive best use of antimicrobials.
MeSH term(s)	Adolescent ; Anti-Bacterial Agents/therapeutic use ; Antimicrobial Stewardship/statistics & numerical data ; Bacteria/drug effects ; Bacterial Infections/diagnosis ; Bacterial Infections/drug therapy ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; Drug Utilization/standards ; Humans ; Infant ; Infant, Newborn ; Procedures and Techniques Utilization ; Treatment Outcome
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2018-04-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	645085-4
ISSN	1473-6527 ; 1535-3877 ; 0951-7375 ; 1355-834X
ISSN (online)	1473-6527 ; 1535-3877
ISSN	0951-7375 ; 1355-834X
DOI	10.1097/QCO.0000000000000449
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Article ; Online: Narrowing the spectrum: development of a UK paediatric antimicrobial prescribing summary.

Shears, Annalie / Demirjian, Alicia / McGarrity, Orlagh / Vergnano, Stefania / Patel, Sanjay Valabh / McMaster, Paddy

Archives of disease in childhood

2022 Volume 107, Issue 7, Page(s) 698–699

MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Child ; Drug Prescriptions ; Humans ; Inappropriate Prescribing ; United Kingdom
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-02-21
Publishing country	England
Document type	Letter
ZDB-ID	524-1
ISSN	1468-2044 ; 0003-9888 ; 1359-2998
ISSN (online)	1468-2044
ISSN	0003-9888 ; 1359-2998
DOI	10.1136/archdischild-2022-323858
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Article ; Online: A Survey on National Pediatric Antibiotic Stewardship Programs, Networks and Guidelines in 23 European Countries.

Kopsidas, Ioannis / Vergnano, Stefania / Spyridis, Nikos / Zaoutis, Theoklis / Patel, Sanjay

The Pediatric infectious disease journal

2020 Volume 39, Issue 11, Page(s) e359–e362

Abstract: Background: Misuse, overuse of antimicrobials and increasing rates of antimicrobial resistance are well-recognized problems throughout Europe. The aim of this survey was to describe the current pediatric antibiotic stewardship (PAS) landscape across ... ...

Abstract	Background: Misuse, overuse of antimicrobials and increasing rates of antimicrobial resistance are well-recognized problems throughout Europe. The aim of this survey was to describe the current pediatric antibiotic stewardship (PAS) landscape across Europe and identify gaps, in terms of national programs, networks and guidelines. Methods: A survey of 17 questions was circulated in July 2019 among 24 European pediatric infectious disease researchers and clinicians, professors and heads of department on the existence of PAS programs, national networks and meetings, established competencies, metrics and guidelines. Results: We received responses from 23 countries. National guidelines on the management of children with common infections treated in hospital settings exist in 15 of 23 (70%); only 8 of 15 (53%) had been updated within the previous 4 years. Most provide guidance on antibiotic initiation and duration (14 of 15, 93%), but few on when to transition from intravenous to oral antibiotics (7 of 15, 47%). National PAS competencies have only been developed in 4 countries; only 1 addressed both community and hospital prescribing. Organized national PAS networks are only established in the United Kingdom and Germany; 21 of 23, 91% countries had no agreed metric for antibiotic prescribing in children; 2 of 23 were based on daily defined doses. Conclusions: Fragmented implementation of PAS programs, no agreed metrics, lack of established PAS competencies and national PAS networks along with inexistent funding is alarming in view of existing high rates of antimicrobial resistance in Europe.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Antimicrobial Stewardship/standards ; Child ; Drug Resistance, Bacterial ; Drug Utilization/standards ; Europe ; Humans ; Practice Guidelines as Topic ; Surveys and Questionnaires
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2020-08-06
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	392481-6
ISSN	1532-0987 ; 0891-3668
ISSN (online)	1532-0987
ISSN	0891-3668
DOI	10.1097/INF.0000000000002835
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Article ; Online: Listeria infection in young infants: results from a national surveillance study in the UK and Ireland.

Vergnano, Stefania / Godbole, Gauri / Simbo, Ameze / Smith-Palmer, Alison / Cormican, Martin / Anthony, Mark / Heath, Paul T

Archives of disease in childhood

2021 Volume 106, Issue 12, Page(s) 1207–1210

Abstract: Objectives: To describe the epidemiology, age at infection, clinical characteristics and outcome of listeria infection in young infants to inform management and empiric antibiotic choice in young infants.: Design: Prospective 2-year surveillance of !# ...

Abstract	Objectives: To describe the epidemiology, age at infection, clinical characteristics and outcome of listeria infection in young infants to inform management and empiric antibiotic choice in young infants. Design: Prospective 2-year surveillance of Setting: National population study (England, Wales, Scotland and the Ireland) PATIENTS: All infants under 90 days with proven or probable invasive listeriosis MAIN OUTCOME MEASURES: Incidence, mortality, age of infection, clinical characteristics and outcome RESULTS: During a 2-year period (2017-2019), 27 cases of listeriosis in infants <90 days of age were reported. The incidence of listeriosis in this study was 1.8 per 100 000 live births with 7% mortality (2/27). Nearly all cases presented within the first 24 hours of life (26/27). The majority (20/27, 74%) were born preterm and 16/24 (67%) were born to women from ethnic minority backgrounds. Conclusions: Invasive listeriosis in young infants in the UK and Ireland is rare and presents early in the neonatal period. National guidelines that recommend the use of amoxicillin as part of empiric regimes for sepsis and meningitis in infants over 1 month of age should be modified.
MeSH term(s)	Female ; Humans ; Incidence ; Infant ; Infant, Newborn ; Ireland/epidemiology ; Leukocytosis/cerebrospinal fluid ; Listeria monocytogenes/genetics ; Listeria monocytogenes/isolation & purification ; Listeriosis/diagnosis ; Listeriosis/epidemiology ; Male ; Polymerase Chain Reaction ; Population Surveillance/methods ; Prospective Studies ; United Kingdom/epidemiology
Language	English
Publishing date	2021-05-13
Publishing country	England
Document type	Journal Article
ZDB-ID	524-1
ISSN	1468-2044 ; 0003-9888 ; 1359-2998
ISSN (online)	1468-2044
ISSN	0003-9888 ; 1359-2998
DOI	10.1136/archdischild-2021-321602
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Article: Antimicrobial resistance in paediatric medicine

Vergnano, Stefania / Sharland, Michael

Journal of Pediatric Infectious Diseases

2014 Volume 09, Issue 03, Page(s) 123–125

Language	English
Publishing date	2014-09-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2236947-8
ISSN	1305-7693 ; 1305-7707 ; 1871-0336
ISSN (online)	1305-7693
ISSN	1305-7707 ; 1871-0336
DOI	10.3233/JPI-140424
Database	Thieme publisher's database

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Article ; Online: Serious bacterial infections in neonates: improving reporting and case definitions.

Vergnano, Stefania / Seale, Anna C / Fitchett, Elizabeth J A / Sharland, Mike / Heath, Paul T

International health

2017 Volume 9, Issue 3, Page(s) 148–155

Abstract: Neonatal infections affect about 7 million neonates causing over 600 000 deaths every year. Estimating the burden is challenging as there are multiple reporting criteria and definitions for serious bacterial infections in neonates. Essential criteria for ...

Abstract	Neonatal infections affect about 7 million neonates causing over 600 000 deaths every year. Estimating the burden is challenging as there are multiple reporting criteria and definitions for serious bacterial infections in neonates. Essential criteria for reporting serious neonatal bacterial infections have recently been published as the STROBE-NI checklist and, in the context of maternal vaccination, definitions have been published by the Brighton Collaboration Global Alignment of Immunization safety Assessment in pregnancy (GAIA) project. Standardisation of reporting criteria is essential to allow data comparability. This an important step in providing a clearer picture of the burden of serious bacterial infections in neonates and a welcome progress for guiding new investments in interventions.
Language	English
Publishing date	2017-05-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2526175-7
ISSN	1876-3405 ; 1876-3413
ISSN (online)	1876-3405
ISSN	1876-3413
DOI	10.1093/inthealth/ihx011
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Article ; Online: Severe refractory Kawasaki disease in seven infants in the COVID-19 era.

Vergnano, Stefania / Alders, Nele / Armstrong, Catherine / Bamber, Andrew R / Bandi, Srini / Evans, Jennifer A / Hajiani, Nadia / Kenny, Julia / Kucera, Filip / Tometzki, Andrew / Uzun, Orhan / Wilkinson, Nick / Ramanan, Athimalaipet V

The Lancet. Rheumatology

2020 Volume 2, Issue 9, Page(s) e520

Keywords	covid19
Language	English
Publishing date	2020-07-10
Publishing country	England
Document type	Journal Article
ISSN	2665-9913
ISSN (online)	2665-9913
DOI	10.1016/S2665-9913(20)30231-9
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Article ; Online: Pediatric Antifungal Prescribing Patterns Identify Significant Opportunities to Rationalize Antifungal Use in Children.

Ferreras-Antolín, Laura / Irwin, Adam / Atra, Ayad / Chapelle, Faye / Drysdale, Simon B / Emonts, Marieke / McMaster, Paddy / Paulus, Stephane / Patel, Sanjay / Rompola, Menie / Vergnano, Stefania / Whittaker, Elizabeth / Warris, Adilia

The Pediatric infectious disease journal

2021 Volume 41, Issue 3, Page(s) e69–e74

Abstract: Objective: The need for pediatric antifungal stewardship programs has been driven by an increasing consumption of antifungals for prophylactic and empirical use. Drivers and rational of antifungal prescribing need to be identified to optimize ... ...

Abstract	Objective: The need for pediatric antifungal stewardship programs has been driven by an increasing consumption of antifungals for prophylactic and empirical use. Drivers and rational of antifungal prescribing need to be identified to optimize prescription behaviors. Methods: A prospective modified weekly Point Prevalence Survey capturing antifungal prescriptions for children (> 90 days to < 18 years of age) in 12 centers in England during 26 consecutive weeks was performed. Demographic, diagnostic and treatment information was collected for each patient. Data were entered into an online REDCap database. Results: One thousand two hundred fifty-eight prescriptions were included for 656 pediatric patients, 44.9% were girls, with a median age of 6.4 years (interquartile range, 2.5-11.3). Most common underlying condition was malignancy (55.5%). Four hundred nineteen (63.9%) received antifungals for prophylaxis, and 237 (36.1%) for treatment. Among patients receiving antifungal prophylaxis, 40.2% did not belong to a high-risk group. In those receiving antifungal treatment, 45.9%, 29.4%, 5.1% and 19.6% had a diagnosis of suspected, possible, probable of proven invasive fungal disease (IFD), respectively. Proven IFD was diagnosed in 78 patients, 84.6% (n = 66) suffered from invasive candidiasis and 15.4% (n = 12) from an invasive mold infection. Liposomal amphotericin B was the most commonly prescribed antifungal for both prophylaxis (36.6%) and empiric and preemptive treatment (47.9%). Throughout the duration of the study, 72 (11.0%) patients received combination antifungal therapy. Conclusions: Antifungal use in pediatric patients is dominated by liposomal amphotericin B and often without evidence for the presence of IFD. A significant proportion of prophylactic and empiric antifungal use was seen in pediatric patients not at high-risk for IFD.
MeSH term(s)	Adolescent ; Amphotericin B ; Antifungal Agents/therapeutic use ; Antimicrobial Stewardship/methods ; Antiprotozoal Agents/therapeutic use ; Azoles/therapeutic use ; Candidiasis/drug therapy ; Candidiasis, Invasive/drug therapy ; Child ; Child, Preschool ; England ; Female ; Humans ; Invasive Fungal Infections/drug therapy ; Liposomes/therapeutic use ; Male ; Prescriptions ; Prospective Studies
Chemical Substances	Antifungal Agents ; Antiprotozoal Agents ; Azoles ; Liposomes ; liposomal amphotericin B ; Amphotericin B (7XU7A7DROE)
Language	English
Publishing date	2021-11-16
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	392481-6
ISSN	1532-0987 ; 0891-3668
ISSN (online)	1532-0987
ISSN	0891-3668
DOI	10.1097/INF.0000000000003402
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Article ; Online: The current and future roles of neonatal infection surveillance programmes in combating antimicrobial resistance.

Cailes, Benjamin / Vergnano, Stefania / Kortsalioudaki, Christina / Heath, Paul / Sharland, Mike

Early human development

2015 Volume 91, Issue 11, Page(s) 613–618

Abstract: Neonatal sepsis is an important cause of morbidity and mortality, particularly in premature or low birth weight babies. Hospital-acquired blood stream infections represent a significant and largely preventable cause of disease in this population. ... ...

Abstract	Neonatal sepsis is an important cause of morbidity and mortality, particularly in premature or low birth weight babies. Hospital-acquired blood stream infections represent a significant and largely preventable cause of disease in this population. Neonatal units have been identified as a common site for the development and transmission of antimicrobial-resistant pathogens, a significant issue in modern medicine. Neonatal surveillance programmes collect prospective data on infection rates and may be used to optimise therapy, benchmark practice and develop quality improvement programmes. Despite this, the number of networks is relatively few and these are largely concentrated in resource-rich nations. Furthermore, surveillance definitions may vary between programmes impairing our ability to draw comparisons between them. Better harmonisation is required between networks to ensure that they achieve their potential as a valuable tool for benchmarking of hospital-acquired infection rates between units.
MeSH term(s)	Anti-Infective Agents/therapeutic use ; Cross Infection/congenital ; Cross Infection/epidemiology ; Cross Infection/prevention & control ; Drug Resistance, Microbial ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases/epidemiology ; Infant, Newborn, Diseases/prevention & control ; Infection/congenital ; Infection/epidemiology ; Infection Control/methods ; Infection Control/trends ; Intensive Care Units, Neonatal ; Population Surveillance/methods ; Sepsis/congenital ; Sepsis/epidemiology ; Sepsis/prevention & control
Chemical Substances	Anti-Infective Agents
Language	English
Publishing date	2015-11
Publishing country	Ireland
Document type	Journal Article ; Review
ZDB-ID	752532-1
ISSN	1872-6232 ; 0378-3782
ISSN (online)	1872-6232
ISSN	0378-3782
DOI	10.1016/j.earlhumdev.2015.08.012
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