Diagnosis Of Acute Respiratory Infections Research Articles

A Multifaceted Intervention Improves Prescribing for Acute Respiratory Infection for Adults and Children in Emergency Department and Urgent Care Settings.

Antibiotics are commonly prescribed during emergency department (ED) and urgent care center (UCC) visits for viral acute respiratory infection (ARI). We evaluate the comparative effectiveness of an antibiotic stewardship intervention adapted for acute care ambulatory settings (adapted intervention) to a stewardship intervention that additionally incorporates behavioral nudges (enhanced intervention) in reducing inappropriate prescriptions. This study was a pragmatic, cluster-randomized clinical trial conducted in three academic health systems comprising five adult and pediatric EDs and four UCCs. Randomization of the nine sites was stratified by health system; all providers at each site received either the adapted or the enhanced intervention. The main outcome was the proportion of antibiotic-inappropriate ARI diagnosis visits that received an outpatient antibiotic prescription by individual providers. We estimated a hierarchical mixed-effects logistic regression model comparing visits during the influenza season for 2016 to 2017 (baseline) and 2017 to 2018 (intervention). There were 44,820 ARI visits among 292 providers across all nine cluster sites. Antibiotic prescribing for ARI visits dropped from 6.2% (95% confidence interval [CI]= 4.5% to 7.9%) to 2.4% (95% CI= 1.3% to 3.4%) during the study period. We found a significant reduction in inappropriate prescribing after adjusting for health-system and provider-level effects from 2.2% (95% CI= 1.0% to 3.4%) to 1.5% (95% CI= 0.7% to 2.3%) with an odds ratio of 0.67 (95% CI= 0.54 to 0.82). Difference-in-differences between the two interventions was not significantly different. Implementation of antibiotic stewardship for ARI is feasible and effective in the ED and UCC settings. More intensive behavioral nudging methods were not more effective in high-performance settings.

Model-based standardization using an outcome model with random effects.

Model-based standardization uses a statistical outcome model or exposure model to estimate a population-average association that is unconfounded by selected covariates. With it, one can compare groups using a distribution of confounders identical in each group to that of a standard population. We develop an approach based on an outcome model, in which the mean of the outcome is modeled conditional on the exposure and the confounders. In our approach, there is a confounder that clusters the observations into a very large number of categories. We treat the parameters for the clusters as random effects. We use a between-within model to account for the association of the random effects not only with the exposure but also with the cluster population sizes. We review alternative approaches presented in the literature, and we compare the outcome-modeling approach to recently proposed exposure-modeling approaches incorporating random effects. To illustrate, we use 2014 to compare proportions of acute respiratory tract infection diagnoses with an antibiotic prescription for emergency department versus outpatient visits, adjusting for confounding by unmeasured patient level variables and measured diagnosis-level variables. We also present results of a simulation study.

Free hospitalization for acute respiratory infections in children: what effect and how much does it cost for Armenia?

The "Child Certificate" program, launched in Armenia in 2011, made hospitalization for children less than seven years free in order to improve access to hospitalization, reduce out-of-pocket expenses and ensure Universal Health Coverage. We aimed to estimate trends in the number of outpatient and hospitalized acute respiratory infection (ARI) cases and related under-five mortality. Cross-sectional study using data from national databases before (2008-2011) and after (2012-2017) Program implementation. The diagnosis of ARI was based on the International Classification of Disease (ICD-10). The average hospitalization per 1000 children under 14 and infants increased by 85% and 75% respectively, compared with the period before the introduction of the Program, while the frequency of outpatient visits remained unchanged. The ARI-related mortality in children less than five years and in infants decreased by 11% and 19%, respectively. Financial allocations for ARI-associated hospitalizations amounted to 2.1 billion Armenian drams in 2011 and increased to 3.3 billion drams in 2016 (an increase of 57%). For pneumonia, this increase was 108% (from 0.35 to 0.72 billion). The introduction of free hospitalization for ARI led to an increase in the hospitalization rates. There was a favorable decline in under-five mortality and an exponential increase in financial allocations. The reasons for hospitalization should be investigated to ensure rational hospitalization with parallel improvement of primary care to reduce delayed presentations. It is necessary to find ways addressing the growing financial allocations for ARI-associated hospitalization.

Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits.

Use of commercial direct-to-consumer (DTC) telemedicine outside of the pediatric medical home is increasing among children, and acute respiratory infections (ARIs) are the most commonly diagnosed condition at DTC telemedicine visits. Our objective was to compare the quality of antibiotic prescribing for ARIs among children across 3 settings: DTC telemedicine, urgent care, and the primary care provider (PCP) office. In a retrospective cohort study using 2015-2016 claims data from a large national commercial health plan, we identified ARI visits by children (0-17 years old), excluding visits with comorbidities that could affect antibiotic decisions. Visits were matched on age, sex, chronic medical complexity, state, rurality, health plan type, and ARI diagnosis category. Within the matched sample, we compared the percentage of ARI visits with any antibiotic prescribing and the percentage of ARI visits with guideline-concordant antibiotic management. There were 4604 DTC telemedicine, 38 408 urgent care, and 485 201 PCP visits for ARIs in the matched sample. Antibiotic prescribing was higher for DTC telemedicine visits than for other settings (52% of DTC telemedicine visits versus 42% urgent care and 31% PCP visits; P < .001 for both comparisons). Guideline-concordant antibiotic management was lower at DTC telemedicine visits than at other settings (59% of DTC telemedicine visits versus 67% urgent care and 78% PCP visits; P < .001 for both comparisons). At DTC telemedicine visits, children with ARIs were more likely to receive antibiotics and less likely to receive guideline-concordant antibiotic management compared to children at PCP visits and urgent care visits.

Faktor Risiko Kejadian Recurrent Respiratory Infection pada Anak Usia 2-5 Tahun

&lt;p class="AbstractNormal"&gt;&lt;strong&gt;&lt;em&gt;Introduction:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; Acute Respiratory Infection (ARI) is the most prevalent disease with high mortality and morbidity on infant. ARI that happens more than five times annually is called Recurrent Respiratory Infection (RRI). Some mortality of ARI comes from kind of ARI that developed from diseases that could be prevented by immunization. This study aimed to find correlation between immunization status, nutritional status, crowding, smoker in house, mother education level, family income level and RRI incident on children age 2-5 years old in Sibela Primary Health Care (PHC) work area, Surakarta.&lt;/em&gt;&lt;/p&gt;&lt;p class="AbstractNormal"&gt;&lt;strong&gt;&lt;em&gt;Methods&lt;/em&gt;&lt;/strong&gt;&lt;em&gt;:&lt;/em&gt;&lt;em&gt; This was an observational analytic study with cross-sectional approach. Sample for this study was children age 2-5 years old from Sibela PHC work area, Surakarta. Sample was taken by cluster sampling method as much as 121 children, the parent interviewed using questioner and children was measured for their height and weight. Data of immunization history was obtained from Kesehatan Ibu dan Anak (KIA) Book and PHC data information system for ARI diagnosis. Data was analyzed using chi-square and logistic regression.&lt;/em&gt;&lt;/p&gt;&lt;p class="AbstractNormal"&gt;&lt;strong&gt;&lt;em&gt;Result&lt;/em&gt;&lt;/strong&gt;&lt;em&gt;:&lt;/em&gt;&lt;em&gt; Chi-square result shows significant correlation between incomplete immunization status and incident of RRI (p=0,000) and OR = 18,774. Logistic regression results shows significant correlation between immunization status and incident of RRI (p=0,000; OR=21,3). &lt;/em&gt;&lt;/p&gt;&lt;p class="AbstractNormal"&gt;&lt;strong&gt;&lt;em&gt;Conclusions&lt;/em&gt;&lt;/strong&gt;&lt;em&gt;:&lt;/em&gt; &lt;em&gt;Incomplete immunization status significantly correlate to increasing RRI incident 21,3 times on children age 2-5 years old than children which acquired complete immunization status.&lt;/em&gt; &lt;em&gt;Nutritional status, crowding, smoker in house, mother educational level, and family income level has no significant correlation with RRI incidence.&lt;/em&gt;&lt;/p&gt;

Antibiotic Prescribing Practices: Is There a Difference Between Patients Seen by Telemedicine Versus Those Seen In-Person?

Background: Direct-to-consumer telemedicine is becoming part of mainstream medicine, but questions exist regarding the quality of care provided. We assessed antibiotic stewardship, one measure of quality, by comparing antibiotic prescription rates for acute respiratory infections (ARIs) between patients seen by telemedicine and patients seen in-person in two urban emergency departments (EDs). Methods: In two urban EDs where low-acuity patients in the ED have the option of being seen by telemedicine rather than in-person, we analyzed telemedicine and in-person visits of patients ≥18 years who received ARI diagnoses between July 2016 and September 2017. The identified ARI telemedicine visits were matched to in-person visits by diagnosis, treatment hospital, and Emergency Severity Index level. We compared antibiotic prescribing rates for telemedicine and in-person visits. Results: We identified 260 telemedicine visits and compared with 260 matched in-person visits. Antibiotics for ARIs were prescribed for 29% of telemedicine visits and 28% of in-person visits (odds ratio [OR] 1.038; 95% confidence interval [CI] 0.71-1.52; p = 0.846). This finding did not materially change after adjustment for age and gender (adjusted OR 1.034; 95% CI 0.70-1.53; p = 0.86). Conclusions: Antibiotic prescribing rates for ARIs were similar for patients seen by telemedicine and patients seen in-person at two urban EDs. If differences in antibiotic stewardship between telemedicine and in-person encounters are found, contextual factors unrelated to the video-based evaluation should be investigated.

Geographical disparities in emergency department presentations for acute respiratory infections and risk factors for presenting: a population-based cohort study of Western Australian children

IntroductionStudies examining acute respiratory infections (ARIs) in emergency department (EDs), particularly in rural and remote areas, are rare. This study aimed to examine the burden of ARIs among Aboriginal and...

Variability of Antibiotic Prescribing in a Large Healthcare Network Despite Adjusting for Patient-Mix: Reconsidering Targets for Improved Prescribing

BackgroundIn the outpatient setting, the majority of antibiotic prescriptions are for acute respiratory infections (ARIs), but most of these infections are viral and antibiotics are unnecessary. We analyzed provider-specific antibiotic prescribing in a group of outpatient clinics affiliated with an academic medical center to inform future interventions to minimize unnecessary antibiotic use.MethodsWe conducted a cross-sectional study of patients who presented with an ARI to any of 15 The Emory Clinic (TEC) primary care clinic sites between October 2015 and September 2017. We performed multivariable logistic regression analysis to examine the impact of patient, provider, and clinic characteristics on antibiotic prescribing. We also compared provider-specific prescribing rates within and between clinic sites.ResultsA total of 53.4% of the 9600 patient encounters with a diagnosis of ARI resulted in an antibiotic prescription. The odds of an encounter resulting in an antibiotic prescription were independently associated with patient characteristics of white race (adjusted odds ratio [aOR] = 1.59; 95% confidence interval [CI], 1.47–1.73), older age (aOR = 1.32, 95% CI = 1.20–1.46 for patients 51 to 64 years; aOR = 1.32, 95% CI = 1.20–1.46 for patients ≥65 years), and comorbid condition presence (aOR = 1.19; 95% CI, 1.09–1.30). Of the 109 providers, 13 (12%) had a rate significantly higher than predicted by modeling.ConclusionsAntibiotic prescribing for ARIs within TEC outpatient settings is higher than expected based on prescribing guidelines, with substantial variation in prescribing rates by site and provider. These data lay the foundation for quality improvement interventions to reduce unnecessary antibiotic prescribing.

Prevalence of Self-Medication for Acute Respiratory Infections in Young Children in Namibia: Findings and Implications.

Objective:Acute respiratory infections (ARIs) are a leading cause of morbidity and mortality among under-fives. However, self-medication and “self-care” care practices remain common, especially among informal settlements in Namibia. Consequently, we sought to ascertain the rationale for this to guide the future activities.Methods:Mixed method approach among residents in an informal settlement in Namibia to determine the extent of health-seeking behaviors and the rationale for any self-medication.Findings:Of the 100 everyday households surveyed, 60% used self-medication for ARIs in children under five including cold/flu medication, paracetamol, and decongestants. There was no self-purchasing of antibiotics. The main drivers of self-medication were a perceived diagnosis of ARI as “minor or mild” as well as long waiting times and queues to receive care at public health facilities.Conclusion:The majority of households in this settlement self-medicate their children for ARIs. There are needs for outreach primary health care services in the future in townships to screen and appropriately manage ARI to address concerns. This can include increasing pharmacy services.

Quality Of Care For Acute Respiratory Infections During Direct-To-Consumer Telemedicine Visits For Adults.

In direct-to-consumer telemedicine, physicians treat patients through real-time audiovisual conferencing for common conditions such as acute respiratory infections. Early studies had mixed findings on the quality of care provided during direct-to-consumer telemedicine and were limited by small sample sizes and narrow geographic scopes. Using claims data for 2015-16 from a large national commercial insurer, we examined the quality of antibiotic management in adults with acute respiratory infection diagnoses at 38,839 direct-to-consumer telemedicine visits, compared to the quality at 942,613 matched primary care visits and 186,016 matched urgent care visits. In the matched analyses, we found clinically similar rates of antibiotic use, broad-spectrum antibiotic use, and guideline-concordant antibiotic management. However, direct-to-consumer telemedicine visits had less appropriate streptococcal testing and a higher frequency of follow-up visits. These results suggest specific opportunities for improvement in direct-to-consumer telemedicine quality.

Variation in Outpatient Antibiotic Dispensing for Respiratory Infections in Children by Clinician Specialty and Treatment Setting.

Antibiotics are commonly prescribed for children with acute respiratory infections (ARIs). This study describes the distribution of ARI diagnoses and specifically quantifies antibiotic dispensing for bronchitis and upper respiratory infection (URI) by treatment setting and specialty. This retrospective, observational cross-sectional study used data from the HealthCore Integrated Research Environment containing claims from 14 commercial health plans for 2012 to 2014. Children (2-17 years) with first-episode ARI were identified by diagnosis of acute otitis media (AOM), sinusitis, pharyngitis, bronchitis or URI with no competing infections or chronic illnesses. Treatment setting was where diagnoses were made: primary care offices, urgent care centers (UCC), retail health clinics (RHCs) or emergency departments. Primary outcome measure was antibiotic prescription fills from pharmacies within 2 days of start of ARI episode. For URI, the highest proportions in antibiotic dispensing were ordered by office-based or UCC family physicians (28% and 30%, respectively) and office-based or UCC nurse practitioners/physician assistants (30% and 29%, respectively). Across all settings and specialties, there was high proportion of antibiotic dispensing for bronchitis (75%). Overall, 48% of 544,531 children diagnosed with ARI filled antibiotics. Nurse practitioners/physician assistants in RHC made the most diagnoses of AOM (24%) and streptococcal pharyngitis (22%). Outreach efforts to decrease antibiotic dispensing for URI can be focused on office-based and UCC family physicians and nurse practitioners/physician assistants. All specialties need widespread interventions to reduce antibiotic dispensing for bronchitis. RHC nurse practitioners/physician assistants can be targeted to reduce high proportion of AOM and streptococcal pharyngitis diagnoses.

2019. Host Gene Expression Signatures for Diagnosis of Acute Respiratory Infections in the Elderly

BackgroundDespite advances in molecular techniques the etiology of acute respiratory infections (ARIs) is often difficult to differentiate either at the point of care or with advanced microbiological techniques. There is growing interest in host biomarker assays, including those based on gene expression patterns in circulating cells, to aid in differentiation of viral and bacterial diseases. However, there are concerns about how such tests perform in vulnerable aging populations where host responses are often muted.MethodsIn order to assess performance of gene expression-based biomarkers, we enrolled patients presenting to the emergency department with clinical ARI and selected 184 individuals aged ≤25 and ≥60 years old with proven viral or bacterial ARI. Gene expression in peripheral blood was measured with Affymetrix microarrays. Published viral and bacterial signatures were applied to the data and Bayesian approaches were used to develop novel discriminative models.ResultsWe noted a marked decline in signature performance between younger and older individuals in both viral (AUC 0.90 vs. 0.64) and bacterial (AUC 0.91 vs. 0.50) infections. Incorporation of age-related genomic changes was able to restore much of the signature performance in older individuals. When examining the genomic differences driving the drop in signature performance, we found marked perturbations in expression of immunoglobulin genes and pathways driving known immunoregulatory mechanisms that provide novel insights into an age-related decline in ARI-focused immunity.ConclusionPathogen class-specific host-based gene expression signatures offer great promise as diagnostic tools. However, altered immune responses in vulnerable populations such as the elderly are also manifested at the genomic level and can affect diagnostic signature performance. Age-specific alterations in the components of a diagnostic signature can minimize much of this effect, however this work highlights the need for consideration of age during biomarker development for infectious diseases. Furthermore, studies of age-related differences in biomarker performance can lead to important breakthroughs in our understanding of age-associated alterations in immunity.Disclosures All authors: No reported disclosures.

1846. Outpatient Antibiotic Use in Viral Acute Upper Respiratory Tract Infections at a Military Treatment Facility: A Target for Stewardship Intervention

BackgroundAntimicrobial stewardship programs (ASP) can be effective at reducing inappropriate antimicrobial usage that contributes to antimicrobial resistance and adverse medical outcomes. However, developing effective ASP remains an important challenge, especially in the ambulatory setting. Outpatient antibiotic prescriptions for acute respiratory tract infections (ARI) are one area in which inappropriate prescribing has been previously described, and are a potential ASP target.MethodsIn effort to develop targeted interventions, antibiotic prescribing for viral ARI was examined in primary care outpatient clinics and the emergency department (ED) of a large military medical center using the military health system management and analysis reporting tool. Adult and pediatric patient encounters from calendar year 2017 were included using 23 relevant ICD-10 diagnostic codes for viral ARIs; those with concurrent diagnoses of asthma/COPD, pneumonia, chronic sinusitis, streptococcal pharyngitis, or otitis media were excluded. Frequencies of ARI diagnosis and antibiotic dispersal were calculated.ResultsAmong the 6,354 patients diagnosed with ARI in 2017, 728 (11.5%) were prescribed an unnecessary antibiotic with the highest frequency of such prescriptions in those over the age of 45, females, and family members of service members. Diagnoses most associated with unnecessary antibiotic prescribing were uncomplicated bronchitis (39%) and pharyngitis (22%) for adult medicine; acute rhinosinusitis (40%) and pharyngitis (19%) for pediatric medicine; and uncomplicated bronchitis (33%) for the ED. This increased in the winter months when viral ARI are common. Approximately $22,000 was spent on unnecessary antimicrobial prescriptions with the largest contribution from macrolides.ConclusionBased on our analysis, we developed multipronged interventions at facility, clinic, and provider levels. Planned interventions will include interval facility-wide ASP updates with increased frequency during winter months and biannual educational sessions with staff emphasizing clinic-specific diagnoses associated with inappropriate antibiotic prescribing. Program success will be assessed with interval analysis of antibiotic prescribing after intervention implementation.Disclosures All authors: No reported disclosures.

725. Clinical Outcomes of Elderly Individuals Presenting with Acute Respiratory Infections

BackgroundElderly individuals experience increased morbidity and mortality from acute respiratory infections (ARI), which are complicated by difficulties defining etiologies of ARI and risk-stratifying patients in order to guide care. A number of scoring tools have been developed to predict illness severity and patient outcome for proven pneumonia, however less is known about the use of such metrics for all causes of ARIs.MethodsWe analyzed risk factors, clinical course and major outcomes of individuals ≥60 years of age presenting to the emergency department with a clinical diagnosis of ARI over a 5-year period.ResultsOf the enrolled individuals 40 had proven viral infection and 52 proven bacterial infections, but 184 patients with clinically adjudicated ARI (67%) remained without a proven microbial etiology despite extensive workup. Age (71.5 vs. 65.9 years, P < 0.001) and presence of cancer and heart failure were strongly predictive of illness severe enough to require hospital admission as compared with treatment in the outpatient setting. Of those with proven etiology, individuals with bacterial infection were more likely to require hospital and ICU admission (P < 0.001). When applied to this study, a modified PORT score was found to correlate more closely with clinical outcome measures than a modified CURB-65 (r, 0.54 vs. 0.39). Jackson symptom scores, historically used for viral illness, were found to inversely correlate with outcomes (r, −0.34) and show potential for differentiating viral and bacterial etiologies (P = 0.02). Interestingly, a multivariate analysis showed that a novel scoring tool utilizing sex, heart rate, respiratory rate, blood pressure, BUN, glucose and presence of chronic lung disease and cancer was highly predictive of poor outcome in elderly subjects with all-cause ARI.ConclusionElderly subjects are at increased risk for poor clinical outcomes from ARI and their clinical management remains challenging. However, modified PORT, CURB-65, Jackson symptom score, and a novel scoring tool presented herein all offer some predictive ability for all-cause ARI in elderly subjects. Such broadly applicable scoring metrics have the potential to assist in treatment and triage decisions at the point of care.Disclosures All authors: No reported disclosures.

1633. A Multifaceted Intervention to Improve Prescribing for Acute Respiratory Infection in Adults and Children in Emergency Department and Urgent Care Settings (MITIGATE Trial)

BackgroundAntibiotics are prescribed in approximately half of emergency department (ED) and urgent care center (UCC) visits for antibiotic inappropriate or presumed viral acute respiratory infection (ARI). Unnecessary antibiotic use increases adverse events, antibiotic resistance, and healthcare costs. Antibiotic stewardship in the ED and UCC requires specific implementation tailored to these unique settings. Objective. To evaluate the comparative effectiveness of patient and provider education adapted for the acute care setting (adapted intervention) to an intervention with behavioral nudges and individual peer comparisons (enhanced intervention), on reducing inappropriate antibiotic use for ARI in EDs and UCCs.MethodsPragmatic, cluster randomized clinical trial conducted in 3 academic health systems (1 pediatric-only, 2 serving adults and children) that included 5 adult and pediatric EDs and 4 UCCs. Sites were block randomized by health system, and providers at each site assigned to receive the adapted or enhanced intervention. Implementation science strategies were employed to tailor interventions at each site. The main outcome was the proportion of antibiotic inappropriate ARI diagnosis visits that received an antibiotic. We estimated a hierarchical mixed effects logistic regression model for visits that occurred between November and February for 2016–2017 (baseline) and 2017–2018 (intervention), controlling for organization and provider fixed effects.ResultsAcross all sites, there were 45,160 ARI visits among 534 providers, with overall antibiotic prescribing at 2.6%; the pediatric-only system had a lower baseline rate (1.6%) compared with the other 2 systems (5.0% and 7.1%), P < 0.001). Despite the unusually low rate, we found a significant reduction in inappropriate prescribing after adjusting for health-system and provider-level effects from 2.6% to 1.4 % (odds ratio 0.52; 0.38–0.72). Reductions in prescribing between the 2 interventions were in the expected direction, but not significantly different (P < 0.062).ConclusionImplementation of antimicrobial stewardship for ARI is feasible and effective in the ED and UCC settings. The enhanced behavioral nudging methods were not more effective in high-performance settings.Disclosures All authors: No reported disclosures.

Etiology of Coinfections in Children with Influenza during 2015/16 Winter Season in Nepal.

Acute respiratory infections (ARIs) are one of the major public health problems in developing countries like Nepal. Besides the influenza, several other pathogens are responsible for acute respiratory infection in children. Etiology of infections is poorly characterized at the course of clinical management, and hence empirical antimicrobial agents are used. The objective of this study was to characterize the influenza and other respiratory pathogens by real-time PCR assay. A total of 175 throat swab specimens of influenza-positive cases collected at National Influenza Center, Nepal, during the 2015/16 winter season were selected for detecting other respiratory copathogens. Total nucleic acid was extracted using Pure Link viral RNA/DNA mini kit (Invitrogen), and multiplex RT-PCR assays were performed. Influenza A and B viruses were found in 120 (68.6%) and 55 (31.4%) specimens, respectively, among which coinfections were found in 106 (60.6%) specimens. Among the influenza A-positive cases, 25 (20.8%) were A/H1N1 pdm09 and 95 (79.2%) were A/H3 subtypes. Viruses coinfected frequently with influenza virus in children were rhinovirus (26; 14.8%), respiratory syncytial virus A/B (19; 10.8%), adenovirus (14; 8.0%), coronavirus (CoV)-HKU1 (14; 8.0%), CoV-OC43 (5; 2.9%), CoV-229E (2; 1.1%), metapneumovirus A/B (5; 2.9%), bocavirus (6; 3.4%), enterovirus (5; 2.9%), parainfluenza virus-1 (3; 1.7%), and parainfluenza virus-3 (2; 1.1%). Coinfection of Mycoplasma pneumoniae with influenza virus was found in children (5; 2.8%). Most of the viral infection occurred in young children below 5 years of age. In addition to influenza virus, nine different respiratory pathogens were detected, of which coinfections of rhinovirus and respiratory syncytial virus A/B were predominantly found in children. This study gives us better information on the respiratory pathogen profile and coinfection combinations which are important for diagnosis and treatment of ARIs.

Acute respiratory diseases: progression features, pharmaceutical therapy

Acute respiratory diseases (ARD) are widespread diseases and are of great social importance. Diagnosis of acute respiratory infections implies the damage to the respiratory system caused by a wide range of pathogens. Among the pathogens of acute respiratory infections are viruses of acute respiratory viral infection (ARVI) group, including influenza, as well as fungal and bacterial pathogens, which include intracellular bacteria: mycoplasma and chlamydia. Diseases caused by intracellular pathogens are treated by antibacterial drugs that can easily penetrate the cells and create there high concentrations.

Outpatient Antibiotic Prescribing for Acute Respiratory Infections During Influenza Seasons

Acute respiratory infections (ARIs) are the syndrome for which antibiotics are most commonly prescribed; viruses for which antibiotics are ineffective cause most ARIs. To characterize antibiotic prescribing among outpatients with ARI during influenza season and to identify targets for reducing inappropriate antibiotic prescribing for common ARI diagnoses, including among outpatients with laboratory-confirmed influenza. Cohort study enrolling outpatients aged 6 months or older with ARI evaluated at outpatient clinics associated with 5 US Influenza Vaccine Effectiveness Network sites during the 2013-2014 and 2014-2015 influenza seasons. All patients received influenza testing by real-time reverse transcriptase-polymerase chain reaction for research purposes only. Antibiotic prescriptions, medical history, and International Classification of Diseases, Ninth Revision diagnosis codes were collected from medical and pharmacy records, as were group A streptococcal (GAS) testing results in a patient subset. Visit for ARI, defined by a new cough of 7 days' duration or less. Antibiotic prescription within 7 days of enrollment. Appropriateness of antibiotic prescribing was based on diagnosis codes, clinical information, and influenza and GAS testing results. Of 14 987 patients with ARI (mean [SD] age, 32 [24] years; 8638 [58%] women; 11 892 [80%] white), 6136 (41%) were prescribed an antibiotic. Among these 6136 patients, 2522 (41%) had diagnoses for which antibiotics are not indicated; 2106 (84%) of these patients were diagnosed as having a viral upper respiratory tract infection or bronchitis (acute or not otherwise specified). Among the 3306 patients (22%) not diagnosed as having pneumonia and who had laboratory-confirmed influenza, 945 (29%) were prescribed an antibiotic, accounting for 17% of all antibiotic prescriptions among patients with nonpneumonia ARI. Among 1248 patients with pharyngitis, 1137 (91%) had GAS testing; 440 of the 1248 patients (35%) were prescribed antibiotics, among whom 168 (38%) had negative results on GAS testing. Of 1200 patients with sinusitis and no other indication for antibiotic treatment who received an antibiotic, 454 (38%) had symptoms for 3 days or less prior to the outpatient visit, suggesting acute viral sinusitis not requiring antibiotics. Antibiotic overuse remains widespread in the treatment of outpatient ARIs, including among patients with laboratory-confirmed influenza, although study sites may not be representative of other outpatient settings. Identified targets for improved outpatient antibiotic stewardship include eliminating antibiotic treatment of viral upper respiratory tract infections and bronchitis and improving adherence to prescribing guidelines for pharyngitis and sinusitis. Increased access to sensitive and timely virus diagnostic tests, particularly for influenza, may reduce unnecessary antibiotic use for these syndromes.

Impact of A/H1N1 influenza in children at a Brazilian University Hospital

BackgroundA/H1N1 influenza is a viral disease that affects a significant part of the population mainly in winter, leading to increased number of medical consultations, hospitalizations and consequently care spending in emergency. MethodsThis is a case-series retrospective study, involving patients admitted to a tertiary hospital in southern Brazil in 2016 with a clinical diagnosis of acute respiratory infection of the influenza type and laboratory confirmation of influenza A/H1N1. Results64 patients were included, mostly male, median age of 48.3 months. Chronic underlying diseases were found in 73% of the patients, and these patients evolved to the most unfavorable outcome. About vaccination, of the 57 patients with an age range for vaccination, only 28% had complete vaccination coverage. The main clinical manifestations found in the included patients were fever, cough, intercostal indrawing, wheezing, tachypnea and pulmonary crackles. These patients were mainly followed-up with laboratory tests and chest X-ray. Consolidation was evident in 43% of patients followed by interstitial infiltrate in 33%. A five-day course of neuraminidase inhibitor was prescribed for all patients, as recommended by the WHO, but due to the complications, 73% of the patients required antibiotic therapy, and 61% oxygen therapy. The majority of patients had a favorable outcome, but 11 required intensive care and one died. ConclusionsA/H1N1 influenza persists as an important public health problem, mainly due to high morbidity and hospitalization rates. It is important to identify patients with A/H1N1 influenza and clinical situations with higher risk of complications. Through this study, it is possible to analyze the characteristics of pediatric patients with A/H1N1 influenza and mainly to emphasize assistance of populations with comorbidities, since they present higher rates of complications and death.

Cross Sectional Survey of Care Seeking For Acute Respiratory Illness in Children Under 5 Years in Rural Kenya

Acute respiratory infection (ARI) is a leading cause of childhood morbidity and mortality in developing countries. In Kenya, diagnosis and treatment of ARI remains predominantly health facility based. This presumes that caretakers can recognize ARI symptoms promptly and make a decision to take the child to an appropriate health facility for treatment. Unfortunately, these presumptions have not been assessed. This study sought to establish determinants of health care seeking among caretakers of children under five years (CU5) of age with ARI. An analytic cross sectional survey was carried out in Githunguri Sub - County of Kiambu County. Households with CU5 who had recently suffered an episode of ARI were enrolled. Structured questionnaires, focused group discussions and key informant guides were used to gather information. Structured questionnaires were administered to caretakers to obtain information on socio-demographics, knowledge and health seeking practices. Bivariate and multivariate analysis was carried out with a p value of 1hour) before service provision (p = 0.001), use of a motorbike to access the nearest health facility (p = 0.001) and traveling for 4 - 4.9 kilo meters to the nearest health facility (p = 0.002). Travelling for long distance and long waiting time before service provision during the previous facility visit were the main determinants of delayed facility consultations. The study recommends increased sensitization on symptom recognition among caretakers, and intensified efforts to reduce turn-around time during health facility consultations in order to minimize delays in health facility consultation.