Viral bronchiolitis management in hospitals in the UK

Background Viral bronchiolitis is the leading cause of hospitalisation in infants less than a year old. The United Kingdom (UK) National Institute for Health and Care Excellence (NICE) published a guideline for the management of viral bronchiolitis in June 2015. Objectives This study aimed to prospectively survey the management of viral bronchiolitis in hospital Trusts in the UK to provide a baseline of practice prior to the publication of the 2015 NICE bronchiolitis guideline against which future practice can be assessed. Study design An electronic, structured questionnaire was sent to hospital paediatricians in the UK prior to the publication of the NICE bronchiolitis guideline via the Royal College of Paediatrics and Child Health e-portfolio system to assess the quality of Trust’s viral bronchiolitis management guidelines. Results Paediatricians from 111 (65% of all) UK Trusts completed an electronic questionnaire. 91% of Trusts had a bronchiolitis guideline. Overall only 18% of Trusts would be fully compliant with the NICE guideline. Between 43–100% of Trusts would be compliant with different sections of the guideline. There was variation in hospital admission criteria with respect to the need for supplemental oxygen (oxygen saturations <88% to <95%). ‘Unnecessary’ medications (especially bronchodilators, nebulised hypertonic saline and antibiotics) and investigations (chest x-ray and blood gas) were regularly advised. 72% of Trusts advised respiratory virus testing in all hospitalised infants and 64% created bronchiolitis bays to cohort infants. Conclusions There was wide variation in the management of infants with bronchiolitis in Trusts. Most bronchiolitic infants are not managed optimally in hospitals. Future guidelines should include advice on virus testing and isolation/cohorting

Nirsevimab for prevention of hospitalizations due to RSV in infants

Background: this pragmatic trial assessed the safety and impact of the monoclonal antibody nirsevimab on hospitalizations associated with RSV lower respiratory tract infection (LRTI) in healthy infants.Methods: infants ≤12 months old, born ≥29 weeks gestational age entering their first RSV season in France, Germany and the UK were randomized 1:1 to receive a single intramuscular injection of nirsevimab or no intervention (standard-of-care) before/during the RSV season. Participants were monitored remotely for RSV LRTI hospitalization (defined as in-patient care with confirmed RSV) and very severe RSV LRTI (defined as RSV LRTI hospitalization with oxygen saturation &lt;90% and requiring oxygen supplementation) through the RSV season.Results: 8,058 participants were randomized: 4,037 to the nirsevimab group and 4,021 to no intervention. Eleven (0.3%) RSV LRTI hospitalizations occurred in the nirsevimab group and 60 (1.5%) in the no intervention group, giving an efficacy of 83.2% (95% CI: 67.8 to 92.0; P&lt;0.001). Very severe RSV LRTI occurred in five (0.1%) participants in the nirsevimab group and 19 (0.5%) in the no intervention group, giving an efficacy of 75.7% (95% CI: 32.8 to 92.9; P=0.004). Efficacy against RSV LRTI hospitalization in each of the countries, France, Germany, and the UK were 89.6% (adjusted 95% CI, 58.8 to 98.7; multiplicity-adjusted P&lt;0.001), 74.2% (adjusted 95% CI, 27.9 to 92.5; multiplicity-adjusted P=0.006), and 83.4% (adjusted 95% CI, 34.3 to 97.6; multiplicity-adjusted P=0.003), respectively. In the nirsevimab group treatment related AEs occurred in 86 (2.1%).Conclusions: Nirsevimab protects infants against RSV LRTI hospitalization and very severe RSV LRTI in near real-world settings.<br/

IMPROVING ACCESS TO COLLECTIONS FOR SAMPLING

The commitment to increasing access to collections has resulted in concepts such as ‘acceptable’ rates of damage. This new pragmatism has yet to be developed into a consistent approach to access for analysis. This paper uses a case study of the scientific examination of early Greek copper alloy helmets to illustrate a range of problems encountered by researchers. In the context of the case study it considers national and political criteria, the policies and procedures of museums and professional ethical codes. The paper also considers additional barriers that can be encountered by younger researchers, who may be considered less credible than their more established colleagues, and discusses strategies that they can use to increase the likelihood of gaining access to samples

Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries

Background Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions. Methods 1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance networks. We included hospital inpatients aged younger than 19 years receiving at least one antibiotic on the day of the survey. The WHO AWaRe classification was used to describe overall antibiotic use as assessed by the variation between use of Access, Watch, and Reserve antibiotics, for neonates and children and for the commonest clinical indications. Findings Of the 23 572 patients included from 56 countries, 18305 were children (77.7%) and 5267 were neonates (22.3%). Access antibiotic use in children ranged from 7.8% (China) to 61.2% (Slovenia) of all antibiotic prescriptions. The use of Watch antibiotics in children was highest in Iran (77.3%) and lowest in Finland (23.0%). In neonates, Access antibiotic use was highest in Singapore (100.0%) and lowest in China (24.2%). Reserve antibiotic use was low in all countries. Major differences in clinical syndrome-specific patterns of AWaRe antibiotic use in lower respiratory tract infection and neonatal sepsis were observed between WHO regions and countries. Interpretation There is substantial global variation in the proportion of AWaRe antibiotics used in hospitalised neonates and children. The AWaRe classification could potentially be used as a simple traffic light metric of appropriate antibiotic use. Future efforts should focus on developing and evaluating paediatric antibiotic stewardship programmes on the basis of the AWaRe index. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd