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, 18 305 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. FUNDING: GARPEC was funded by the PENTA Foundation. GARPEC-China data collection was funded by the Sanming Project of Medicine in Shenzhen (SZSM2015120330). bioMérieux provided unrestricted funding support for the Global-PPS

Group 1 ITI Consensus Report: The influence of implant length and design and medications on clinical and patient-reported outcomes

This is the peer reviewed version of the following article: Jung, R. E., et al. (2018). "Group 1 ITI Consensus Report: The influence of implant length and design and medications on clinical and patient-reported outcomes." Clinical Oral Implants Research 29(S16): 69-77., which has been published in final form at. https://doi.org/10.1111/clr.13342 This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions

Group 5 ITI Consensus Report: Digital technologies

This is the peer reviewed version of the following article: Wismeijer, D., et al. (2018). "Group 5 ITI Consensus Report: Digital technologies." Clinical Oral Implants Research 29(S16): 436-442., which has been published in final form at https://doi.org/10.1111/clr.13309. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Objectives: Working Group 5 was assigned the task to review the current knowledge in the area of digital technologies. Focused questions on accuracy of linear measure-ments when using CBCT, digital vs. conventional implant planning, using digital vs. conventional impressions and assessing the accuracy of static computer-aided im-plant surgery (s-CAIS) and patient-related outcome measurements when using s-CAIS were addressed.Materials and methods: The literature was systematically searched, and in total, 232 articles were selected and critically reviewed following PRISMA guidelines. Four sys-tematic reviews were produced in the four subject areas and amply discussed in the group. After emendation, they were presented to the plenary where after further modification, they were accepted.Results: Static computer-aided surgery (s-CAIS), in terms of pain & discomfort, eco-nomics and intraoperative complications, is beneficial compared with conventional implant surgery. When using s-CAIS in partially edentulous cases, a higher level of accuracy can be achieved when compared to fully edentulous cases. When using an intraoral scanner in edentulous cases, the results are dependent on the protocol that has been followed. The accuracy of measurements on CBCT scans is software dependent.Conclusions: Because the precision intraoral scans and of measurements on CBCT scans and is not high enough to allow for the required accuracy, s-CAIS should be considered as an additional tool for comprehensive diagnosis, treatment planning, and surgical procedures. Flapless s-CAIS can lead to implant placement outside of the zone of keratinized mucosa and thus must be executed with utmost car

Antibiotics and cure rates in childhood febrile urinary tract infections in clinical trials: a systematic review and meta-analysis

Purpose: Urinary tract infections (UTIs) are common bacterial infections among children. Objective: To systematically review the antimicrobials used for febrile urinary tract infections in pediatric clinical trials and meta-analyze the observed cure rates and reasons for treatment failure. Materials and Methods: We searched Medline, Embase and Cochrane central databases between January 1, 1990, and November 24, 2016, combining MeSH and free-text terms for: “urinary tract infections”, AND “therapeutics”, AND “clinical trials” in children (age range 0–18 years). Two independent reviewers assessed study quality and performed data extraction. The major outcome measures were clinical and microbiological cure rates according to different antibiotics. Results: We identified 2,762 published studies and included 30 clinical trials investigating 3913 cases of pediatric febrile urinary tract infections. Children with no underlying condition were the main population included in the trials (n=2,602; 66.5%). Cephalosporins were the most frequent antibiotics studied in trials (22/30, 73.3%). Only a few antibiotics active against resistant urinary tract infections have been tested in randomised clinical trials, mainly aminoglycosides. The average point cure rate of all investigational drugs was estimated to 95.3% [95% CI 93.5-96.9%]. Among 3,002 patients for whom cure and failure rates were reported, only 3.9% (3.9%; 118/3,002) were considered clinically to have treatment failure, while 135 (4.5%; 135/3,002) had microbiological failure. Conclusions: We observed high treatment cure rates, regardless of the investigational drug chosen, the route of administration, duration and dosing. This suggests that future research should prioritise observational studies and clinical trials on children with multi-drug resistant infections