Comparison of changes in etiologic microorganisms causing early-onset neonatal sepsis between preterm labor and preterm premature rupture of membranes

<div><p></p><p><i>Objective</i>: To investigate changes in the etiologic microorganisms causing early-onset neonatal sepsis (EONS) in preterm labor (PTL) or preterm premature rupture of membranes (pPROM) cases over the past 16 years and to analyze the associated factors.</p><p><i>Methods</i>: We included consecutive singleton pregnancies delivered before 34 weeks due to PTL or pPROM. The etiologic microorganisms causing EONS in PTL and pPROM cases were compared between period 1 (1996–2004) and period 2 (2005–2012).</p><p><i>Results</i>: There was no difference in the incidence of Gram-positive bacteria causing EONS between period 1 and 2, either in PTL (2.0% versus 2.1%, <i>p</i> = 1.0) or in pPROM (1.5% versus 1.6%, <i>p</i> = 1.0). However, the incidence of EONS caused by Gram-negative bacteria was significantly increased in pPROM (0.6% versus 2.7%, <i>p</i> = 0.040) during period 2, compared to period 1; but not in PTL (0.3% versus 1.2%, <i>p</i> = 0.211). Multivariable analysis revealed that a prolonged ROM-to-delivery interval (>7 d) was significantly associated with EONS caused by Gram-negative bacteria in pPROM (odds ratio: 6.6, 95% confidence interval: 1.4–31.8, <i>p</i> = 0.018).</p><p><i>Conclusions</i>: The etiologic microorganisms causing EONS have changed over the past 16 years in pPROM cases but not in PTL cases.</p></div

Impact of drug utilization review (DUR) intervention on the monthly fluoroquinolone prescription rates per 100,000 children younger than 18 years old.

<p>(A) monthly prescription rate of CF in inpatient setting; (B) monthly prescription rate of LF in inpatient setting; (C) monthly prescription rate of CF in outpatient setting; (D) monthly prescription rate of LF in outpatient setting. Solid lines represent observed values, dashed lines represent predicted values and dotted lines represent 95% confidence intervals of predicted values. Abbreviations: CF, ciprofloxacin; LF, levofloxacin; DUR, drug utilization review.</p

Distribution of pediatric fluoroquinolone prescriptions in medical facilities before and after implementation of drug utilization review.

<p>(A) distribution of CF prescriptions in medical facilities in inpatient setting, pre- and post-DUR (log scale); (B) distribution of LF prescriptions in medical facilities in inpatient setting, pre- and post-DUR (log scale); (C) distribution of CF prescriptions in medical facilities in outpatient setting, pre- and post-DUR (log scale); (D) distribution of LF prescriptions in medical facilities in outpatient setting, pre- and post-DUR (log scale).</p

Pediatric fluoroquinolone prescription in South Korea before and after a regulatory intervention: A nationwide study, 2007-2015

<div><p>Objective</p><p>To investigate the impact of national implementation of age restriction on fluoroquinolone prescription in children and adolescents.</p><p>Methods</p><p>Data collected from the database of Health Insurance Review and Assessment Service in South Korea, a national health insurance system to analyze fluoroquinolone prescribing practice in children and adolescents younger than 18 years, between 2007 and 2015. The age restriction was implemented in December 2009. The annual prescription rate of FQ per 100,000 person-years was calculated and an autoregressive model was used to predict the prescription pattern if an intervention had not occurred.</p><p>Results</p><p>A total of 505,859 children received systemic fluoroquinolone during the study period—297,054 ciprofloxacin, and 208,805 levofloxacin. After implementation of the drug utilization review program, the annual prescription rate for ciprofloxacin declined by 97.5% (from 840 to 21 per 100,000 person-years, P < 0.001), and for levofloxacin by 96.4% (from 598 to 11 per 100,000 person-years, P < 0.001). The decline was more dramatic in the outpatient setting than in the inpatient setting for both drugs.</p><p>Conclusion</p><p>The dramatic and sustained decline in prescription number and change in prescription pattern after the regulatory action suggests that the implementation under drug utilization review program was successful in controlling excessive and inappropriate use of fluoroquinolones in children, possibly guiding towards more judicious and selective prescription behavior.</p></div

Demographic characteristics of pediatric patients who received systemic fluoroquinolone treatment.

<p>Demographic characteristics of pediatric patients who received systemic fluoroquinolone treatment.</p

Yearly distribution of pediatric fluoroquinolone prescriptions in medical facilities in outpatient setting.

<p>Abbreviations: CF, ciprofloxacin; LF, levofloxacin; DUR, drug utilization review.</p

Five most common medical specialties of physicians prescribing pediatric fluoroquinolone prescriptions.

<p>Five most common medical specialties of physicians prescribing pediatric fluoroquinolone prescriptions.</p

Univariate and multivariate analysis for factors affecting fever duration during the early transplant period of tandem HDCT/auto-SCT.

<p>Univariate and multivariate analysis for factors affecting fever duration during the early transplant period of tandem HDCT/auto-SCT.</p

Etiology of bacterial infection.

<p>Etiology of bacterial infection.</p

Respiratory virus infections during the early transplant period of tandem HDCT/auto-SCT.

<p>Number of isolates and respiratory symptoms for each respiratory virus during the first (A) and second (B) HDCT/auto-SCT. (C) The high-risk RV group had a higher incidence of LRTI than the low-risk RV group (43.5% versus 10.0%, p = 0.005). HDCT/auto-SCT, high-dose chemotherapy and autologous stem cell transplantation; URI, upper respiratory infection; LRTI, lower tract respiratory infection; RhV, rhinovirus; RSV, respiratory syncytial virus; CoV, coronavirus; PIV, parainfluenza virus; IV, influenza virus; AdV, adenovirus; RV, respiratory virus.</p