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Antibiotic treatment failure in children aged 1 to 59 months with World Health Organization-defined severe pneumonia in Malawi: A CPAP IMPACT trial secondary analysis
Pneumonia is a leading cause of mortality in children
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| Published in: | PloS one 2022-12, Vol.17 (12), p.e0278938-e0278938 |
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| creator | Mvalo, Tisungane Smith, Andrew G Eckerle, Michelle Hosseinipour, Mina C Kondowe, Davie Vaidya, Dhananjay Liu, Yisi Corbett, Kelly Nansongole, Dan Mtimaukanena, Takondwa A Lufesi, Norman McCollum, Eric D |
| description | Pneumonia is a leading cause of mortality in children |
| doi_str_mv | 10.1371/journal.pone.0278938 |
| format | article |
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Participants were 1-59 months old with World Health Organization-defined severe pneumonia and hypoxemia, severe malnutrition, and/or HIV exposure/infection. All participants received intravenous antibiotics per standard care. First-line antibiotics were benzylpenicillin and gentamicin for five days. Study staff assessed patients for first-line antibiotic failure daily between days 3-6. When identified, patients failing antibiotics were switched to second-line ceftriaxone. Analyses excluded children receiving ceftriaxone and/or deceased by hospital day two. We compared characteristics between patients with and without treatment failure and fit multivariable logistic regression models to evaluate associations between treatment failure and admission characteristics.
From June 2015-March 2018, 644 children were enrolled and 538 analyzed. Antibiotic failure was identified in 251 (46.7%) participants, and 19/251 (7.6%) died. Treatment failure occurred more frequently with severe malnutrition (50.2% (126/251) vs 28.2% (81/287), p<0.001) and amongst those dwelling ≥10km from a health facility (22.3% (56/251) vs 15.3% (44/287), p = 0.026). Severe malnutrition occurred more frequently among children living ≥10km from a health facility than those living <10km (49.0% (49/100) vs 35.7% (275/428), p = 0.014). Children with severe malnutrition (adjusted odds ratio (aOR) 2.2 (95% CI 1.52, 3.24), p<0.001) and pre-hospital antibiotics ((aOR 1.47, 95% CI 1.01, 2.14), p = 0.043) had an elevated aOR for antibiotic treatment failure.
Severe malnutrition and pre-hospital antibiotic use predicted antibiotic treatment failure in this high-risk severe pneumonia pediatric population in Malawi. Our findings suggest addressing complex sociomedical conditions like severe malnutrition and improving pneumonia etiology diagnostics will be key for better targeting interventions to improve childhood pneumonia outcomes.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0278938</identifier><identifier>PMID: 36516197</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Age ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Bacterial pneumonia ; Benzylpenicillin ; Biology and Life Sciences ; Ceftriaxone ; Child ; Child, Preschool ; Children ; Children & youth ; Continuous positive airway pressure ; Data collection ; Diseases ; Dosage and administration ; Drug therapy ; Edema ; Etiology ; Evaluation ; Failure analysis ; Gentamicin ; Health care facilities ; Health facilities ; Health risks ; Hemoglobin ; HIV ; Hospital facilities ; Hospitalization ; Hospitals ; Human immunodeficiency virus ; Humans ; Hypoxemia ; Impact analysis ; Infant ; Intravenous administration ; Low income groups ; Malaria ; Malawi - epidemiology ; Malnutrition ; Malnutrition - complications ; Medicine and Health Sciences ; Mortality ; Patient outcomes ; Patients ; Pediatrics ; Physical Sciences ; Pneumonia ; Pneumonia - complications ; Regression analysis ; Regression models ; Risk analysis ; Risk factors ; Secondary analysis ; Streptococcus infections ; Treatment Failure ; Vaccines ; World Health Organization</subject><ispartof>PloS one, 2022-12, Vol.17 (12), p.e0278938-e0278938</ispartof><rights>Copyright: © 2022 Mvalo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>2022 Mvalo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 Mvalo et al 2022 Mvalo et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-30ed44801c488270ddafe98b3772f1dc336459d27299b1a5c9714e3aed3cc9673</citedby><cites>FETCH-LOGICAL-c692t-30ed44801c488270ddafe98b3772f1dc336459d27299b1a5c9714e3aed3cc9673</cites><orcidid>0000-0002-7164-1601 ; 0000-0002-6775-7919 ; 0000-0003-2174-313X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2754486268/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2754486268?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,315,733,786,790,891,25783,27957,27958,37047,37048,44625,53827,53829,75483</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36516197$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Zalm, Maria Elisabeth Johanna</contributor><creatorcontrib>Mvalo, Tisungane</creatorcontrib><creatorcontrib>Smith, Andrew G</creatorcontrib><creatorcontrib>Eckerle, Michelle</creatorcontrib><creatorcontrib>Hosseinipour, Mina C</creatorcontrib><creatorcontrib>Kondowe, Davie</creatorcontrib><creatorcontrib>Vaidya, Dhananjay</creatorcontrib><creatorcontrib>Liu, Yisi</creatorcontrib><creatorcontrib>Corbett, Kelly</creatorcontrib><creatorcontrib>Nansongole, Dan</creatorcontrib><creatorcontrib>Mtimaukanena, Takondwa A</creatorcontrib><creatorcontrib>Lufesi, Norman</creatorcontrib><creatorcontrib>McCollum, Eric D</creatorcontrib><title>Antibiotic treatment failure in children aged 1 to 59 months with World Health Organization-defined severe pneumonia in Malawi: A CPAP IMPACT trial secondary analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Pneumonia is a leading cause of mortality in children <5 years globally. Early identification of hospitalized children with pneumonia who may fail antibiotics could improve outcomes. We conducted a secondary analysis from the Malawi CPAP IMPACT trial evaluating risk factors for antibiotic failure among children hospitalized with pneumonia.
Participants were 1-59 months old with World Health Organization-defined severe pneumonia and hypoxemia, severe malnutrition, and/or HIV exposure/infection. All participants received intravenous antibiotics per standard care. First-line antibiotics were benzylpenicillin and gentamicin for five days. Study staff assessed patients for first-line antibiotic failure daily between days 3-6. When identified, patients failing antibiotics were switched to second-line ceftriaxone. Analyses excluded children receiving ceftriaxone and/or deceased by hospital day two. We compared characteristics between patients with and without treatment failure and fit multivariable logistic regression models to evaluate associations between treatment failure and admission characteristics.
From June 2015-March 2018, 644 children were enrolled and 538 analyzed. Antibiotic failure was identified in 251 (46.7%) participants, and 19/251 (7.6%) died. Treatment failure occurred more frequently with severe malnutrition (50.2% (126/251) vs 28.2% (81/287), p<0.001) and amongst those dwelling ≥10km from a health facility (22.3% (56/251) vs 15.3% (44/287), p = 0.026). Severe malnutrition occurred more frequently among children living ≥10km from a health facility than those living <10km (49.0% (49/100) vs 35.7% (275/428), p = 0.014). Children with severe malnutrition (adjusted odds ratio (aOR) 2.2 (95% CI 1.52, 3.24), p<0.001) and pre-hospital antibiotics ((aOR 1.47, 95% CI 1.01, 2.14), p = 0.043) had an elevated aOR for antibiotic treatment failure.
Severe malnutrition and pre-hospital antibiotic use predicted antibiotic treatment failure in this high-risk severe pneumonia pediatric population in Malawi. Our findings suggest addressing complex sociomedical conditions like severe malnutrition and improving pneumonia etiology diagnostics will be key for better targeting interventions to improve childhood pneumonia outcomes.</description><subject>Age</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Bacterial pneumonia</subject><subject>Benzylpenicillin</subject><subject>Biology and Life Sciences</subject><subject>Ceftriaxone</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Children & youth</subject><subject>Continuous positive airway pressure</subject><subject>Data collection</subject><subject>Diseases</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Edema</subject><subject>Etiology</subject><subject>Evaluation</subject><subject>Failure analysis</subject><subject>Gentamicin</subject><subject>Health care facilities</subject><subject>Health facilities</subject><subject>Health risks</subject><subject>Hemoglobin</subject><subject>HIV</subject><subject>Hospital facilities</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Hypoxemia</subject><subject>Impact analysis</subject><subject>Infant</subject><subject>Intravenous administration</subject><subject>Low income groups</subject><subject>Malaria</subject><subject>Malawi - epidemiology</subject><subject>Malnutrition</subject><subject>Malnutrition - complications</subject><subject>Medicine and Health Sciences</subject><subject>Mortality</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Physical Sciences</subject><subject>Pneumonia</subject><subject>Pneumonia - complications</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Secondary analysis</subject><subject>Streptococcus infections</subject><subject>Treatment Failure</subject><subject>Vaccines</subject><subject>World Health Organization</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNqNk99u0zAUxiMEYmPwBggsISG4aLHjJI65QKoqYJU2rYIBl5Zrn7SeXLvYzsZ4IJ4Td-2mFu0C5SKx8_s-nz8-RfGc4CGhjLy78H1w0g5X3sEQl6zltH1QHBJOy0FTYvpw5_ugeBLjBcY1bZvmcXFAm5o0hLPD4s_IJTMzPhmFUgCZluAS6qSxfQBkHFILY3UAh-QcNCIoeVRztPQuLSK6MmmBfvhgNToGafPiLMylM79lMt4NNHTGZVWES8huKwd9Fhq59j2VVl6Z92iExtPRFE1Op6PxeQ7BSJt55Z2W4RrJnOF1NPFp8aiTNsKz7fuo-Pbp4_n4eHBy9nkyHp0MVMPLNKAYdFW1mKiqbUuGtZYd8HZGGSs7ohWlTVVzXbKS8xmRteKMVEAlaKoUbxg9Kl5ufFfWR7EtcRQlq7NtUzZtJiYbQnt5IVbBLHOcwksjbjZ8mAsZcjUtCNzWpO46hnlVVSUFWTXQzTBuKa0176rs9WF7Wj9bgla59EHaPdP9P84sxNxfCs5qjHGTDd5sDYL_2UNMYmmiAmulA99v4q4xqfg67lf_oPdnt6XmMidgXOfzuWptKkaMYkxJXeNMDe-h8qNhaXLrctvz_p7g7Z4gMwl-pbnsYxSTr1_-nz37vs--3mEXN1cwetuvb1_cB6sNqIKPMUB3V2SCxXqcbqsh1uMktuOUZS92G3Qnup0f-hdFkBoK</recordid><startdate>20221214</startdate><enddate>20221214</enddate><creator>Mvalo, Tisungane</creator><creator>Smith, Andrew G</creator><creator>Eckerle, Michelle</creator><creator>Hosseinipour, Mina C</creator><creator>Kondowe, Davie</creator><creator>Vaidya, Dhananjay</creator><creator>Liu, Yisi</creator><creator>Corbett, Kelly</creator><creator>Nansongole, Dan</creator><creator>Mtimaukanena, Takondwa A</creator><creator>Lufesi, Norman</creator><creator>McCollum, Eric D</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-7164-1601</orcidid><orcidid>https://orcid.org/0000-0002-6775-7919</orcidid><orcidid>https://orcid.org/0000-0003-2174-313X</orcidid></search><sort><creationdate>20221214</creationdate><title>Antibiotic treatment failure in children aged 1 to 59 months with World Health Organization-defined severe pneumonia in Malawi: A CPAP IMPACT trial secondary analysis</title><author>Mvalo, Tisungane ; Smith, Andrew G ; Eckerle, Michelle ; Hosseinipour, Mina C ; Kondowe, Davie ; Vaidya, Dhananjay ; Liu, Yisi ; Corbett, Kelly ; Nansongole, Dan ; Mtimaukanena, Takondwa A ; Lufesi, Norman ; McCollum, Eric D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-30ed44801c488270ddafe98b3772f1dc336459d27299b1a5c9714e3aed3cc9673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Age</topic><topic>Anti-Bacterial Agents - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mvalo, Tisungane</au><au>Smith, Andrew G</au><au>Eckerle, Michelle</au><au>Hosseinipour, Mina C</au><au>Kondowe, Davie</au><au>Vaidya, Dhananjay</au><au>Liu, Yisi</au><au>Corbett, Kelly</au><au>Nansongole, Dan</au><au>Mtimaukanena, Takondwa A</au><au>Lufesi, Norman</au><au>McCollum, Eric D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antibiotic treatment failure in children aged 1 to 59 months with World Health Organization-defined severe pneumonia in Malawi: A CPAP IMPACT trial secondary analysis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2022-12-14</date><risdate>2022</risdate><volume>17</volume><issue>12</issue><spage>e0278938</spage><epage>e0278938</epage><pages>e0278938-e0278938</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-1</notes><notes>content type line 23</notes><notes>Competing Interests: The authors have declared that no competing interests exist.</notes><abstract>Pneumonia is a leading cause of mortality in children <5 years globally. Early identification of hospitalized children with pneumonia who may fail antibiotics could improve outcomes. We conducted a secondary analysis from the Malawi CPAP IMPACT trial evaluating risk factors for antibiotic failure among children hospitalized with pneumonia.
Participants were 1-59 months old with World Health Organization-defined severe pneumonia and hypoxemia, severe malnutrition, and/or HIV exposure/infection. All participants received intravenous antibiotics per standard care. First-line antibiotics were benzylpenicillin and gentamicin for five days. Study staff assessed patients for first-line antibiotic failure daily between days 3-6. When identified, patients failing antibiotics were switched to second-line ceftriaxone. Analyses excluded children receiving ceftriaxone and/or deceased by hospital day two. We compared characteristics between patients with and without treatment failure and fit multivariable logistic regression models to evaluate associations between treatment failure and admission characteristics.
From June 2015-March 2018, 644 children were enrolled and 538 analyzed. Antibiotic failure was identified in 251 (46.7%) participants, and 19/251 (7.6%) died. Treatment failure occurred more frequently with severe malnutrition (50.2% (126/251) vs 28.2% (81/287), p<0.001) and amongst those dwelling ≥10km from a health facility (22.3% (56/251) vs 15.3% (44/287), p = 0.026). Severe malnutrition occurred more frequently among children living ≥10km from a health facility than those living <10km (49.0% (49/100) vs 35.7% (275/428), p = 0.014). Children with severe malnutrition (adjusted odds ratio (aOR) 2.2 (95% CI 1.52, 3.24), p<0.001) and pre-hospital antibiotics ((aOR 1.47, 95% CI 1.01, 2.14), p = 0.043) had an elevated aOR for antibiotic treatment failure.
Severe malnutrition and pre-hospital antibiotic use predicted antibiotic treatment failure in this high-risk severe pneumonia pediatric population in Malawi. Our findings suggest addressing complex sociomedical conditions like severe malnutrition and improving pneumonia etiology diagnostics will be key for better targeting interventions to improve childhood pneumonia outcomes.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>36516197</pmid><doi>10.1371/journal.pone.0278938</doi><tpages>e0278938</tpages><orcidid>https://orcid.org/0000-0002-7164-1601</orcidid><orcidid>https://orcid.org/0000-0002-6775-7919</orcidid><orcidid>https://orcid.org/0000-0003-2174-313X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2022-12, Vol.17 (12), p.e0278938-e0278938 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2754486268 |
| source | Publicly Available Content Database; PubMed Central |
| subjects | Age Anti-Bacterial Agents - therapeutic use Antibiotics Bacterial pneumonia Benzylpenicillin Biology and Life Sciences Ceftriaxone Child Child, Preschool Children Children & youth Continuous positive airway pressure Data collection Diseases Dosage and administration Drug therapy Edema Etiology Evaluation Failure analysis Gentamicin Health care facilities Health facilities Health risks Hemoglobin HIV Hospital facilities Hospitalization Hospitals Human immunodeficiency virus Humans Hypoxemia Impact analysis Infant Intravenous administration Low income groups Malaria Malawi - epidemiology Malnutrition Malnutrition - complications Medicine and Health Sciences Mortality Patient outcomes Patients Pediatrics Physical Sciences Pneumonia Pneumonia - complications Regression analysis Regression models Risk analysis Risk factors Secondary analysis Streptococcus infections Treatment Failure Vaccines World Health Organization |
| title | Antibiotic treatment failure in children aged 1 to 59 months with World Health Organization-defined severe pneumonia in Malawi: A CPAP IMPACT trial secondary analysis |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-09-21T12%3A49%3A50IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Antibiotic%20treatment%20failure%20in%20children%20aged%201%20to%2059%20months%20with%20World%20Health%20Organization-defined%20severe%20pneumonia%20in%20Malawi:%20A%20CPAP%20IMPACT%20trial%20secondary%20analysis&rft.jtitle=PloS%20one&rft.au=Mvalo,%20Tisungane&rft.date=2022-12-14&rft.volume=17&rft.issue=12&rft.spage=e0278938&rft.epage=e0278938&rft.pages=e0278938-e0278938&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0278938&rft_dat=%3Cgale_plos_%3EA730031550%3C/gale_plos_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c692t-30ed44801c488270ddafe98b3772f1dc336459d27299b1a5c9714e3aed3cc9673%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2754486268&rft_id=info:pmid/36516197&rft_galeid=A730031550&rfr_iscdi=true |