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2 results on '"Andrea Gastaldi"'

1. Point-of-Care and Rapid Tests for the Etiological Diagnosis of Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis

Author

Giulia Brigadoi, Andrea Gastaldi, Marco Moi, Elisa Barbieri, Sara Rossin, Annalisa Biffi, Anna Cantarutti, Carlo Giaquinto, Liviana Da Dalt, and Daniele Donà

Subjects
diagnostic stewardship, antimicrobials, children, POCT, film-array, RIDT, Therapeutics. Pharmacology, RM1-950
Abstract

Fever is one of the most common causes of medical evaluation of children, and early discrimination between viral and bacterial infection is essential to reduce inappropriate prescriptions. This study aims to systematically review the effects of point-of-care tests (POCTs) and rapid tests for respiratory tract infections on changing antibiotic prescription rate, length of stay, duration of therapy, and healthcare costs. Embase, MEDLINE, and Cochrane Library databases were systematically searched. All randomized control trials and non-randomized observational studies meeting inclusion criteria were evaluated using the NIH assessment tool. A meta-analysis was performed to assess the effects of rapid influenza diagnostic tests and film-array respiratory panel implementation on selected outcomes. From a total of 6440 studies, 57 were eligible for the review. The analysis was stratified by setting and POCT/rapid test type. The most frequent POCTs or rapid tests implemented were the Rapid Influenza Diagnostic Test and film-array and for those types of test a separate meta-analysis assessed a significant reduction in antibiotic prescription and an improvement in oseltamivir prescription. Implementing POCTs and rapid tests to discriminate between viral and bacterial infections for respiratory pathogens is valuable for improving appropriate antimicrobial prescriptions. However, more studies are needed to assess these findings in pediatric settings.

Published
2022
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2. Effects of clinical pathway implementation on antibiotic prescriptions for pediatric community-acquired pneumonia

Author

Carlo Giaquinto, Theoklis E. Zaoutis, Andrea Gastaldi, Rana F. Hamdy, Rebecca Lundin, Silvia Zingarella, Anna Chiara Frigo, Giorgio Perilongo, Daniele Donà, and Liviana Da Dalt

Subjects
Genetics and Molecular Biology (all), Pulmonology, Medical Doctors, Health Care Providers, Antibiotics, lcsh:Medicine, Pathology and Laboratory Medicine, Biochemistry, Pediatrics, 0302 clinical medicine, Clinical pathway, Mycoplasma, Community-acquired pneumonia, Outpatients, Medicine and Health Sciences, Antimicrobial stewardship, Mycoplasma Pneumoniae, 030212 general & internal medicine, Treatment Failure, Medical Personnel, lcsh:Science, Child, Multidisciplinary, Antimicrobials, Drugs, Anti-Bacterial Agents, Bacterial Pathogens, Community-Acquired Infections, Exact test, Professions, Medical Microbiology, Child, Preschool, Critical Pathways, Pathogens, medicine.drug, Research Article, medicine.medical_specialty, Combination therapy, Adolescent, Patients, medicine.drug_class, Mollicutes, Drug Prescriptions, Humans, Infant, Inpatients, Length of Stay, Pneumonia, Biochemistry, Genetics and Molecular Biology (all), Agricultural and Biological Sciences (all), Microbiology, 03 medical and health sciences, 030225 pediatrics, Internal medicine, Microbial Control, Physicians, medicine, Medical prescription, Preschool, Microbial Pathogens, Pharmacology, Bacteria, business.industry, lcsh:R, Organisms, Biology and Life Sciences, Amoxicillin, medicine.disease, Health Care, People and Places, lcsh:Q, Population Groupings, business
Abstract

Background Italian pediatric antimicrobial prescription rates are among the highest in Europe. As a first step in an Antimicrobial Stewardship Program, we implemented a Clinical Pathway (CP) for Community Acquired Pneumonia with the aim of decreasing overall prescription of antibiotics, especially broad-spectrum. Materials and methods The CP was implemented on 10/01/2015. We collected antibiotic prescribing and outcomes data from children aged 3 months-15 years diagnosed with CAP from 10/15/2014 to 04/15/2015 (pre-intervention period) and from 10/15/2015 to 04/15/2016 (post-intervention period). We assessed antibiotic prescription differences pre- and post-CP, including rates, breadth of spectrum, and duration of therapy. We also compared length of hospital stay for inpatients and treatment failure for inpatients and outpatients. Chi-square and Fisher’s exact test were used to compare categorical variables and Wilcoxon rank sum test was used to compare quantitative outcomes. Results 120 pre- and 86 post-intervention clinic visits were identified with a diagnosis of CAP. In outpatients, we observed a decrease in broad-spectrum regimens (50% pre-CP vs. 26.8% post-CP, p = 0.02), in particular macrolides, and an increase in narrow-spectrum (amoxicillin) post-CP. Post-CP children received fewer antibiotic courses (median DOT from 10 pre-CP to 8 post-CP, p

Published
2017

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