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BAKGRUNN - Hud- og bløtvevsinfeksjoner er vanlig hos barn. Vi ønsket å undersøke forekomsten av meticillinresistens blant gule stafylokokker i sårsekret fra barn i Norge. MATERIALE OG METODE - Vi gjennomførte en observasjonsstudie basert på data fra Norsk overvåkingssystem for antibiotikaresistens hos mikrober (NORM) for perioden 2013–21. Resistensdata fra sårsekret med vekst av gule stafylokokker fra barn (0–17 år) og voksne ble inkludert i studien. RESULTATER - Totalt ble 1 416 isolat fra sårsekret fra barn og 7 623 isolat fra voksne med vekst av gule stafylokokker inkludert. Meticillinresistente gule stafylokokker (MRSA, meticillinresistente Staphylococcus aureus) ble påvist i 33 (2,3 %) av isolatene fra barn og 95 (1,2 %) av isolatene fra voksne (p = 0,002). Hos barn var det høyest forekomst av MRSA blant barn i barnehagealder (1–5 år, 4,4 %), sammenlignet med spedbarn (< 1 år, 1,0 %) og barn i skolealder (6–17 år, 1,7 %) (p = 0,011). Barnehagebarn hadde høyest forekomst av erytromycinresistens (9,0 %). FORTOLKNING - Forekomsten av meticillinresistens blant gule stafylokokker i sårsekret fra barn i Norge var generelt lav, men noe høyere i sekret fra barnehagebarn sammenlignet med andre aldersgrupper. En trenger normalt ikke ta høyde for meticillinresistens ved empirisk behandling av hud- og bløtvevsinfeksjoner hos barn i Norge. HOVEDFUNN - Forekomsten av meticillinresistens blant gule stafylokokker i sårsekret fra barn i Norge var på 2,3 %. Høyest forekomst av meticillinresistente gule stafylokokker ble påvist i sårsekret fra barnehagebarn (4,4 %).

Objectives To investigate whether infants exposed to antimicrobials in hospital during the first 3 months of life had an increased risk of ambulatory antimicrobial use during the following year compared with infants not exposed to antimicrobials during the first 3 months of life. Methods Norwegian cohort study of infants less than 3 months consisting of one group exposed to antimicrobials recruited during hospitalization and one group not exposed to antimicrobials. Ten unexposed infants were matched with one exposed infant according to county of residence, birth year and month, and sex. The Norwegian Prescription Database was applied to register antimicrobial use from the month after discharge and 1 year onward. We defined comorbidity based on antimicrobials prescribed as reimbursable prescriptions due to underlying diseases. Results Of 95 infants exposed to antimicrobials during the first 3 months of life, 23% had recurrent use compared with 14% use in 950 unexposed infants [relative risk (RR) = 1.7 (95% CI = 1.1–2.5) and comorbidity-adjusted RR = 1.4 (95% CI = 0.9–2.2)]. The recurrence use rate in exposed term infants (≥37 weeks, n = 70) was 27% compared with 12% in their unexposed matches [RR 2.3 = (95% CI = 1.4–3.7) and comorbidity-adjusted RR = 1.9 (95% CI = 1.2–3.2). Of 25 exposed preterm infants, 3 (12%) had recurrent use. The total antimicrobial prescription rate was 674/1000 in the exposed group and 244/1000 in the unexposed group [incidence rate ratio = 2.8 (95% CI = 1.6–4.9)]. Conclusions Infants exposed to antimicrobials during the first 3 months of life had an increased risk of recurrent use during the following year. This increased risk also appeared in term infants without infection-related comorbidity.

Urinary tract infections are common in children. The purpose of this study was to describe national resistance data from urinary isolates from children with a view to informing antibiotic use.We conducted an observational study based on culture responses with resistance determination in urine from the Norwegian Surveillance System for Antimicrobial Drug Resistance (NORM). All urinary isolates from children (0-17 years) in the period 2013-17 were included and compared with urinary isolates from adults. For cephalexin resistance, we used data from two Norwegian hospitals covering the period 2015-19.Of 13 211 urinary isolates included in the NORM register, 589 (4.5 %) were from children. Weighted by the number of data collection days, Escherichia coli accounted for 85.2 % of the isolates from children. For E. coli, there was a higher proportion of trimethoprim resistance in urine samples from children (27.0 %) compared to adults (22.9 %), p = 0.02. For ciprofloxacin, we found a lower resistance rate in E. coli in urine samples from children (5.7 %) compared to adults (8.7 %), p = 0.03. For other selected antibiotics, we found the following resistance rates in E. coli in children: nitrofurantoin (0.5 %), mecillinam (4.0 %), cephalexin (4.3 %), amoxicillin-clavulanic acid (7.2 %) and trimethoprim-sulfamethoxazole (24.1 %).Pivmecillinam, cephalexin and amoxicillin-clavulanic acid are relevant choices in the empirical treatment of upper urinary tract infections. Nitrofurantoin and pivmecillinam are relevant for lower urinary tract infections. Trimethoprim and trimethoprim-sulfamethoxazole should only be used after resistance determination.

Background Urinary tract infections are common in children. The purpose of this study was to describe national resistance data from urinary isolates from children with a view to informing antibiotic use. Method We conducted an observational study based on culture responses with resistance determination in urine from the Norwegian Surveillance System for Antimicrobial Drug Resistance (NORM). All urinary isolates from children (0-17 years) in the period 2013-17 were included and compared with urinary isolates from adults. For cephalexin resistance, we used data from two Norwegian hospitals covering the period 2015-19. Results Of 13 211 urinary isolates included in the NORM register, 589 (4.5 %) were from children. Weighted by the number of data collection days, Escherichia coli accounted for 85.2 % of the isolates from children. For E. coli, there was a higher proportion of trimethoprim resistance in urine samples from children (27.0 %) compared to adults (22.9 %), p = 0.02. For ciprofloxacin, we found a lower resistance rate in E. coli in urine samples from children (5.7 %) compared to adults (8.7 %), p = 0.03. For other selected antibiotics, we found the following resistance rates in E. coli in children: nitrofurantoin (0.5 %), mecillinam (4.0 %), cephalexin (4.3 %), amoxicillin-clavulanic acid (7.2 %) and trimethoprim-sulfamethoxazole (24.1 %). Interpretation Pivmecillinam, cephalexin and amoxicillin-clavulanic acid are relevant choices in the empirical treatment of upper urinary tract infections. Nitrofurantoin and pivmecillinam are relevant for lower urinary tract infections. Trimethoprim and trimethoprim-sulfamethoxazole should only be used after resistance determination.

Crack arrest testing of micro-sized cantilever beams (≈8 × 4 × 6 μm, length, width and height, respectively) was conducted in order to evaluate the suitability of a new method to quantify local crack arrest properties. Chevron notched cantilevers were milled to match the (1 0 0)[0 1 ¯ 1] crack system in α-iron, where earlier attempts to obtain brittle or rapidly propagating fracture proved difficult. Brittle crack initiation and propagation was achieved by means of the deposition of a layer of SiOX on the surface, acting as a brittle starter. All tests were performed at −75 °C, using an in-house designed cooling system. The cracks arrested after propagation into the iron cantilever. A finite element model was developed to determine the appropriate dimensionless shape factor and provide a rigorous computer analysis of these complexly shaped cantilevers. KQC and KQa, at initiation and arrest respectively, were determined and evaluated. The cantilevers were later displaced further at 40 K to allow evaluation of crack jump lengths and to obtain a more complete analysis of the fracture surfaces. The average fracture toughness was determined to be 3.89 ± 1.00 MPa m , and the average arrest toughness to be 2.6 ± 0.86 MPa m . The finite element model highlights the effect of small variations in geometry which was larger than anticipated and strongly affects the shape factor, up to a 25% difference in f(a/W). As small variations in geometry are inevitable when milling with FIB, the need for individual models tailored to every cantilever is discussed.

Objective: To describe epidemiology and antimicrobial susceptibility testing (AST) data of bacteria causing invasive infections in Norwegian children (0–18 years). Methods: Population-based observational study using prospectively collected AST data from the Norwegian Surveillance System of Antimicrobial Resistance from 2013 to 2017. We included all clinically relevant bacterial isolates (blood and cerebrospinal fluid), and compared incidence of invasive infections and AST data in isolates from children and adults. Results: We included 1173 isolates from children and 44,561 isolates from adults. Staphylococcus aureus accounted for 220/477 (46.2%, 95% CI: 41.6–50.7) of all isolates in schoolchildren (6–18 years). Compared with Streptococcus pneumonia isolates from adults (N = 2674), we observed higher nonsusceptibility rates to penicillin in isolates from children (N = 151), 11.9% versus 5.8%, P < 0.01; also higher resistance rates to erythromycin (11.3% vs. 4.9%, P < 0.01), clindamycin (9.3% vs. 3.6%, P < 0.001), and trimethoprim/sulfamethoxazole (17.9% vs. 6.4%, P < 0.001). Compared with Escherichia coli isolates in adults (N = 9073), we found lower rates of ESBL in isolates from children (N = 212), 2.4% versus 6.4%, P < 0.05. Conclusion: The study indicates the importance of microbiologic surveillance strategies in children and highlights the need for pediatric AST data. The high rates of nonsusceptibility to commonly used antibiotics among S. pneumoniae in children and the high burden of invasive S. aureus infections in schoolchildren calls for modifications of Norwegian guidelines.

BACKGROUND: Antimicrobial resistance (AMR) is low in Norway, but to prevent an increase the Norwegian Government has launched a National Strategy including a 30% reduction of broad-spectrum antibiotics (BSA) in hospitals within 2020. BSA are defined as second- and third-generation cephalosporins, carbapenems, piperacillin/tazobactam and quinolones. There are no recent studies of antibiotic use in Norwegian hospitalized children. AIM OF THE STUDY: To describe the use of antibiotics with emphasis on BSA in Norwegian hospitalized children and neonates in order to detect possibilities for optimization. METHODS: Data were extracted from eight national point prevalence surveys of systemic antibiotic prescriptions in Norwegian hospitals between 2015 and 2017. The choices of antibiotics were compared with the empirical recommendations given in available Norwegian guidelines. In total, 1323 prescriptions were issued for 937 patients. RESULTS: Twenty-four percent of pediatric inpatients were given antibiotics. Adherence to guidelines was 48%, and 30% (95% CI 27%-33%) of all patients on antibiotics received BSA. We identified only small variations in use of BSA between hospitals. One third of the patients on antibiotic therapy received prophylaxis whereof 13% where given BSA. In 30% of prescriptions with BSA, no microbiological sample was obtained prior to treatment. CONCLUSION: This study reveals an excess of prescriptions with BSA in relation to the low resistance rate in Norway. Our findings reveal areas for improvement that can be useful in the forthcoming antibiotic stewardship programs in Norwegian pediatric departments

Studies have shown that children with attention-deficit/hyperactivity disorder (AD/HD) have a lower quality of life (QoL), and lower school and psychosocial functioning than healthy children.This is the first study to compare these domains and child competence between children with AD/HD- and anxiety/depression-related problems and healthy children using data from multiple informants.Children were matched by age and sex, resulting in two clinical groups consisting of 62 children with AD/HD-related problems, 49 children with anxiety/depression-related problems and a reference group of 65 healthy schoolchildren. The Inventory of Life Quality for Children and Adolescents (parent and child report), the Child Behaviour Checklist (parent report), the Teacher's Report Form and the Children's Global Assessment Scale (therapist evaluation) were used. Differences between group means were analysed by t-tests and analysis of variance.The AD/HD group reported a significantly higher QoL than did the Anxiety/Depression group. However, no significant differences in QoL were found between the two clinical groups by parent proxy report. The AD/HD group reported a significantly higher QoL than shown by parent proxy evaluation. According to parent and teacher reports, both clinical groups showed significantly lower school functioning than the group of healthy children. Further, the AD/HD group showed significantly lower school functioning and total competence than the Anxiety/Depression group.To obtain a full clinical picture of subgroups of patients with AD/HD- and anxiety/depression-related problems referred to child mental health outpatient treatment, clinicians should always use multiple informants to evaluate symptoms/problems, functioning and QoL.