Hayek Haya, Amarin Justin Z, Hamdan Olla, Qwaider Yasmeen Z, Khraise Tala, Banerjee Ritu, Spieker Andrew J, Chappell James D, Khuri-Bulos Najwa, Katz Sophie E, Howard Leigh M, Halasa Natasha B
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Epidemiology Doctoral Program, School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
Microbiol Spectr. 2025 Apr;13(4):e0269124. doi: 10.1128/spectrum.02691-24. Epub 2025 Feb 14.
Inappropriate antibiotic use drives antimicrobial resistance, a global health threat causing increased morbidity and mortality. Understanding antibiotic practices in low-resource settings is essential to identify intervention targets. This study investigates antibiotic prescription practices in Amman, Jordan. We conducted three prospective viral surveillance studies at the largest public hospital in Amman, Jordan (2010-2013, 2020, and 2023) and included children <2 years old hospitalized with fever or respiratory symptoms. The data collected included antibiotic use and the results of blood, urine, and cerebrospinal fluid (CSF) cultures performed. We classified antibiotics according to the 2023 WHO AWaRe system. Nasal or throat samples were tested in a research laboratory for respiratory viruses using RT-PCR. The median age of the 4,724 children included was 3.5 months (IQR, 1.6-8.4). A clinical blood, urine, or CSF sample was collected from 2,565/4,712 children (54.4%), 356 (13.9%) of whom tested positive. During hospitalization, 4,375 children (92.6%) received at least one antibiotic, and 4,245 (97.0%) received at least one antibiotic from the group. One or more respiratory viruses were detected in 3,911 children (82.8%). Providers ordered cultures most often for children 0-2 months old ( = 1,579 [73.5%]) and those with an admission diagnosis of rule-out sepsis ( = 1,164 [95.4%]). Antibiotic use and testing practices were consistent across study years, age groups, and admission diagnoses. In conclusion, widespread antibiotic use despite the preponderance of viral infections highlights a significant discrepancy in aligning treatment practices with disease etiology. Strengthening diagnostic and preventive capabilities in low-resource settings is crucial to combat antimicrobial resistance.
In this study of 4,724 children under 2 years old hospitalized in the largest public hospital in Jordan between 2010 and 2023, 92.6% received antibiotics despite 82.8% testing positive for respiratory viruses and only 13.9% of collected cultures suggesting bacterial infection. Despite the predominance of viral infections, the widespread use of antibiotics, particularly from the World Health Organization Watch group, highlights the need for improved antibiotic stewardship and diagnostic capabilities in Jordan.
不恰当的抗生素使用推动了抗菌药物耐药性的产生，这是一种全球健康威胁，导致发病率和死亡率上升。了解资源匮乏地区的抗生素使用情况对于确定干预目标至关重要。本研究调查了约旦安曼的抗生素处方情况。我们在约旦安曼最大的公立医院开展了三项前瞻性病毒监测研究（2010 - 2013年、2020年和2023年），纳入了因发热或呼吸道症状住院的2岁以下儿童。收集的数据包括抗生素使用情况以及进行的血液、尿液和脑脊液（CSF）培养结果。我们根据2023年世界卫生组织的AWaRe系统对抗生素进行分类。在一个研究实验室中，使用逆转录聚合酶链反应（RT - PCR）对鼻或咽样本进行呼吸道病毒检测。纳入的4724名儿童的中位年龄为3.5个月（四分位距，1.6 - 8.4）。从4712名儿童中的2565名（54.4%）采集了临床血液、尿液或脑脊液样本，其中356名（13.9%）检测呈阳性。在住院期间，4375名儿童（92.6%）接受了至少一种抗生素治疗，4245名（97.0%）接受了至少一种来自该组的抗生素治疗。在3911名儿童（82.8%）中检测到一种或多种呼吸道病毒。医护人员最常为0 - 2个月大的儿童（n = 1579 [73.5%]）以及入院诊断为排除败血症的儿童（n = 1164 [95.4%]）开具培养检查。抗生素使用和检测情况在各研究年份、年龄组和入院诊断之间保持一致。总之，尽管病毒感染占主导，但抗生素的广泛使用凸显了治疗实践与疾病病因之间的显著差异。加强资源匮乏地区的诊断和预防能力对于对抗抗菌药物耐药性至关重要。
在这项对2010年至2023年期间在约旦最大的公立医院住院的4724名2岁以下儿童的研究中，92.6%的儿童接受了抗生素治疗，尽管82.8%的儿童呼吸道病毒检测呈阳性，且仅13.9%的采集培养结果提示细菌感染。尽管病毒感染占主导，但抗生素的广泛使用，尤其是来自世界卫生组织观察组的抗生素，凸显了约旦改善抗生素管理和诊断能力的必要性。
