For supporting antibiotic stewardship interventions, the World Health Organization (WHO) classified antibiotics through the AWaRe (Access, Watch, and Reserve) classification. Inappropriate use of antimicrobials among hospital-admitted patients exposes them to the vulnerability of developing resistant organisms which are difficult to treat. We aimed to describe the proportion of antibiotic use based on the WHO AWaRe classification in tertiary and secondary level hospitals in Bangladesh. A point prevalence survey (PPS) was conducted adapting the WHO PPS design in inpatients departments in 2021. Among the 1417 enrolled patients, 52% were female and 63% were from the 15–64 years age group. Nearly 78% of patients received at least one antibiotic during the survey period. Third-generation cephalosporins (44.6%), penicillins (12.3%), imidazoles (11.8%), aminoglycosides (7.2%), and macrolides (5.8%) were documented as highly used antibiotics. Overall, 64.0% of Watch, 35.6% of Access, and 0.1% of Reserve group antibiotics were used for treatment. The use of Watch group antibiotics was high in medicine wards (78.7%) and overall high use of Watch antibiotics was observed at secondary hospitals (71.5%) compared to tertiary hospitals (60.2%) (p-value of 0.000). Our PPS findings underscore the need for an urgent nationwide antibiotic stewardship program for physicians including the development and implementation of local guidelines and in-service training on antibiotic use.

Nasogastric feeding is commonly used to deliver enteral feed in critically ill patients and several methods are used for assessing the gastric residual volume with limitations. A new approach for gastric emptying time measurement has been developed using Electric Impedance Method (EIM). The study aims to establish whether EIM is useful for measuring gastric emptying during nasogastric feeding compared with nasogastric suction. The pilot study was performed among the patients in the Intensive Care Unit (ICU), Bangladesh, from 2018 to 2019. Enteral feed was given to patients by NG tube. Gastric emptying and Gastric Residual Volume (GRV) were measured using EIM and nasogastric suction tube. Patterns of filling and emptying were almost the same in all subjects but emptying time varied between individuals that correlated well with GRV in 16 patients. Therefore, the study showed that the measurement of gastrc volume by the non-invasive and hazard-free electrical impedance method has a high specificity (90%) and efficacy of 80%. The study also revealed significant changes in gastric emptying time due to different body statuses. EIM seemed to be capable of measuring gastric emptying over time. EIM could become a standard tool for monitoring gastric emptying in patients at risk of gastroparesis.

Background and Objective: Worldwide, up to 40% of all asthma hospitalisations are due to repeat admissions. This study aimed to estimate the burden of asthma readmission among children aged 2 to 17 years in New South Wales (NSW), Australia.Methods: A retrospective longitudinal whole‐of‐population‐based cohort study was conducted using linked administrative data. Children born in NSW from 2005 to 2015 having at least one asthma hospitalisation after the age of 2 years were included in the study and followed up for 12 months from the asthma index hospitalisation. The incidence rates for asthma first readmission within 12 months and associated direct medical costs were calculated.Results: During 2007–2022, 48,217 asthma hospitalisations occurred in children, with 28,177 children hospitalised for asthma as a primary diagnosis identified as asthma index hospitalisations. Among them, 21.6% experienced first asthma readmissions within 12 months, including over 80% from the 2–4 years age group and a significant proportion from socioeconomically disadvantaged areas. The overall incidence rate of first asthma readmission was 23.8 per 100 person‐years and 28.7 per 100 person‐years for children aged 2–4 years. The highest incidence rate (38.3 per 1000 person‐months) occurred within 1 month. The total direct medical cost of the first asthma readmission within 12 months was AU$ 15.6 million.Conclusion: Our study suggests that pre‐school children have the highest rate of asthma readmission, with a significant economic burden highlighting the need for identifying modifiable factors such as asthma management after discharge to reduce the burden of asthma hospital readmission in children.

Background: Repeat hospitalisations among asthmatic children pose a significant burden on the healthcare system. Identifying risk factors for asthma readmission may help detect at-risk children and promote effective interventions. The study aimed to identify risk factors for asthma readmission among children aged 2 to 17 years in New South Wales, Australia. Methods: A retrospective birth cohort study was conducted using linked administrative data. The study cohort included children born in NSW between 2005 and 2015 who had at least one asthma-related hospitalisation. Risk factors for early and late readmission were identified using modified Poisson regression. Results: From 2007 to 2022, a total of 27,430 children were hospitalised. Among them, 17.9% of children experienced early readmission, and 82.1% late readmission. In the adjusted multivariable model, risk factors for early readmission included children’s age 2-4 years (adjusted Relative Risk [aRR] 1.73; 95% confidence interval [CI] 1.50-1.99), no older siblings (1.26; 95%CI 1.12-1.42), length of stay (LOS) ≥2days (1.43; 95%CI 1.26-1.62), ICU admission (2.29; 95%CI 1.48-3.54), and underlying chronic comorbidities and/or congenital anomalies (1.31; 95%CI 1.15-1.51). Additionally, children’s age 2-4 years (1.94; 95%CI 1.82-2.08), no older siblings (1.10; 95%CI 1.04-1.15), maternal residence in the poor neighbourhoods and in major cities, and index admission during spring and summer, and LOS ≥2days (1.22, 95%CI 1.15-1.28) were associated with higher likelihood of late readmission. Conclusion: Risk factors for asthma readmission among children vary according to the timing of readmission. Risk stratification and targeted post-discharge follow-up for at-risk children may reduce the overall asthma readmission burden.