الفهرس 
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Abstract
The rational use of antibiotics should be based on rules; the correct diagnosis, the patient’s condition, the location of the infection, the severity of the microbial cause, sensitivities to antibiotics, the pharmacokinetics and pharmacodynamics of antimicrobials. The side effects and cost are the main elements which must be supported in every decision for their use.
The overuse of antibiotics contributes toward the growing number of bacterial infections that are becoming resistant to antibacterial medications. The incidence of antimicrobial resistance (AMR) has been increasing worldwide in the past decades, which include resistance to bacteria that cause common infections in children. Previous studies have shown that the use of antibiotic was associated with higher rates of resistance in children.
A large variation was observed in the use of antibiotics among children between countries. The global consumption of antibiotics had increased significantly, mainly due to the increase of antibiotic use in low- and middle-income countries. Misuse and overuse of antibiotics are considered a more serious problem Therefore, the appropriate use of antibiotics must be promoted in these countries to prevent the increasing trend of antibiotic resistance at the global level.
The same was observed in our practice in Pediatric Cardiology Unit, Assuit University Children Hospital.
The use of antibiotics in patients admitted to the Pediatric Cardiology Unit, Assuit University Children Hospital with different diagnosis as pneumonia in patient with CHD, infective endocarditis, rheumatic fever and pericarditis will be reviewed.
At least 2 million people in the U.S. are infected with antibiotic-resistant bacteria every year, leading to the death of at least 23,000 people .
Methicillin resistant Staphylococcus aureus (MRSA), for example, is one of the more notorious antibiotic-resistant bacterial strains; it resists methicillin and other antibiotics used to treat Staphylococcus infections, which are acquired primarily through skin contact
So, the adherence of antibiotics use to the guide lines in different indications in Pediatric Cardiology Unit will be reviewed in this clinical audit.
The aim of the present study was to audit the use of antibiotics in the Pediatric Cardiology Unit, Assuit University Children Hospital and to evaluate their adherence to the guidelines of their use in rheumatic fever, infective endocarditis, pericarditis and pneumonia in patient with CHD.
We consider that this critical appraisal of our own performance is a crucial step before any further correction or development of that performance could take place.
This retrospective observational study was done at Pediatric Cardiology Unit, Assuit University Children Hospital during one year period from October 2019 to September 2020. The study included 200 patients received antibiotics as a part of their management plan for rheumatic fever, infective endocarditis, pericarditis or pneumonia in patient with CHD.
The age of patients ranges from 31 day to 15 years old with a mean± SD (2.86 ±3.83). 82(41.0%) of patients were females and 118 (59.0%) of patients were males.
Pneumonia with CHD was the most common cause of admission of the included patients in Pediatric Cardiology Unit and represents 78.5% of all patients.
Regarding the clinical data of studied patients, fever was the most common presentation in the studied patients and represented 90% of patients and cough was the second common presentation in the studied patients and represented 78.5 % of patients.
Regarding the laboratory investigations of studied patients, we found that CBC was done in all included patients. Total leucocytic count range was more than the normal value in children. Neutrophils percentage range was more than the normal value in children. Hemoglubin level range was less than the normal value in children. CRP was done in only 26.5% of patients. CRP range was more than the normal value in children. ESR was done in only 9.5% of patients. ESR range was more than the normal value in children. Blood culture was done in only 7.5% of patients and was not done in 92.5% of patients. Throat swab and culture was not done in cases of rheumatic fever. Culture of pericardial fluid was done in (1.5%)of patients.
Antibiotic therapy used for eradication of GAS (empirical) in 8 (80%) whereas it was used for prophylaxis in 2 (20%) of patients. Benzathine penicillin was used for eradication of GAS (empirical) in 100% of patients whereas Ampicillin+sulbactam was used in 3 (37.5%) of the patients and cefotaxime was used in 1 (12.5%) of the patients. Benzathine penicillin was used for prophylaxis in 2 (100%) of patients. Antibiotic therapy used as a prophylaxis against rheumatic fever was adherent to guidelines in 100% of patients but regarding eradication of GAS only 50% of patients were adherent to guidelines due to inappropriate use of Ampicillin+sulbactam and cefotaxime with benzathine penicillin.
Antibiotic therapy was used in 19 patients prepared to cardiac catheterization as a prophylaxis against infective endocarditis. Ampicillin + sulbactam was used in 100% of the patients. Amikacin was used in about 21% of the patients. Cefotaxime was used in about 10.5% of the patients. Antibiotic therapy was adherent to guidelines in 68.5% of the patients while it was not adherent to guidelines in 31.5% of the patients due to inappropriate use of amikacin and cefotaxime with ampicillin.
Antibiotic therapy was empirical in 6 patients with infective endocarditis. Vancomycin and gentamicin were used in all of the patients. Ceftriaxone was used in about 16.6% of the patients. Antibiotic therapy used in treatment of patients with infective endocarditis was adherent to guidelines in 100% of the patients.
Antibiotic therapy used in patients with pericarditis was empirical in most of the patients. Vancomycin was used in all of the patients. Ceftriaxone was used in most of the patients. Antibiotic therapy used in patients with pericarditis was adherent to guidelines in only 75% of patients due to inappropriate use of metronidazole as empirical therapy.
Antibiotic therapy used in patients with pneumonia with CHD was empirical in most of patients. Ampicillin+sulbactam was used in most of patients. Antibiotic therapy used in patients with pneumonia with CHD was adherent to guidelines in only 68.8% of patients due to inappropriate use of metronidazole, ceftazidime and amikacin as empirical therapy.
Antibiotic therapy used in all included patients was empirical in most of patients. It was adherent to guidelines in only 69% of patients.