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Mekali, Vijayalaxmi, i Girijamma H. A. "Fully Automatic Detection and Segmentation Approach for Juxta-Pleural Nodules From CT Images". International Journal of Healthcare Information Systems and Informatics 16, nr 2 (kwiecień 2021): 87–104. http://dx.doi.org/10.4018/ijhisi.20210401.oa5.
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Early detection of all types of lung nodules with different characters in medical modality images using computer-aided detection is the best acceptable remedy to save the lives of lung cancer sufferers. But accuracy of different types of nodule detection rates is based on chosen segmented procedures for parenchyma and nodules. Separation of pleural from juxta-pleural nodules (JPNs) is difficult as intensity of pleural and attached nodule is similar. This research paper proposes a fully automated method to detect and segment JPNs. In the proposed method, lung parenchyma is segmented using iterative thresholding algorithm. To improve the nodules detection rate separation of connected lung lobes, an algorithm is proposed to separate connected left and right lung lobes. The new method segments JPNs based on lung boundary pixels extraction, concave points extraction, and separation of attached pleural from nodule. Validation of the proposed method was performed on LIDC-CT images. The experimental result confirms that the developed method segments the JPNs with less computational time and high accuracy.
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Aldiabat, Khaldoun M., i Michael Clinton. "Understanding Jordanian Psychiatric Nurses’ Smoking Behaviors: A Grounded Theory Study". Nursing Research and Practice 2013 (2013): 1–7. http://dx.doi.org/10.1155/2013/370828.
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Purpose. Smoking is prevalent in psychiatric facilities among staff and patients. However, there have been few studies of how contextual factors in specific cultures influence rates of smoking and the health promotion role of psychiatric nurses. This paper reports the findings of a classical grounded theory study conducted to understand how contextual factors in the workplace influences the smoking behaviors of Jordanian psychiatric nurses (JPNs).Method. Semi-structured individual interviews were conducted with a sample of eight male JPNs smokers at a psychiatric facility in Amman, Jordan.Findings. Constant comparative analysis identifiedbecoming a heavy smokeras a psychosocial process characterized by four sub-categories: normalization of smoking; living in ambiguity; experiencing workplace conflict; and, facing up to workplace stressors.Conclusion. Specific contextual workplace factors require targeted smoking cessation interventions if JPNs are to receive the help they need to reduce health risks associated with heavy smoking.
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Kim, Tae-Il. "New Year's resolution in JPIS". Journal of Periodontal & Implant Science 43, nr 6 (2013): 249. http://dx.doi.org/10.5051/jpis.2013.43.6.249.
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Maeda, Makiko, Douglas Humber, Eisuke Hida, Tomohito Ohtani, Guannan Wang, Tong Wu, Shiori Takeda i in. "Lower doses of carvedilol in Japanese heart failure patients with reduced ejection fraction could show the potential to be non-inferior to higher doses in US patients: An international collaborative observational study". PLOS ONE 19, nr 3 (7.03.2024): e0299510. http://dx.doi.org/10.1371/journal.pone.0299510.
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The Japanese national guidelines recommend significantly lower doses of carvedilol for heart failure with reduced ejection fraction (HFrEF) management than the US guidelines. Using real-world data, we determined whether initial and target doses of carvedilol in Japanese patients (JPNs) differ from those in US patients (USPs), especially in Asian Americans (ASA) and Caucasians (CA), and investigated differences in outcomes. We collected data from the electronic medical records, including demographics, carvedilol dosing, tolerability, cardiac functional indicators like EF, cardiovascular events including all-cause deaths, and laboratory values from the University of California, San Diego Health and Osaka University. JPNs had significantly lower doses (mg/day) of carvedilol initiation (66 USPs composed of 38 CAs and 28 ASAs, 17.1±16.2; 93 JPNs, 4.3±4.2, p<0.001) and one year after initiation (33.0±21.8; 11.2±6.5, p<0.001), and a significantly lower relative rate (RR) of dose discontinuation and reduction than USPs (RR: 0.406, 95% confidence interval (CI): 0.181–0.911, p<0.05). CAs showed the highest reduction rate (0.184), and ASAs had the highest discontinuation rate (0.107). A slight mean difference with narrow 95% CI ranges straddling zero was observed between the two regions in the change from the baseline of each cardiac functional indicator (LVEF, -0.68 [−5.49–4.12]; LVDd, −0.55 [−3.24–2.15]; LVDd index, −0.25 [−1.92–1.43]; LVDs, −0.03 [−3.84–3.90]; LVDs index, −0.04 [−2.38–2.30]; heart rate, 1.62 [−3.07–6.32]). The event-free survival showed no difference (p = 0.172) among the races. Conclusively, despite JPNs exhibiting markedly lower carvedilol doses, their dose effectiveness has the potential to be non-inferior to that in USPs. Dose de-escalation, not discontinuation, could be an option in some Asian and ASA HFrEF patients intolerable to high doses of carvedilol.
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Kim, Tae-Il. "The digital version of JPIS offers more than ever". Journal of Periodontal & Implant Science 44, nr 3 (2014): 101. http://dx.doi.org/10.5051/jpis.2014.44.3.101.
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Joseena, Sr. "An Evaluation Study on Accredited Social Health Activists (ASHA)". Indian Journal of Obstetrics and Gynecology 9, nr 1 (15.03.2021): 57–63. http://dx.doi.org/10.21088/ijog.2321.1636.9121.9.
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One of the core strategies of NRHM was to promote access to improved health care at household level through ASHA. A community based research study was conducted to assess the knowledge and functioning of ASHA with respect to three selected districts of Kerala and to analyze the problems faced by them in the delivery of Primary Health Care Services at the village level. A survey approach with selective employment of qualitative method was used.A descriptive cross sectional survey design was used. To represent the entire state of Kerala one district each from Northern (Wayanad, Central (Kottayam), and Southern (Thiruvananthapuram) region of Kerala was randomly selected. The Sample consists of 405 ASHAs and 73 JPHNs and they were selected using cluster sampling technique. Data collection instruments were structured knowledge questionnaire, self administered rating scale ,focus group interview guidelines, in-depth interview guidelines and opinionnaire. Quantitative analysis revealed that almost half (42.3%) of the ASHAs from Thiruvananthapuram belongs to the category of good knowledge level ,Thiruvananthapuram (good- 36.3%) has better functioning than Kottayam and Wayanad and Significant association was found between knowledge scores and educational status and level of satisfaction of ASHA workers(P>0.05). Themes derived from qualitative analysis are problems related to Maternal Child Health services, adoption of Family planning services, Communicable and Non communicable Disease monitoring, work load, Lack of transportation facilities, Inadequate payment structure, inappropriate Government health infrastructure ,lack of recognition by the Panchayat, lack of medicine kit, lack of follow up after initial training, inadequate knowledge and communication skill, lack of supervision and lack of co-operation from the families. Majority (49.3%) of the JPHNs have only average opinion regarding the functioning of ASHAs in the community. Only 16(21.9%) had good opinion about the services rendered by the ASHAs in the community. Key Words: ASHA; JPHN; Knowledge; Functioning; Primary Health Care Services.
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Domachowske, Joseph B. "Introduction to This JPIDS Supplement: All Infant Protection Against Serious RSV Disease". Journal of the Pediatric Infectious Diseases Society 13, Supplement_2 (12.07.2024): S91—S92. http://dx.doi.org/10.1093/jpids/piae037.
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Grall-Bronnec, M., G. Bouju, A. Guilleux, M. Grall-Bronnec, G. Bouju, J. L. Vénisse, J. B. Hardouin i in. "Ces français qui jouent, du plaisir à l’excès. À partir d’une étude multicentrique portant sur 628 joueurs". European Psychiatry 28, S2 (listopad 2013): 6. http://dx.doi.org/10.1016/j.eurpsy.2013.09.014.
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Il aura fallu attendre 2010 pour que soit menée en France la première étude de prévalence des troubles liés à la pratique des jeux de hasard et d’argent [1]. Si cette enquête a indiqué que les problèmes de jeu touchaient environ 1,3 % de la population adulte, elle ne décrivait que partiellement les caractéristiques associées. Il est cependant essentiel de disposer d’informations pouvant expliquer qu’une pratique récréative devienne hors de contrôle. L’étude JEU a cette ambition. Impliquant 7 centres hospitaliers français, elle a débuté en 2009 et a permis de recruter 628 sujets ayant joué au moins une fois au cours de l’année écoulée, qui seront suivis pendant les 5 années suivantes. Répartis en 3 groupes (« joueurs non problématiques = JNP », « joueurs problématiques sans soin = JPNS » et « joueurs problématiques avec soins = JPS »), l’un des objectifs de cette étude est de comparer leurs caractéristiques respectives. Lors du suivi de la cohorte, l’évolution de ces variables sera mise en perspective avec l’évolution de la pratique et du recours à des soins spécifiques. Une partie des résultats issus de la description des 3 groupes sera présentée ici. Des régressions logistiques multivariées, comparant 2 à 2 les groupes, ont été réalisées. Elles indiquent que, par rapport aux JNP, les JP jouent plus fréquemment, ont un score de distorsions cognitives plus élevé et un score de détermination plus faible. Par rapport aux JPNS, les JPS sont plus jeunes, plus fréquemment actifs, plus nombreux à jouer sur Internet, avec un jeu pathologique plus sévère et un risque suicidaire plus important. Cette étude permet de dresser le tableau des joueurs, en particulier ceux pour lesquels la pratique devient problématique. Des hypothèses au sujet des facteurs favorisant et limitant l’accès aux soins sont discutées.
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Parot-Schinkel, E., V. Gueritault i S. Fanello. "A1-4 - Validation de la version française de l’échelle d’interaction de la personne avec son contexte professionnel (JPIS)". Revue d'Épidémiologie et de Santé Publique 54 (sierpień 2006): 5. http://dx.doi.org/10.1016/s0398-7620(06)76774-8.
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Mishra, Aakriti, i Walter Dehority. "Influenza Immunization of Adults During Outpatient Pediatric Visits". Journal of the Pediatric Infectious Diseases Society 10, nr 7 (2.06.2021): 793–96. http://dx.doi.org/10.1093/jpids/piab038.
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Abstract The American Academy of Pediatrics suggests pediatricians may provide influenza immunization to adults accompanying children to outpatient appointments. Analysis of the IBM Watson MarketScan database demonstrated that of 1 546 340 encounters for pediatric influenza immunization in 2016, only 1.5% of encounters with a pediatrician resulted in immunization of an accompanying adult.
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Yeoh, Daniel K., Christopher C. Blyth i Brendan J. McMullan. "Echinocandins in Pediatric Invasive Candidiasis and the Challenges of Antifungal Use in Children". Journal of the Pediatric Infectious Diseases Society 10, nr 7 (9.06.2021): 755–56. http://dx.doi.org/10.1093/jpids/piab039.
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Ben-Shimol, Shalom, Gilat Livni, Orli Megged, David Greenberg, Dana Danino, Ilan Youngster, Yael Shachor-Meyouhas i in. "COVID-19 in a Subset of Hospitalized Children in Israel". Journal of the Pediatric Infectious Diseases Society 10, nr 7 (15.06.2021): 757–65. http://dx.doi.org/10.1093/jpids/piab035.
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Abstract Background Most pediatric coronavirus disease 2019 (COVID-19) is mild. We assessed nationally severe COVID-19, including pediatric inflammatory multisystem syndrome (PIMS), in hospitalized children. Methods An ongoing, prospective, national surveillance was conducted from March 2020 through March 2021, at 20 hospitals treating children <18 years across Israel (~75% of Israeli hospitals). Results Overall, 1007 cases (439 outpatients and 568 hospitalized) identified represent 0.35% of pediatric COVID-19 nationwide (n = 291 628). Of hospitalized cases, 464 (82%), 48 (8%), and 56 (10%) had mild, moderate/severe, and PIMS disease, respectively. The mean ± SD age was 5.6 ± 6.4 years. In mild, moderate/severe, and PIMS disease, 55%, 23%, and 4% of patients were <1 year old, respectively. Obesity was reported in 1%, 4%, and 13% of patients, respectively (P < .001). The most common symptom was fever in 67%, 60%, and 100%, respectively, whereas respiratory symptoms were documented in 33%, 41%, and 38% of patients, respectively. Lymphopenia was recorded in 25%, 60%, and 86% of cases, respectively. PIMS diagnosis was mainly serology-based (in 59%). Gastrointestinal symptoms, cardiovascular involvement, rash, and conjunctivitis were noted in 82%, 61%, 57%, and 34% of PIMS episodes, respectively. Elevated C-reactive protein (100%), ferritin, troponin, D-dimer, low albumin, and thrombocytopenia were common in PIMS. Echocardiography revealed pathological findings in 33% of patients. PIMS mainstay treatment included corticosteroids (77%) and intravenous immunoglobulin (53%). No mortality was recorded. Conclusions At a national level, pediatric COVID-19 is mild, even in hospitalized cases, with only a third presenting with respiratory involvement. PIMS is rare, but necessitates a high index of suspicion, and with suitable treatment prognosis is favorable.
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Ferguson, Rina A., Joshua C. Herigon, Brian R. Lee, Mari M. Nakamura i Jason G. Newland. "Variability in Ceftriaxone Dosing Across 32 US Acute Care Children’s Hospitals". Journal of the Pediatric Infectious Diseases Society 10, nr 5 (2.02.2021): 677–81. http://dx.doi.org/10.1093/jpids/piab004.
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Abstract Ceftriaxone is one of the most common antibiotics prescribed for hospitalized children in the United States. However, ceftriaxone is not dosed consistently. Sepsis/serious bacterial infection had high dosing variability. Dosing for central nervous system infection was frequently suboptimal. Future efforts should focus on optimizing and standardizing ceftriaxone dosing.
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Khan, Aslam, Hayden T. Schwenk, Krystal Kohlman, Alice Bertaina, Stephanie Cho, Jose G. Montoya i Despina Contopoulos-Ioannidis. "Response to Trimethoprim-Sulfamethoxazole in a Pediatric Hematopoietic Stem Cell Transplant Recipient With Disseminated Toxoplasmosis: A Case Report". Journal of the Pediatric Infectious Diseases Society 10, nr 6 (6.03.2021): 745–48. http://dx.doi.org/10.1093/jpids/piab006.
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Abstract We describe the presentation and treatment of a patient who developed ongoing fever and diagnosed with disseminated toxoplasmosis post-hematopoietic stem cell transplantation. He was initially treated with trimethoprim-sulfamethoxazole (TMP-SMX) and there was dramatic improvement in his fever curve. He successfully completed a modified course of therapy.
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Cirks, Blake T., Samantha J. Rowe, Sarah Y. Jiang, Robert M. Brooks, Michael P. Mulreany, Wendy Hoffner, Olcay Y. Jones i Patrick W. Hickey. "Sixteen Weeks Later: Expanding the Risk Period for Multisystem Inflammatory Syndrome in Children". Journal of the Pediatric Infectious Diseases Society 10, nr 5 (18.01.2021): 686–90. http://dx.doi.org/10.1093/jpids/piab007.
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Abstract Multisystem inflammatory syndrome in children (MIS-C) has been observed in temporal association with coronavirus disease 2019 (COVID-19), typically within 2 to 6 weeks of illness or exposure. We present a case of MIS-C occurring 16 weeks after initial COVID-19 illness to highlight the prolonged period of risk for developing MIS-C.
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Gharpure, Radhika, Zachary A. Marsh, Danielle M. Tack, Sarah A. Collier, Jonathan Strysko, Logan Ray, Daniel C. Payne i Amanda G. Garcia-Williams. "Disparities in Incidence and Severity of Shigella Infections Among Children—Foodborne Diseases Active Surveillance Network (FoodNet), 2009-2018". Journal of the Pediatric Infectious Diseases Society 10, nr 7 (19.06.2021): 782–88. http://dx.doi.org/10.1093/jpids/piab045.
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Abstract Background Shigella infections are an important cause of diarrhea in young children and can result in severe complications. Disparities in Shigella infections are well documented among US adults. Our objective was to characterize disparities in incidence and severity of Shigella infections among US children. Methods We analyzed laboratory-diagnosed Shigella infections reported to FoodNet, an active, population-based surveillance system in 10 US sites, among children during 2009-2018. We calculated the incidence rate stratified by sex, age, race/ethnicity, Shigella species, and disease severity. Criteria for severe classification were hospitalization, bacteremia, or death. The odds of severe infection were calculated using logistic regression. Results During 2009-2018, 10 537 Shigella infections were reported in children and 1472 (14.0%) were severe. The incidence rate was 9.5 infections per 100 000 child-years and the incidence rate of severe infections was 1.3 per 100 000 child-years. Incidence was highest among children aged 1-4 years (19.5) and lowest among children aged 13-17 years (2.3); however, children aged 13-17 years had the greatest proportion of severe infections (21.2%). Incidence was highest among Black (16.2 total; 2.3 severe), Hispanic (13.1 total; 2.3 severe), and American Indian/Alaska Native (15.2 total; 2.5 severe) children. Infections caused by non-sonnei species had higher odds of severity than infections caused by Shigella sonnei (adjusted odds ratio 2.58; 95% confidence interval 2.12-3.14). Conclusions The incidence and severity of Shigella infections among US children vary by age, race/ethnicity, and Shigella species, warranting investigation of unique risk factors among pediatric subpopulations.
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Sampaio, Virginia Vilar, Adriana S. O. Melo, Anne L. Coleman, Fei Yu, Sarah Rogeria Martins, Luciana Portela Rabello, Jousilene Sales Tavares i Karin Nielsen-Saines. "A Novel Radiologic Finding to Predict Ophthalmic Abnormalities in Children With Congenital Zika Syndrome". Journal of the Pediatric Infectious Diseases Society 10, nr 6 (20.05.2021): 730–37. http://dx.doi.org/10.1093/jpids/piab010.
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Abstract Background The Zika virus (ZIKV) epidemic had devastating consequences in Brazil. We investigated whether a radiologic finding (ie, infratentorial abnormalities) was associated with sight-threatening defects in children born with congenital Zika syndrome (CZS). We also investigated whether ophthalmic abnormalities correlated with head circumference (HC) and gestational age of infection. Methods Cross-sectional evaluation based upon a previous cohort from March 2016 to December 2018, in Paraíba, Brazil. The study population was comprised of children born to mothers with laboratory-confirmed ZIKV infection during pregnancy (ZIKV reverse transcriptase polymerase chain reaction [RT-PCR]+) and children born with clinical and radiologic features of CZS. Results A total of 75 infants had complete data. All 75 had brain calcifications. Microcephaly was present in 53 (71%) of them. Infratentorial abnormalities were present in 17 infants (22.7%). Ophthalmic abnormalities were seen in 16 of the 17 children (94%) with infratentorial abnormalities, while 28% of children without infratentorial abnormalities had ophthalmic findings (odds ratio [OR]: 42.0; 95% confidence interval [CI]: 5.1-342.9). Similar associations were observed when macular chorioretinal atrophy and optic nerve abnormalities were analyzed individually (OR: 23.7; 95% CI: 6.0-93.3 and OR: 11.5; 95% CI: 3.3-40.0, respectively). Infratentorial abnormalities were more frequently associated with ophthalmic abnormalities (94%) than microcephaly (43.4%) (P < .001). Mean HC was statistically different between groups with and without ophthalmic abnormalities (P = .01). A statistically significant difference in gestational age between both groups was not noted (P = .12). Conclusions In children with CZS, the presence of infratentorial abnormalities is a significant predictor of ophthalmic abnormalities. All neonates whose mothers had ZIKV exposure during pregnancy should have an ophthalmologic examination.
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Cattaneo, Chiara, Maureen Drean, Marion Subiros, Patrice Combe, Soumeth Abasse, Abdourahim Chamouine i Thomas Simon. "Multisystem Inflammatory Syndrome Associated With Severe Acute Respiratory Syndrome Coronavirus 2 in Children: A Case Series From Mayotte Island". Journal of the Pediatric Infectious Diseases Society 10, nr 6 (13.03.2021): 738–41. http://dx.doi.org/10.1093/jpids/piab011.
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Abstract During the COVID-19 outbreak in the French overseas department Mayotte, 11 children developed multisystem inflammatory syndrome (MIS-C). They all had a fever and gastrointestinal symptoms. Six patients were admitted to intensive care unit; management included intravenous immunoglobulin and corticosteroid. Severe acute respiratory syndrome coronavirus 2 was documented in all patients. The risk of developing MIS-C was much higher than in all of France.
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Tamma, Pranita D., i Gina A. Suh. "Phage Are All the Rage: Bacteriophage in Clinical Practice". Journal of the Pediatric Infectious Diseases Society 10, nr 6 (23.03.2021): 749–53. http://dx.doi.org/10.1093/jpids/piab012.
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Skanke, Lars Høsøien, Hilde Lysvand, Inger Heimdal, Nina Moe, Sidsel Krokstad, Andreas Christensen, Kari Risnes, Svein Arne Nordbø i Henrik Døllner. "Parechovirus A in Hospitalized Children With Respiratory Tract Infections: A 10-Year-Long Study From Norway". Journal of the Pediatric Infectious Diseases Society 10, nr 6 (26.04.2021): 722–29. http://dx.doi.org/10.1093/jpids/piab009.
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Abstract Background The role of Parechovirus A (PeV-A) in hospitalized children with respiratory tract infections (RTIs) is unclear. We studied the occurrence and impact of PeV-A over 10 years. Methods Children from Sør-Trøndelag County, Norway, hospitalized with RTI and a comparison group of asymptomatic children admitted to elective surgery, were prospectively enrolled from 2006 to 2016. Nasopharyngeal aspirates were cultured and analyzed with polymerase chain reaction tests for PeV-A and 19 other pathogens. The cycle threshold levels of PeV-A were reported as measures of viral genomic loads. Parechovirus A-positive samples were genotyped by amplification and sequencing of the VP3/VP1 junction. Results Parechovirus A was detected in 8.8% (323/3689) patients with RTI and in 10.1% (45/444) of the children in the comparison group (P = .34). Parechovirus A genotyping (n = 188) revealed PeV-A1 (n = 121), PeV-A3 (n = 15), PeV-A5 (n = 6), and PeV-A6 (n = 46). Viral codetections occurred in 95% of patients and in 84% of the children in the comparison group (P = .016). In multivariable logistic regression analysis, RTI was unrelated to PeV-A genomic loads, adjusted for other viruses and covariates. Similar results were found for PeV-A1 and PeV-A6. Conclusions Parechovirus A and viral codetections were common in hospitalized children with RTI and asymptomatic children in a comparison group. Our findings suggest that PeV-A has a limited role in hospitalized children with RTI.
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Sarmiento, Adriana, Ana Del Valle Penella, P. Marcelo Laufer, Carolina Sanchez-Vegas, Manuel R. Cotilla, Connie Trieu, John C. Arnold, Alejandro Jordan Villegas, Martin S. Lindner i Asim A. Ahmed. "#97: Rapid, Noninvasive Detection of Kingella kingae Pediatric Vertebral Infections Using a Microbial Cell-free DNA Sequencing Test for Pathogen Identification". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S10. http://dx.doi.org/10.1093/jpids/piaa170.030.
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Abstract Background Kingella kingae is a recognized cause of bone and joint infections (BJI) in infants. The diagnosis of Kingella kingae BJI can be challenging due to its fastidious growth with conventional culturing methods even when infected tissue is obtained. Kingella kingae spinal infections are likely an underdiagnosed entity given the limitations of culture-based methods and the reluctance to biopsy spinal locations of infection (in favor of empiric treatment). This approach often necessitates MRSA coverage. A sensitive, rapid, noninvasive diagnostic approach to pediatric vertebral infections would enable targeted therapy. Detection of circulating microbial cell-free DNA (mcfDNA) in the plasma originating from areas of sequestered infection through next-generation sequencing (NGS) has shown utility in pediatric pneumonia (Farnaes et al. DMID 2019) and a wide variety of infections in the immunocompromised host (Rossoff et al. OFID 2019) and potentially offers promise in resolving the etiology of pediatric vertebral infections. Methods The Karius test is a CLIA-certified/CAP-accredited NGS plasma test that detects circulating mcfDNA in the blood. After mcfDNA is extracted and NGS performed, human sequences are removed and remaining sequences are aligned to a curated pathogen database of >1400 organisms. Organisms present above a statistical threshold are reported and quantified. The time to result reporting is on average 24 hours from sample receipt. Karius Test results over the prior 2 years were reviewed for detections of Kingella kingae in the context of spinal infections. Clinical chart review was performed by the treating pediatric infectious diseases physicians at each participating institution after IRB notification and approval. Results Six cases of Kingella kingae pediatric vertebral infections were identified across five institutions; clinical data were available for five cases across four institutions (see Table). Four cases were male; the average age was 15.3 months. Four of five cases had an antecedent URI. The clinical presentations were characterized by decreased mobility and relatively bland inflammatory response (lack of fever, bland inflammatory markers). The lumbar region was the most commonly affected vertebral location (80%). Blood cultures were negative in all cases; empiric anti-MRSA therapy was initiated in all cases. The time to result of Kingella kingae mcfDNA detection in the plasma was one day from sample receipt in all cases. McfDNA from co-pathogens were detected in 66.7% of cases (Haemophilus influenzae was the most common). The detection of Kingella kingae by the Karius test influenced a decision to narrow coverage in 80% of cases and a decision to forego biopsy in 60% of cases. Conclusion Plasma NGS for circulating mcfDNA offers a rapid, noninvasive means of detecting Kingella kingae pediatric vertebral infection. This culture-independent approach may enable specific diagnosis despite antibiotic pretreatment and obviate the need for an invasive procedure. Accurate identification of Kingella kingae has important implications on antibiotic stewardship enabling targeted therapy without the reliance on empiric MRSA coverage. Given the capacity to detect over 1400 organisms from a single sample NGS for mcfDNA offers a means to detect a broad variety of pathogens known to have predilection to cause pediatric spine infection.
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Sánchez-Medina, E., A. Reyes-Hernández i A. Severiano-Tellez. "#10: Fever and neutropenia. 10 years surveillance in a pediatric Mexican hospital". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S15. http://dx.doi.org/10.1093/jpids/piaa170.045.
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Abstract Background Fever and neutropenia, is a very common complication of chemotherapy in the treatment of cancer. It could happen in 10–50% of patients with solid tumors and more than 80% of patients with blood cancer. During leukemia treatment is very important first defense mechanisms integrity, such as skin, mucous membranes, Tlaxcala Children’s Hospital is a pediatric general hospital, located in the center of Mexico and is where the pediatric cancer patients are treated, with almost 30 new cases by year, treatment with chemotherapy and as an adverse event fever and neutropenia, which increases morbidity and mortality Methods We conducted an observational, descriptive, and analytic study aiming to identify fever and neutropenic events in ALL patients, their epidemiologic characteristics, antibiotic use, isolation and antibiogram, and outcome. Results We reviewed 124 files from ALL patients between 2007–2017, we found 204 cases, 70 (33.8%) at induction, 18.6% consolidation, reinduction 17.6%, maintenance 14.2%. Out of 204 cases, we documented 177 with fever and neutropenia, 15 events of septic shock and 12 with fever and neutropenia with an identifiable source; the first-line antibiotic for fever and neutropenia was ceftazidime/amikacin, and for septic shock cefepime with an aminoglycoside, we found 3.39%, 20%, and 0% deaths from each group. Patients with fever and neutropenia with or without identifiable source had a length-stay average of 9.8 days compared with 30 days in patients with septic shock, CRP average was 12.47 mg/dL in the patients who survived and 8.23 mg/dL in those who did not. We found a very low positivity in cultures, and in most cases, those cultures did not meet criteria for diagnosis, the most common bacteria identified were E. coli, P. aeruginosa. Conclusions This is the first approach to get a better knowledge about infectious complications in patients with ALL, these findings could lead to identifying opportunities to improve diagnosis and treatment which lead to reducing cost, morbidity, healthcare-associated infections.
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Tarrasa, Giancarlo Hernán Cristerna, Martha Ramiro Mendoza, Francisco Javier Otero Mendoza i Eduardo Arias de la Garza. "#29: Clinical Evaluation of Pediatric Patients with Respiratory Symptoms with Confirmed and Negative Influenza in a Third-level Pediatric Center in Mexico City". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S23—S24. http://dx.doi.org/10.1093/jpids/piaa170.075.
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Abstract Background Influenza virus is responsible for 3 to 5 million cases every year with an estimated mortality in children around 0.15 deaths per 100,000 population. Mexico reported in the 2018–2019 Influenza season 7,210 confirmed cases with 811 deaths (11%) with AH1N1 the most frequent type with 67% of the cases and 88% of the deaths. Clinical assessment of children with influenza is difficult because of the overlap of symptoms between other viral diseases so we evaluated the severity of respiratory symptoms in influenza-positive and -negative children to attain better clinical assessment of influenza cases. Methods We evaluated 846 children less than 18 years old who were screened for influenza in the emergency department at our hospital by using the WHO Influenza Like Disease (ILD) definition between epidemiological week 40 up to week 20 of the 2018–2019 influenza season. Clinical characteristics, evolution and comorbidities were assessed between positive and negative influenza test. Influenza was confirmed by RT–PCR of a nasal swab. Both χ 2 test and t-test were used for statistical analysis of both groups. Results Of the 846 children evaluated for ILD, 177 were positive and 669 were negative for influenza virus. 53.6% of the positive group and 52.2% of the negative group were male, mean ages were 5.25 years and 3.73 years, respectively (P < 0.0001) with 55% and 73.9% less than 5 years old, respectively. 75.7% of the positive group had severe disease defined as hypoxemic pneumonia and 78.6% of the negative group. Statistically significant differences in clinical evaluation were observed regarding frequency of fever, cough, sore throat, chills, myalgias, arthralgias, malaise, conjunctivitis and sudden onset of symptoms. Also, in the positive group there was higher probability of having a positive close contact (6.8%) case than in the negative group (2.5%) (P = 0.005). Cardiopathy, immunosuppression and cancer were the most frequent comorbidities in the influenza group. Four percent of the influenza-positive group and 5% of the negative group were vaccinated. Influenza types were 55.4% AH1N1pdm09, 35% B (29% Yamagata, 22.6% Victoria, 48.4% undetermined) and 9% of AH3. Two deaths were reported in the influenza-positive group. Conclusions Influenza can produce a severe disease in children, especially with those with co-morbidity; therefore, careful evaluation of respiratory symptoms, contact history to ILD, and highly sensitive diagnostics will accurately diagnose influenza. Patients with severe influenza should be promptly treated with antivirals and isolated to decrease intrahospital transmission.
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Riaño-Galvis, O. E., D. P. Cerinza-Villanueva, I. F. Gutierrez-Tobar, J. P. Londoño-Ruiz, A. S. Marin-Castro i N. Bermudez-Bohorquez. "#86: A Quality Improvement Study Using Blended Learning as Part of Antimicrobial Stewardship Program (ASP) to Improve Ampicillin Sulbactam Prescription in Pediatric Hospital in Bogotá, Colombia". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S24. http://dx.doi.org/10.1093/jpids/piaa170.078.
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Abstract Background Antimicrobial agents are the second most common prescribed drugs in hospital settings. Antibiotic resistance is a major public health problem. Some studies have found that 20–50% of antibiotics prescriptions are inadequate or not necessary. Ampicillin-sulbactam is the second most common prescribed antibiotic in inpatients children in our hospital. We designed a quality improvement study to improve ampicillin–sulbactam prescription in a third-level children hospital in Bogotá, Colombia. Methods A before and after study was designed. We obtained days of treatment (DOT) for ampicillin–sulbactam in last 3 years (2017, 2018, and 2019). In October of 2019, we included ampicillin–sulbactam as a targeted antibiotic in our ASP. We focus the efforts in 2 principals’ strategies: Educative strategy and audit and feedback strategy. Educative strategy included a blended learning intervention and audit and feedback strategy included surveillance of prescriptions in real time to evaluate local guidelines adherence with feedback to prescribers. We designed a form to collect and analyze data with Epi Info®. Results In 2 months of surveillance, we reviewed and analyzed 67 prescriptions. Median age of patients was 2 years (0.75–7.5 years). The main diagnosis was pulmonary infection in 70.1% (multilobar pneumonia 13 patients, lobar pneumonia 8 patients and bacterial co-infected bronchiolitis in 5 patients). Three prescriptions were based in etiologic isolation while 64 was an empiric formulation. Only 24 prescriptions (35%) were considered adequate according to local guidelines. The principal’s reasons of inadequate prescription were the possibility to use a narrow-spectrum antibiotic (58.1%) and error about inadequate infectious disease diagnosis (39.5%). In 43 of inadequate prescriptions, ASP changed the antibiotic in 24 patients, stopped all antimicrobial therapy in 14, and changed to oral rout in other 4. In the patient’s follow-up, all have an adequate clinical course, and only 3 required to restart antimicrobial therapy. There were no deaths related to infectious diseases. In the educational strategy we trained 34 staff members (32.9%) with lectures and 72 staff members (69.2%) using virtual strategy. We use a pre- and post-test evaluations, with a score improvement in 33% after the educational strategy. Finally, we compared DOT of ampicillin-sulbactam for the last 3 years and we found a reduction of 65% in prescription between October 2017 and October 2019 (Figure 1). Conclusion This is the first quality improvement study with an ASP targeting a narrow-spectrum antibiotic in children. Many ASP focused their efforts only in broad-spectrum antibiotics, but few studies have been published in narrow-spectrum antibiotics. The implementation of an ASP to improve prescription of ampicillin–sulbactam had a dramatic impact in reduction of prescriptions in our settings. The educational strategy using blended learning strategy is especially valuable in hospital education because virtual learning has a great flexibility and if facilitated by the high availability of mobile devices.
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Treadway, Taylor A., Phoenix M. Shepherd, Christina M. Newman, Emma L. Mohr, Dawn M. Dudley, Meghan E. Breitbach, Keisuke Yamamoto i in. "#79: Modeling Zika Virus Tissue Tropism in Rhesus Macaques to Define the Risk of Donor-derived Transmission". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S4. http://dx.doi.org/10.1093/jpids/piaa170.012.
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Abstract Background Almost 115,000 people in the United States are currently on a transplant waitlist, which vastly exceeds the number of organ donors every year. This discrepancy emphasizes the need for retention of all possible donors. Those who have recently traveled to an area with an active outbreak of Zika virus (ZIKV) are often disqualified as a donor because immunosuppressed recipients would be at risk of a donor-derived ZIKV infection. Therefore, we define ZIKV tissue tropism and the risk of donor-derived transmission. Methods We subcutaneously inoculated 15 Indian-origin rhesus macaques (RM) with a Puerto Rican isolate of ZIKV (PRVABC59). All RMs were inoculated in mid to early gestation. We inoculated during pregnancy because plasma viremia is typically prolonged in pregnancy and we wanted to model tissue tropism for donor-derived transmission in the worst scenario of prolonged viremia. At 30, 65, and 105 days post-infection (dpi), the animals were euthanized and comprehensive necropsies were performed, which evaluated a minimum of 60 tissues per animal. ZIKV RNA was quantified in tissues via qRT-PCR. Results Plasma viremia duration was >10 days in 13 of 15 RMs. ZIKV RNA was most commonly detected in lymph nodes, with 19/45 lymph nodes that were vRNA positive in 5 RMs at 30 dpi. There were 15/45 vRNA positive lymph nodes at 60 dpi and 8/38 at 105 dpi. Reproductive and maternal fetal-interface (MFI) tissues were the second most commonly positive tissues. Twenty-five MFI tissues, including the amniotic/chorionic membrane, decidua, placenta, uterus, and placental bed, were positive, with 10/53 positive at 30 dpi, 14/24 positive at 60 dpi and 1/47 positive at 105 dpi. Other vRNA positive tissues included the primary bronchus, femoral vein, kidney, thyroid, lung, colon, mammary gland, pericardium, hand nerve, and sciatic nerve in 1–2 RMs at one of the three timepoints. Conclusions We found ZIKV RNA most frequently within lymph nodes. Lymph nodes are included in lung and small bowel transplants, indicating that these transplants could pose a risk of donor-derived ZIKV transmission. Virus detection within other commonly transplanted tissues, such as the kidney and blood vessels was much less common. We did not determine what fraction of vRNA comes from replication-competent virus in each tissue; some tissues with vRNA might not contain virions that could initiate new infections. Donor-derived Zika virus transmission from other commonly transplanted organs, such as the liver, seems unlikely since no viral RNA was detected in this organ.
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Nevarez, Juan, Elena Holley i Michael E. Watson. "#17: DNA Methylation in Streptococcus pyogenes Promotes M-Protein Expression and Enhances Epithelial Cell Adherence and Persistence on a Mucosal Surface". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S5. http://dx.doi.org/10.1093/jpids/piaa170.016.
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Abstract Background DNA methylation has been extensively studied as a regulator of gene expression among eukaryotes, but the regulatory role for DNA methylation has been far less studied in bacterial pathogens. Streptococcus pyogenes, or Group A Streptococcus, is an important bacterial pathogen of children. Our group has recently shown that S. pyogenes utilizes DNA methylation at N6-methyladenine (m6A) as a regulatory mechanism, modulating gene transcription and influencing the expression of several genes recognized as potential virulence factors. Our goal was to further explore how DNA methylation impacts virulence properties of S. pyogenes through adherence to epithelial cells and persistence on a mucosal surface. Methods S. pyogenes strains HSC12 (M14), MEW123 (M28), and MEW431 (M4) were modified by in-frame genetic deletion of a 3-gene operon encoding the only Type-I Restriction-Modification locus, resulting in mutant strains lacking the majority of m6A base modifications (ΔRSM). S. pyogenes parent and ΔRSM mutant strains were subjected to transcriptional profiling by RT–PCR and RNA-Seq analysis. Adherence rates of streptococci to D562 human pharyngeal epithelial cells and VKE6E7 human vaginal epithelial cells were assessed. A murine vaginal mucosa colonization model was used to monitor streptococcal mucosal persistence. Results The ΔRSM mutants of all three strains lacked essentially all m6A DNA base modifications by dot-blot with anti-m6A antibody and PacBio™ sequencing with methylation analysis. Transcriptional profiling demonstrated that a limited subset of ~20 genes was strongly down-regulated in all of the ΔRSM mutant strains, most notably genes in the core Mga regulon involved in tissue adherence and evasion of the host immune response, including the M protein (emm gene). The ΔRSM mutants of all 3 strains were attenuated for adherence to human respiratory and vaginal epithelial cells compared with parent strains or complemented mutant strains. The HSC12 and MEW431 ΔRSM mutant strains exhibited significantly decreased bacterial burdens over time compared with parent strains in the murine mucosal carriage model. The bacterial burdens of strain MEW123 and its ΔRSM mutant were not significantly different in the murine mucosal carriage model. Expression of R28, an adhesin specifically promoting adherence to vaginal epithelial cells, was not altered in the MEW123 ΔRSM mutant, which may explain the continued persistence of this strain in the murine model. Conclusions DNA methylation influences gene expression at the transcriptional level in S. pyogenes and affects virulence properties in both in vitro and in vivo models of infection. We report that methylation promotes activation of several important virulence factors, including the M protein and other members of the Mga regulon, and influences epithelial cell adherence and streptococcal persistence on a mucosal surface. DNA methylation appears to be an important contributor to bacterial physiology and pathogenesis. Future work will identify the interaction of m6A base modifications and transcriptional regulatory proteins.
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Molina, Sara Eloisa Rivera, Claudia Romero Quiroz i Dilcia Sauceda Acosta. "#58: Improving the Peritoneal Dialysis Program in a Pediatric hospital in Honduras Using Six Sigma Methodology". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S20—S21. http://dx.doi.org/10.1093/jpids/piaa170.065.
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Abstract Background Peritoneal dialysis (PD) is the most common method of renal replacement therapy (RRT) in pediatric patients in Honduras. It has improved survival and quality of life. Unfortunately, there are complications associated with the use of PD catheters, 85% of which, are of infectious origin. These infections carry a high burden of morbidity and mortality, lengthen hospital stays, and increase costs and are a motive for transfer to hemodialysis. Hospital María Especialidades Pediátricas (HMEP) is a pediatric hospital caring for patients with chronic kidney disease in Honduras, PD has been offered as a method for RRT since September 2014. Methods In HMEP, monitoring of PD infection rates through active surveillance began December 1, 2017, as the first step (define and measure) toward the improvement of the PD Program based on Six Sigma methodology. A case of peritonitis was diagnosed when at least 2 of the following 3 criteria were met: (1) Clinical signs or symptoms of peritonitis (cloudy effluent or abdominal pain with fever or vomiting); (2) Altered peritoneal fluid cell count (after a dwell time of 2 hours: a WBC above 100 cells/mm3 in an uncentrifuged sample, with at least 50% neutrophils; or any WBC count with at least 50% neutrophils if the dwell time was less than 2 hours); (3) Positive peritoneal fluid culture. Patient data, risk factors for infection, causative organisms, and event outcomes were recorded. We present the main results of the analysis phase of all peritonitis cases using descriptive statistics. Results From December 1, 2017, through November 30, 2019, 79 patients required PD, representing 8931 catheter-days; and 30 peritonitis episodes occurred among 28 individuals (35%). The peritonitis rate during the 2-year surveillance period was 1.2 infections per patient-years (ideally: <0.67). Twenty-seven (90%) of cases were classified as healthcare associated since these patients underwent PD 3 times a week in the hospital and the catheter was only manipulated by medical staff; the other patients received dialysis at home. The median time from catheter placement to the event was 27 days (5–383 days). All patients had clinical signs or symptoms of peritonitis. Peritoneal fluid cell count results were available for 29 infections, all of which reported altered results. Peritoneal fluid cultures were positive in only 12 events (40%); 6 (50%) reported Gram-negative organisms, 5 (41%) reported Gram-positive and 1 reported Aspergillus spp. Nonfermentative Gram-negative bacteria (Pseudomonas aeruginosa and Acinetobacter lwoffii) were the most common organisms identified; Staphylococcus epidermidis was the most common Gram-positive. Ten events (33%) required removal and replacement of the catheter due to the infection, 6 (20%) required permanent transfer to hemodialysis; 2 (7.1%) patients experienced a relapse. Two (7.1%) died due to infection. Conclusions Implementing Six Sigma methodology allowed us to improve our PD Program by objectively quantifying the magnitude of the problem and identifying risk factors. This supported the infection prevention and control team with the implementation and improvement of preventive measures: change in hand hygiene products (from triclosan to chlorhexidine), increasing hand hygiene compliance, improving connection/disconnection procedure, PD catheter insertion, and maintenance, empowerment of caregivers.
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Londeree, Jackson, Rouba Garro, Rene Romero, Roshan George, Pamela Winterberg, Rochelle Liverman, Anastacia Serluco, Stella Shin i Inci Yildirim. "#18: Brincidofovir for the Treatment of Disseminated Human Adenovirus Infection in Pediatric Solid-organ Transplant Recipients". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S3. http://dx.doi.org/10.1093/jpids/piaa170.008.
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Abstract Background Human adenovirus (HAdV) viremia can cause significant morbidity among pediatric patients undergoing solid-organ transplantation (SOT). Currently, there are no US Food and Drug Administration (FDA)-approved treatments for HAdV infections, and historically the mainstay of treatment has been decreasing immunosuppression with antiviral therapies reserved for those with severe disease. Brincidofovir (BCV) is an investigational antiviral drug with potency against HAdV. We describe four cases of disseminated HAdV infection treated with (BCV) among pediatric SOT patients. Methods We retrospectively reviewed 4 cases of severe disseminated HAdV infection, which occurred between 2018 and 2019, in a tertiary pediatric transplant center. HAdV infection was defined as a positive HAdV PCR from a clinical specimen. Baseline clinical characteristics, disease course, treatment, and outcomes were reviewed. Results Four pediatric SOT patients (2 kidneys, 1 dual kidney/liver, and 1 liver) ranging in age from 9 months to 19 years were diagnosed with HAdV infection (Table 1). Patients presented with varied symptoms from 12 to 912 days post-transplant. Peak HAdV viral load ranged from 37,000 to >1,000,000 copies/mL. All patients had disseminated disease with evidence of graft involvement and varying degrees of acute kidney injury (AKI) making them candidates for BCV therapy over cidofovir to avoid nephrotoxicity. Three out of four patients received cidofovir prior to conversion to BCV. IRB-approved compassionate use of BCV was dosed at 2 mg/kg (max 100 mg) twice weekly PO along with reduced immunosuppression. Resolution of symptoms and HAdV viremia was seen at a mean of 21.5 days (range 15–32) of therapy. All patients had resolution of AKI with a return to baseline creatinine after therapy. Conclusions Though HAdV infection in pediatric SOT patients is uncommon, a subset of patients experience severe disease, morbidity, and graft loss. Currently, HAdV is not routinely monitored in pediatric SOT transplant patients. Although supportive care and decreased immunosuppression remain as the most important component of therapy, BCV was well tolerated and efficacious in our series. Further research is needed to better understand risk factors for HAdV infection and potential antiviral treatment options to improve patient outcomes.
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Sader, H. S., M. Castanheira, J. M. Streit, C. G. Carvalhaes i R. E. Mendes. "#9: Frequency and Antimicrobial Susceptibility of Gram-Negative Organisms Causing Bloodstream Infections in Pediatric Patients from United States (US) Medical Centers (2014–2018)". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S5. http://dx.doi.org/10.1093/jpids/piaa170.015.
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Abstract Background Ceftazidime–avibactam is US FDA approved for the treatment of pneumonia and complicated intra-abdominal and urinary tract infections in adults, and it is in late-stage clinical development for the treatment of pediatric patients. Methods Organisms were consecutively collected from pediatric patients (≤17 years old) with bloodstream infections in 33 US medical centers in 2014–2018. Enterobacterales, P. aeruginosa, and H. influenzae isolates (n = 976) were susceptibility (S) tested against ceftazidime–avibactam and comparators by reference broth microdilution methods; 42.9% of isolates tested were from patients <1 year old, and 70.7% from patients ≤5 years old. Isolates with an ESBL–phenotype were screened for β-lactamase genes. Results Overall, 40.1% of organisms were Gram-negative bacteria (GNB), 57.0% Gram-positives, and 2.8% Candida spp. The five most common GNB were E. coli (32.4% of GNB), K. pneumoniae (17.3%), E. cloacae (9.8%), P. aeruginosa (9.2%), and S. marcescens (5.5%; Table). Enterobacterales, P. aeruginosa, and H. influenzae isolates combined represented 89% of GNB and all isolates (100.0%) were susceptible to ceftazidime–avibactam. Among Enterobacterales (n = 845; MIC50/90, 0.12/0.25 mg/L), the highest ceftazidime–avibactam MIC value was only 4 mg/L and 99.2% of isolates were inhibited at ≤1 mg/L. Enterobacterales susceptibility to ceftriaxone, piperacillin–tazobactam, ceftolozane–tazobactam, and meropenem were 88.2%, 93.1%, 97.5%, and 99.5%, respectively. Forty-four Enterobacterales isolates (5.2%) produced an ESBL, including CTX-M-type (n = 35 [79.5% of ESBL producers], 21 being CTX-M-15), SHV-type (12; 27.3%), and OXA-1/30 (9; 20.5%). Twelve isolates (27.3%) produced >1 ESBL. No carbapenemase gene was detected. Among ESBL producers, highest ceftazidime–avibactam MIC was 2 mg/L, and susceptibility rates for ceftolozane–tazobactam and meropenem were 92.9% and 100.0%, respectively. Ceftazidime–avibactam exhibited complete activity against P. aeruginosa (MIC50/90, 2/4 mg/L; 100.0% susceptible). P. aeruginosa susceptibility rates for meropenem, piperacillin–tazobactam, and ceftolozane–tazobactam were 82.5%, 85.6%, and 100.0%, respectively; and 10.3% of isolates exhibited multidrug-resistance phenotype (not susceptible to ≥3 classes). Ceftazidime–avibactam was highly active against H. influenzae (n = 34; MIC50/90, ≤0.015/0.03 mg/L; highest MIC, 0.06 m/L). Conclusions Ceftazidime–avibactam exhibited potent activity against a large collection of GNB isolated from pediatric patients with bacteremia and showed complete coverage (100.0% susceptibility) against P. aeruginosa, Enterobacterales, and H. influenzae.
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Zhou, Mi, Peifang Xiao, Hailong He, Jun Lu, Jie Li i Shaoyan Hu*. "#40: Next-generation Sequencing Improves the Diagnosis of Uncommon Infection in children with Hematologic Malignancies: A Case Series Study". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S2. http://dx.doi.org/10.1093/jpids/piaa170.005.
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Abstract Background Children with hematological malignancies are at high risk of infection. Various kinds of pathogens may cause infection in these patients. The effect of traditional methods on these patients is not ideal. Methods This was a case series study. The cases of five patients with clinical symptoms of pulmonary infection. Next-generation sequencing (NGS) was used to identify pathogens in these 5 patients. Results Uncommon pathogens were detected in five patients. Case information are shown in Table 1. Conclusion NGS may serve as a promising tool for rapid and accurate etiological diagnosis, which could greatly improve the diagnosis of uncommon infection in children with hematologic malignancies.
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Sun, Shan, Sameer Patel i Ravi Jhaveri. "#30: Patterns of Post-Exposure Prophylaxis for Varicella-Zoster Virus in Pediatric Patients". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S3. http://dx.doi.org/10.1093/jpids/piaa170.009.
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Abstract Background Varicella-Zoster virus (VZV) is still a significant threat for severe illness for patients in high-risk groups. These patients are candidates for post-exposure prophylaxis (PEP), but among adult providers there is significant variation on what agents are used for PEP. There are little data on PEP practices among pediatric providers. Objective We sought to define patterns of PEP for VZV exposure across children’s hospitals. Methods Using the Pediatric Health Information Systems database, we analyzed claims data for the relevant ICD-9/10 codes for VZV exposure from 2009 to 2018. We evaluated patients for subsequent VZV disease, and we also evaluated how frequently PEP was given, how many days after the exposure or admission, and what agent was used for PEP. We analyzed annual data and institutional-level data over the study period and looked for trends over time. We performed Kruskal–Willis testing when comparing more than two independent samples of equal or different sample sizes. Results Over the 10 years, we identified 1726 children with VZV exposure, 1622 of them with only one exposure. Of these 1662 children, 683 (42.1%) were prescribed some form of PEP after VZV exposure, while 75 (4.6%) ultimately developed some form of symptomatic VZV. Among the agents used for VZV PEP, acyclovir along was the most frequently used overall, but its use declined over time (45% in 2009 to 30% in 2018). Immunoglobulin was the second most used option (26–43%), while a consistent percentage (4–19%) of children also received the combination of acyclovir and IG. Varicella-specific immune globulin (VariZIG) was used sparingly before 2013, but its use was more frequent from 2015 to 2018 (23–27%). Most children receiving VZV PEP had some form of malignancy, with various newborn populations comprising most of the rest of PEP recipients. Efficacy in preventing VZV was significantly different: 27/218 (12.4%) of children with acyclovir PEP ultimately had a VZV-diagnosis code, compared with 1/148 (0.7%) and 1/112 (0.9%) treated, respectively, with either IG or VariZIG (P < 0.0001). Conclusions Increasing use of VariZIG likely corresponded to widespread US availability after a long market absence. Nonetheless, the management of VZV PEP in children with high-risk conditions varied considerably across institutions. As the CDC and AAP Red Book list VariZIG as the primary option for PEP, there is considerable room to optimize PEP practice and reduce breakthrough VZV infections.
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Duvall, Lydia, Brooks Platt, Michelle Kussin i James B. Wood. "#73: Outcomes of Children with Osteoarticular Infections Treated with Trimethoprim–Sulfamethoxazole". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S7—S8. http://dx.doi.org/10.1093/jpids/piaa170.023.
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Abstract Background Early transition to oral antibiotic therapy for the treatment of children with osteoarticular infections (OAI; osteomyelitis [OM], septic arthritis [SA]) has become increasingly common, yet the choice of optimal regimen remains a challenge. With increasing resistance, poor palatability, and reported allergies to commonly used oral antibiotics, including anti-Staphylococcal penicillins and clindamycin, the treatment options for children with OAI are limited. Trimethoprim–sulfamethoxazole (TMP-SMX) is a commonly used antibiotic, with activity against frequently encountered pathogens causing OAI, yet data regarding outcomes of children with OAI treated with TMP-SMX is limited. Thus, we sought to describe the characteristics and outcomes of children with OAI, at our institution, treated with TMP-SMX. Methods Records of children aged ≤18 years old, admitted to Riley Hospital for Children between 2010 and 2018, treated with TMP-SMX for acute OAI were reviewed. Patients were identified by ICD-9/-10 codes and order for TMP-SMX. Patients were excluded if they did not receive TMP-SMX for treatment of OAI, had symptoms >30 days, or had an alternative diagnosis. Demographic, clinical, and outpatient/follow-up data were recorded. Treatment was considered successful if the patient completed treatment with TMP-SMX, and there was no evidence of infection at the end of therapy. Treatment failure was defined as the inability to tolerate the medication, development of an infection-related complication, recurrent or chronic osteomyelitis. Additionally, significant adverse drug events were recorded. Results Eighty-three subjects were identified; however, after screening, 21 subjects were deemed eligible. The majority were non-Hispanic white, males, with a median age of 1.5 years (Interquartile range [IQR], 1–3 years) (Table 1). Twelve patients (57%) had OM, seven (33%) SA, and two (10%) had both OM and SA. A pathogen was recovered in 12 patients (57%), with Staphylococcus aureus being most common. All S. aureus isolates were methicillin resistant, and three were clindamycin resistant. The median duration of intravenous antibiotics prior to discharge was 3 days (IQR 2–4 days). All patients were transitioned to a TMP-SMX containing regimen prior to discharge. The median dose of TMP-SMX was 12.7 mg/kg/day (IQR 11.3–14.9). Reasons for choosing TMP-SMX varied, with the majority (62%) being physician preference. Treatment regimens varied with the majority (62%) receiving TMP-SMX monotherapy. Two patients developed adverse drug reactions attributed to TMP-SMX. Of the 18 patients that completed follow-up, 14 (78%) successfully completed treatment with TMP-SMX. Three patients developed recurrent infections and one patient was unable to finish therapy with TMP-SMX due to developing acute kidney injury. Conclusions In our study, TMP-SMX was well tolerated; however, only 78% of patients were successfully treated. The majority of treatment failures had prolonged bacteremia due to MRSA perhaps suggesting a higher bacterial burden. The poor outcome in these patients is likely multifactorial, and antibiotic contribution is unknown. TMP-SMX may be a reasonable treatment option for children with OAI when the disease is mild; however, caution should be exercised with severe disease, especially when associated with bacteremia. Prospective, randomized control trials are needed to aid in guideline development and understand the role of TMP-SMX in the treatment of children with OAI.
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Tinoco, I., A. Jarrell, L. Correa, J. Bissler, J. DeVincenzo, Ivan Tinoco, Amber Jarrell, Lauren Correa, John J. Bissler i John P. DeVincenzo. "#92: What Is the Optimal Management of Patients Immunosuppressed with the Anti-compliment Monoclonal Antibody, Eculizumab? A Case Report and Review". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S12. http://dx.doi.org/10.1093/jpids/piaa170.034.
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Abstract Background Patients with deficiencies of terminal components of complement are at hundreds to thousands fold increased risk of severe and fatal Neisseria spp. infections compared with the general population. Eculizumab is a newly approved monoclonal antibody C5 complement inhibitor. It is indicated for the treatment of atypical hemolytic uremic syndrome (atypical HUS), myasthenia gravis, and paroxysmal nocturnal hemoglobinuria. Because of the complement-depleting effect of Eculizumab dosing (Soliris®, Alexion Pharmaceuticals, Munich, Germany), patients are immunosuppressed for specific infectious pathogens (including Neisseria species) against which protection partially relies on normal complement activity. Because Eculizumab treatment is associated with a dramatically increased risk of Neisseria species. infections, recommendations for Neisseria meningitidis vaccination and antibiotic prophylaxis are contained in Eculizumab prescribing information. However, the most appropriate prevention of infections after Eculizumab has yet to be determined. Methods Case report and literature review. Results A previously healthy 7-year-old male was diagnosed with atypical HUS which included renal failure progressing to dialysis, persistent thrombocytopenia, hemolytic anemia, and hemoglobinuria. Stool cultures and a stool multiplex PCR panel did not detect Shiga-like producing E. coli nor E. coli O157/H7. Eculizumab dosing was therefore planned and Infectious Diseases consultation was obtained for appropriate preventions. The FDA Prescribing Information recommends Neisseria meningitidis vaccination before starting Eculizumab or, if immediate Eculizumab is necessary, to use antibiotic prophylaxis until 2 weeks after vaccination. The accepted protective titer after meningococcal vaccination is population based and uses the serum bactericidal assay (SBA). An antibody titer of >1:4 (human compliment) or 1:8 (rabbit complement) is considered protective. However, this “gold standard” assay incorporates the use of exogenous human or rabbit complement. The protective SBA titers in subjects with terminal complement component deficiencies may not be properly assessed using these same SBA titer protective thresholds. Furthermore, serious meningococcal infections have occurred after appropriate vaccination in patients receiving chronic Eculizumab treatments (ie for paroxysmal nocturnal hemoglobinuria). Finally, SBA protective levels after single Neisseria meningitidis vaccination have not been achieved in majorities of patients with renal failure receiving dialysis and or transplant immunosuppression. Conclusions The current Eculizumab prescribing information recommendations for vaccination and antimicrobial prophylaxis may be inadequate to prevent serious Neisseria infections. Repeated Neisseria meningitidis vaccination and extended antibiotic prophylaxis may afford better protection in patients chronically dosed with Eculizumab.
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Vishnu, Kaniyarakkal, Edakuneri Najna, Pottammal Ambili i Dinesh Kavitha. "#6: Varicella Outbreak Investigation in a Cancer Hospital". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S23. http://dx.doi.org/10.1093/jpids/piaa170.074.
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Abstract Background Primary varicella infection is usually self-limited in immunocompetent hosts, whereas it can be quite severe in immunocompromised hosts. Atypical presentations of varicella in immunocompromised hosts can be diagnostically challenging, without laboratory testing. Varicella is an occupational hazard for susceptible healthcare providers (HCP). It assumes importance in infection prevention and control, due to the possibility of spread to other susceptible coworkers and patients. Methods This outbreak investigation report is from a 300-bed cancer care hospital in South India. A 62-year-old male patient with lymphoplasmacytic non-Hodgkin’s lymphoma was admitted on October 1 with features of bronchopneumonia and extensive skin lesions, 2 months after his last chemotherapy cycle. The patient was received in the emergency department (ED) and later shifted to the intensive care unit (ICU) due to worsening clinical condition. The clinical picture was more in favor of Stevens–Johnson syndrome, but oral acyclovir therapy was given considering a differential diagnosis of varicella. His condition deteriorated further requiring ventilator support and on the 19th day of admission, the patient succumbed to his illness and passed away. From October 14 to 19, eight HCP presented with vesicular eruptions and fever, clinically diagnosed as having varicella. This aroused the suspicion of an outbreak. An emergency outbreak control group meeting was convened to assess and address the situation. Results All outbreak cases were confirmed as varicella, clinically. Contacts, including patients assigned to HCP involved in the outbreak were traced, and their varicella immune status was assessed. Nonimmune contacts were given oral acyclovir prophylaxis as per CDC recommendations. Other HCP in the hospital were offered first dose of varicella vaccine based on their varicella immune status. With these infection prevention and control measures in place, no additional cases were identified. Being a hospital in low- to middle-income country, it was not routine practice to vaccinate susceptible HCP, after screening of varicella immune status at the time of recruitment. In the wake of the outbreak, assessment of immunity against varicella, and vaccination of susceptible HCP, is being followed up meticulously. Conclusion Varicella can present with atypical symptoms, especially in the immunocompromised host. Suspected cases should be isolated until sensitive PCR studies are done. Varicella immune status of HCP should be assessed at recruitment and vaccination should be offered to susceptible individuals. Implementation and infection prevention and control measures can help prevent and mitigate varicella outbreaks within healthcare facilities.
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Ardianto, Bambang, Rina Triasih, Eddy Supriyadi, Pudjo Hagung Widjajanto, Sri Mulatsih, Alexandra Widita Swipratami Pangarso, Inggar Armytasari i Ignatius Purwanto. "#8: Survival Analysis in Childhood Acute Myeloblastic Leukemia: Do Infection and Lymphocyte-Mediated Immune Response Play a Role?" Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S17—S18. http://dx.doi.org/10.1093/jpids/piaa170.055.
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Abstract Background Acute myeloblastic leukemia (AML) is the second most prevalent cancer among Indonesian children. In contrast, to those of acute lymphoblastic leukemia (ALL), a number of studies reported unfavorable outcomes following the initiation of cytostatic protocols for childhood AML. In addition, our previous study showed that Gram-negative bacterial infection constitutes the major cause of treatment-related mortality in children with AML. These findings raised a question on the prognostic role of diagnostic lymphopenia, which represents the immunosuppressive state, as demonstrated in adult patients with solid tumors. Methods A retrospective cohort study, which involved children younger than 18 years of age with the newly diagnosed, non-M3 AML, was conducted. These children were admitted to Dr. Sardjito General Hospital, Yogyakarta, Indonesia, during the period of 2011–2019 and received National Pilot Protocol (2011–2016), Pediatric AML Protocol (2016–2018), and International Society of Pediatric Oncology (SIOP) Pediatric Oncology in Developing Countries (PODC) Protocol with prephase (2018–2019). One-year overall survival (OS) was analyzed, using diagnostic absolute lymphocyte counts (ALC0) of more than 4.5 × 109/L and less than 4.5 × 109/L as the determinants, in accordance with those reported in a number of studies on adult AML. Results Sixty-five children, which consisted of 41 (63%) children with ALC0 of more than 4.5 × 109/L and 24 (37%) children with ALC0 of less than 4.5 × 109/L, were eligible for this study. Of these 65 children, 56 (86%) children received Cytosine arabinoside in the first week of treatment (National Pilot Protocol and Pediatric AML Protocol), while 9 (14%) children did not (SIOP PODC Protocol with prephase). OS analysis showed that 44% and 19% of children with ALC0 of more than 4.5 × 109/L and ALC0 of less than 4.5×109/L, respectively, were alive within the first year of treatment. Cox-regression analysis, however, failed to reach statistical significance [hazard ratio (HR), 0.63; 95% confidence interval (95% CI), 0.33–1.18; P = 0.15]. Conclusion Despite lacked statistical significance, our study showed the superior one-year OS in children with ALC0 of more than 4.5 × 109/L. Our findings, therefore, might indicate the prognostic role of infection and lymphocyte-mediated immune response in childhood AML.
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León-Lara, X., I. Medina-Vera, E. Arias de la Garza i M. Macías-Parra. "#22: Trends in Bacterial Meningitis in a Tertiary-Level Children′s Hospital in Mexico, Following Haemophilus influenzae and Streptococcus pneumoniae Vaccination (1990–2018)". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S15. http://dx.doi.org/10.1093/jpids/piaa170.047.
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Abstract Background Bacterial meningitis (BM) remains a significant global health problem in pediatric care, with substantial morbidity and mortality. The epidemiology of BM has changed over the last 20 years. The ongoing introduction of conjugate vaccines for the most common meningeal pathogens has reduced the global incidence. However, there is limited epidemiologic and microbiologic data of BM in children before and after the widespread use of these vaccines in Mexico. Methods We conducted a retrospective, observational, analytical study. Pediatric patients (from 1 month to 18 years of age) presenting with BM and hospitalized at the Instituto Nacional de Pediatria in Mexico City, from 1990 to 2018, were included. Meningitis from invasive procedures or complicated head trauma were excluded. BM was classified according to the World Health Organization (WHO) criteria. The cases were analyzed in three periods: period A (1990–1999), period B (2000–2008), and period C (2009–2018). Period A corresponds to the time before the conjugate Haemophilus influenzae type b (Hib vaccine) was introduced in Mexico, while periods B and C correspond to the time after the Hib vaccine was routinely applied. Periods A and B correspond to the period before the pneumococcal conjugate vaccine (PCV7) was administrated in Mexico, while period C is after PCV7 and PCV13 were routinely administrated. The proportion of cases between periods was compared with Chi-square or Fisher exact test; P < 0.05 was considered significant. Binomial logistic regression analysis was used to determine the association between potential risk factors and death due to BM. Results A total of 226 cases with BM were included, 180 (79.6%) confirmed cases, and 46 (20.4%) probable cases. The median age at diagnosis was 10 months. There were 126 (55.8%) cases in Period A, 62 (27.4%) cases in Period B, and 38 (16.8%) cases in Period C, with a statistically significant reduction between periods (P = 0.0001). Hib was the most commonly isolated pathogen, found in 38 (50%) cases. However, its proportion declined significantly after the introduction of the Hib conjugate vaccine (P < 0.0001). S. pneumoniae followed as the second most commonly isolated bacterial pathogen. There was a significant reduction in neurological complications after the Hib conjugate vaccine (P = 0.003) and the S. pneumoniae conjugate vaccine (P = 0. 05) were introduced. Independent risk factors associated with mortality were coma (OR 15, P = 0. 0001), intracerebral bleeding (OR 3.5, P = 0.046), and pneumococcal meningitis (OR 9.4, P = 0. 002). Conclusions BM remains a cause of morbidity and mortality in pediatric patients in this hospital, with a dramatic change in the epidemiology since the introduction of the Hib conjugate vaccine to the national immunization schedule. Routine use of childhood conjugate vaccines against the most frequent etiological agents reduced the number of cases globally, mainly those caused by Hib. Additionally, conjugate vaccines reduced neurological complications and sequelae caused by this disease.
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Camelo, I., L. M. Mwananyanda, D. M. Thea, P. Seidenberg, C. J. Gill i J. R. Weinstein. "#33: A Tale of Two Pneumos: the Impact of HIV Exposure or Infection Status on Pediatric Carriage of Streptococcus pneumoniae and Pneumocystis jirovecii, a Nested Case–control Analysis from the Pneumonia Etiology Research in Child Health (PERCH) study in Zambia". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S18. http://dx.doi.org/10.1093/jpids/piaa170.057.
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Abstract Background Most pediatric HIV cases in Africa reflect maternal to child transmission (MTCT). The persistently high seroprevalence of HIV in pregnant women (16.6%) and the low rates of mother to child HIV transmission (~2%) have resulted in a high number of children who are HIV exposed but uninfected (HEU). HIV exposed but uninfected (HEU) children have increased rates of morbidity and mortality vs. HIV unexposed and uninfected (HUU). Methods To explore the mechanisms behind this phenomenon, each case and control was sampled using a nasopharyngeal NP swab and an oropharyngeal (OP). A multiplex real-time polymerase chain reaction (PCR) assay was used to determine the presence of Streptococcus pneumoniae and Pneumocystis jirovecii in the NP/OP specimens. We compared nasopharyngeal carriage rates of S. pneumoniae and P. jirovecii between HIV-infected, HEU, or HUU case (pneumonia) and control (without pneumonia) children. In bivariate analyses, using carriage as a dichotomous outcome, proportions we compared using chi-square or odds ratios with 95% confidence intervals. In multivariate models, we created logistic and linear regression models adjusting for nutritional status as possible mediators of carriage status. Results SP carriage rates were similar between cases and controls. However, density was increased among HIV-infected children vs. HEU or HUU children (15.8 vs. 4.7 vs. 3.6 × 105 copies/mL, respectively). Among cases, PJ carriage among HIV positive, HEU and HUU children was 31%, 15% and 10%,, respectively, (P < 0.05) and carriage density was 63.9, 20.9, and 4.8 × 103 copies/mL, respectively (P < 0.05). In adjusted logistic regression models, HIV-infected cases were slightly more likely to be an S. pneumoniae carrier compared with HUU cases (aOR = 1.1; 95% CI: 0.57–2.14). In contrast, all other case/exposure combinations were less likely to be S. pneumoniae carriers with the lowest adjusted odds among HIV-infected controls children (aOR = 0.34; 95% CI: 0.17–0.71). The odds of being a PJ carrier was almost 6 times higher in HIV-infected cases than in HIV unexposed cases (aOR = 6.63; 95% CI: 3.24–13.54). Conclusions We demonstrate that HIV infection and HIV exposure without infection each have an impact on carriage rates and density for S. pneumoniae and P. jirovecii, though the magnitude and nature of these effects differs substantially between the two pathogens. This may be explained in part by differences in immune responses to these two different pathogens. Our analysis provides further evidence of fundamental differences in immune function among HIV exposed but uninfected infants compared with HIV unexposed, uninfected infants.
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Janowski, A. B., H. Dudley, T. Feehley, H. Ingle, M. T. Baldridge, H. W. Virgin, R. S. Klein i D. Wang. "#36: Can Astrovirus VA1, a Novel Human Astrovirus, Cause Diseases of the Central Nervous and Cardiovascular Systems?" Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S14. http://dx.doi.org/10.1093/jpids/piaa170.041.
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Abstract Background Since their original isolation from human stool samples in 1975, astroviruses have been assumed to be pathogens exclusive to the gastrointestinal tract. However, astroviruses have been recently identified from brain tissue of humans and other mammals suffering from neurological diseases, suggesting that members of this family of viruses have a previously unrecognized neurotropism. One human astrovirus genotype, astrovirus VA1/HMO-C (VA1) is the most frequently identified astrovirus from cases of human encephalitis. We previously described the ability of several cell lines, including Caco-2, A549, and HEK293, to support VA1 growth in cell culture. Our goals were to develop cell culture and animal models to study the pathogenic potential of VA1. Methods VA1 was inoculated into primary astrocytes, primary neurons, and SK-N-SH cells in tissue culture. Viral RNA was measured in multistep growth curves by qRT-PCR, capsid was detected by immunofluorescence, and infectious titer was measured by a TCID50 assay. For development of an in vivo model of infection, mice were inoculated with VA1 with simultaneous intracranial, intraperitoneal, intravenous, and oral gavage inoculations with a VA1 stock. Mice were sacrificed 7 days after inoculation, RNA extracted from tissues, and viral load quantified by qRT-PCR. Tissue was also processed for histology and staining with hematoxylin and eosin. Primary human cardiac endothelial and myocytes were also inoculated with VA1 and viral RNA was measured in multistep growth curves by qRT-PCR. Results We detected the completion of the full VA1 lifecycle in primary astrocytes and SK-N-SH cells with >100-fold increase in viral RNA in a multistep growth curve, detection of intracellular viral capsid, and a >100-fold increase in the infectious titer. These results support the neurotropic potential of VA1. In the development of a mouse model of VA1 infection, we detected the virus in the brain tissue of mice 7 days after inoculation. Unexpectedly, we detected the highest titer of VA1 in heart tissue, which was associated with histological evidence of myocarditis. Furthermore, we demonstrated VA1 can replicate in primary human cardiac endothelial cells but not in primary human cardiac myocytes. Conclusions Our data demonstrate that astroviruses have tissue tropisms outside of the gastrointestinal tract. We provide the first demonstration that cultured neural-derived cells can support infection and replication of astroviruses, providing a model for studying the neuropathogenic potential of VA1. Furthermore, we have identified a novel cardiotropism for VA1, raising the possibility that VA1 may contribute to human cardiac diseases currently without an ascribed etiology.
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Duque-David, Princess Alexandra B., Jane G. Stewart, Angelita B. Ramos i Johnathan M. Peralta. "#1: The Clinico-Epidemiologic Profile and the Correlation of Nutrition and Immunization Status With Outcome of Measles Patients During an Outbreak". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S13—S14. http://dx.doi.org/10.1093/jpids/piaa170.040.
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Abstract Background Measles is a highly contagious disease that leads to substantial morbidity among pediatric patients. Vaccination has already been implemented in the Philippines, but still measles outbreak is resurgent. This study will be of importance because it can be utilized to establish the factors that lead to the recent measles outbreak. Objectives To describe the demographic and clinical profile of pediatric patients diagnosed with measles during the recent measles outbreak in a tertiary hospital in Central Luzon, Philippines; and to investigate the relationship of nutrition and measles immunization status with the outcomes of measles. Methods Cross-sectional analytic study, conducted in Tertiary training government hospital. Included in the study were less than 19 years old, admitted between January and April 2019, and manifested the following criteria for suspected measles:fever, generalized maculopapular rash, cough, coryza, conjunctivitis. Descriptive statistics was used to present data for the clinico-demographic profile of patients. A correlation study was done by determining the statistical significance of the relationship of nutrition and vaccination status with measles complications and outcomes; and the relationship of complications with outcomes of patients. Results In total, 373 patients were included in this study, 60% (224) were males; 40% (149) were females. The majority was under 0–6 months, 40% (149). Most cases came from Pampanga, 333 (89.2%). A total of 355 (95%) patients were classified as clinically compatible measles, seven (2%) were laboratory confirmed, and all seven had measles IgM antibodies, four (1%) were epidemiologically linked cases. Most of the cases manifested the classic symptoms of measles: fever 100%, rashes 99%, cough 96%, colds 84%, conjunctivitis 55%, and Koplik’s spots was seen in only 13%. As to exposure, those with exposure (49%) and without exposure (51%) are almost the same. The majority of the patients (285, 76%) had no measles vaccine and the top reason for non-immunization is the issue of the patients being too young for vaccination. The majority had normal nutritional status (72.4%). Three hundred and twelve patients reported the occurrence of clinical complications in patients with measles. Pneumonia was seen in 75% of cases and 9.3% had diarrhea. The occurrence of diarrhea is not directly correlated (P = 0.823) with the outcome of measles while Pneumonia shows a significant correlation (P < 0.001) with the outcome of measles. Death among patients was seen in cases with pneumonia. The occurrence of pneumonia is not significantly correlated with nutritional status (P = 0.083) while diarrhea is significantly correlated with nutritional status(P = 0.027). Two hundred and forty-eight patients with normal nutritional status did not develop diarrhea. Vaccination status shows a significant correlation with the occurrence of pneumonia(P =0.001). Out of the 285 non-vaccinated cases, 223 developed pneumonia. Vaccination status did not show a significant correlation with the occurrence of diarrhea (P = 0.946). Nutritional status and vaccination status was not significantly correlated with measles outcome(P = 0.605 and 0.120).In terms of outcome, 90% of the patients were discharged while 10% died. Conclusion Most were males, aged 0 to 6 months. There was a clustering of cases in Pampanga. The majority was classified as clinically compatible measles. The most common complication was pneumonia. Half had exposure to measles. The majority had no vaccine. The presence of diarrhea is significantly related to nutritional status. Pneumonia is significantly correlated with vaccination status and the outcome of measles. Most of the patients were discharged.
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Most, Zachary, Michael Sebert, Patricia Jackson i Trish M. Perl. "#87: Association Between Healthcare-Associated Respiratory Viral Infections and Length of Stay at a Pediatric Hospital". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S15. http://dx.doi.org/10.1093/jpids/piaa170.044.
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Abstract Background Healthcare-associated infections (HAI) are major preventable causes of morbidity and mortality. While there are fewer overall HAI in children, there is a greater potential impact in disability-adjusted life years. Healthcare-associated respiratory viral infections (HARVI) are not frequently tracked within institutions, yet the risk for such infections in pediatric hospitals is very high. Recent data demonstrate large inter-hospital variability of HARVI incidence that may depend on various factors including the number of immunocompromised patients in the hospital and the presence of shared rooms. We hypothesize that the burden of healthcare-associated respiratory viral infections and their impact on the length of stay (LOS) is substantial at a large urban pediatric hospital. Methods A cohort of all children with any HARVI admitted to a large urban pediatric hospital between July 2017 and June 2018 were included after obtaining IRB approval. We defined a HARVI as a respiratory infection with an onset of symptoms while the patient was hospitalized meeting three criteria: A positive microbiologic test for one of 8 viruses, presence of symptoms of a respiratory infection, and onset of symptoms after admission beyond the minimum incubation period for each virus. Infections with symptom onset after admission beyond the maximum incubation period were considered definite hospital onset whereas others were considered possible hospital onset. The electronic medical record provided data on demographics, underlying medical conditions, hospital length of stay prior to infection and hospital unit of infection, and consequences and outcome of HARVI. The at-risk population for calculation of the incidence of HARVI was all admitted patient-days at the hospital over this time period. Results Between July 2017 and June 2018 the incidence of HARVI (definite or possible hospital onset) was 1.2 infections per 1,000 admitted patient-days (60% due to rhinovirus/enterovirus, 12% due to respiratory syncytial virus, and 9% due to influenza). Overall, 48% of patients were under 2 years of age, 18% were between 2 and 5 years of age, and 34% were over 5 years of age. Twenty-one percent were immunocompromised and 35% had underlying lung disease. The median length of stay prior to symptom onset was 11 days (IQR 5–36 days) and the median total length of stay was 30 days (IQR 15–82.5 days). Eight individuals had more than one HARVI over this time period. Nineteen percent were transferred to the intensive care unit and 7% died during their hospital admission Conclusion HARVI occurs frequently in a pediatric hospital and often in patients with underlying comorbidities. The risk for HARVI increases substantially with increased length of stay. Such data support the need for tracking HARVI in high-risk institutions.
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Malhotra, Sanchi, Imran Masood, Noberto Giglio, Jay Pruetz i Pia Pannaraj. "#60: Knowledge of Diagnosis and Management of Chagas-related Heart Disease Among Pediatric Cardiologists in the United States". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S21. http://dx.doi.org/10.1093/jpids/piaa170.066.
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Abstract Background Chagas disease is a highly pathogenic infection with a prevalence of approximately 5.7 million cases worldwide and greater than 300,000 cases in the United States. Up to 40% of immigrants to the United States are from highly endemic Latin American countries. An estimated 40,000 women of childbearing age in the United States are infected, with a 1–5% risk of vertical transmission. The impact of this disease is extensive, often life-long, and difficult to eradicate. The purpose of our study was to better understand current knowledge and experience among pediatric cardiologists in the United States with the cardiac presentations of Chagas disease to determine where to focus educational programs and critical content. Methods We prospectively disseminated a 19-question survey to pediatric cardiologists via the PediHeart, WSOPC, and Pediatric CHF listservs three times between September and November 2019. The survey included demographic, multiple-choice and Likert-scale questions. We used Qualtrics to ensure anonymity. Respondents outside of the United States were excluded. Results Of 140 responses received, 120 cardiologists treated pediatric patients in the United States. Over half (62.5%) of respondents served a >10% Latin American patient population. Most providers (87%) had not seen a case of Chagas disease in their practice; however, most (72%) also had never tested for Chagas. In response to the statement: “I feel comfortable recognizing cardiac presentations of Chagas disease in children”, (85%) of respondents disagreed. Most respondents selected that they would not include Chagas on their differential diagnosis for cardiac presentations that included conduction anomalies, myocarditis, and/or apical aneurysms (Figure 1). However, when considering patients who recently immigrated from Latin American nations, inclusion of Chagas in the differential diagnosis increased. In response to the statement: “If I was offered a lecture on Chagas-related heart disease, I would be likely to attend,” 87% of respondents agreed. Conclusions In our sample of pediatric cardiologists, very few had seen cases of Chagas disease, albeit very few tested for it or included it in their differential diagnosis. However, most individuals agreed that education on Chagas disease would be worth-while. Education could help ensure these cases are not missed in pediatrics. Future analysis should focus on changes in provider knowledge and/or testing as the incidence grows, or as educational programs are implemented.
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Quintana, G. "#3: A Historical Perspective to US Syphilis Reporting and the Recent Rise of Risky Behaviors Among Women with Syphilis". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S13. http://dx.doi.org/10.1093/jpids/piaa170.038.
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Abstract Background Congenital syphilis is a vertically transmitted infectious disease with devastating consequences during the perinatal period, including stillbirth. On October 8, 2019, the CDC published a press release stating the urgent action needed to break the cycle of STD increases, including syphilis. The purpose of this study was to provide a brief historical perspective of syphilis coding, reporting, and monitoring system changes since 1992, discuss US syphilis incidence and trends, and assess risky behaviors among women with primary or secondary syphilis. Methods Quantitative data were obtained from CDC AtlasPlus, STD Surveillance 2018 report, and CDC Syphilis Surveillance Supplement 2013–2017. Results The possible association between risky sexual behaviors among reproductive-age women, such as the use of phone applications like Tinder, and increased rates of congenital syphilis have come into question. In 2017, risky behaviors reported by American women with syphilis were having sex while intoxicated (36.7%), having sex with an anonymous partner (21.8%), use of methamphetamine (16.6%), and having met a sex partner through the internet (11.6%). Women aged 35–39 were most likely to report of having sex while intoxicated (45.3%) followed by ages 25–34 (41.3%). Women aged 15–19 were most likely to meet a sex partner on the internet (16.7%). 22.6% of women reported the use of “other drug,” not categorized under “crack”, “poppers”, “cocaine,” “heroin,” “methamphetamine,” “injection drugs.” Furthermore, younger individuals were more likely to report the use of an “other drug” with increasing annual trends since 2013. Conclusion The highest reported risky behavior among women with syphilis was having sex while intoxicated. Unexpectedly, having met a sex partner on the internet was not among the highest reported risky behavior. Clarification of “other drugs” may be beneficial in understanding the risky behaviors among young women with syphilis. The correlation between risky sexual behaviors and drug use among reproductive-age women and increasing congenital syphilis rates warrants further investigation. A causal relationship between these two variables cannot be excluded until linked data are available, including further stratification of “other drug” categories.
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Hoa, Nguyen Thi Kim, Tran Kiem Hao i Chau Van Ha. "#34: Measles Outbreak in Pediatric Oncology Patients in Hue Central Hospital, Vietnam". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S24. http://dx.doi.org/10.1093/jpids/piaa170.076.
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Abstract Background Measles outbreaks in immunocompromised populations present a significant challenge, and to interrupt endemic transmission can be difficult. This study aimed to investigate measles in pediatric oncology patients at Hue Central Hospital, Vietnam to describe demographic, epidemiological, and clinical features. Methods Potential measles infections among children with cancer were prospectively identified between April 20 to July 10, 2019 at Hue Central Hospital. Measles diagnoses were based on both clinical features and IgM laboratory evaluation. Data were abstracted from patient medical records and analyzed in SPSS v.18.0 (IBM Corp., Armonk, NY, USA). Results From April 20 to July 10 in 2019, a total of 11 patients with malignancies were identified as having measles, with a median age of 4.0 years (range: 1 years to 9 years). Of these 11 patients, 2 (18.2%) had not received any dose of measles vaccine, 4 (36.4%) had received 1 dose of measles vaccine, and 5 (45.5%) had received the recommended 2 doses. All patients had fever with the median temperature of 39 degrees Celsius (range: 38.5–39.5), and median fever duration of 7 days. All patients had cough and rash, while 3 (27.3%) were complicated by pneumonia, and 2 (18.2%) had elevated liver transaminases. All patients had hospital visits or were hospitalized before measles onset, with the median length of stay of 10 days (range: 7–24 days). All patients were likely to exposed each other. 100% of these patients recovered. Conclusions Children with cancer are at extra risk of measles infection due to their immunocompromised status. Getting vaccinated is the best way to prevent measles, and improved infection control is critical for the prevention of measles in patients with malignancies. Following this measles outbreak, a designated outpatient area was established to separate the inpatient unit and limit hospital transmission.
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Minero, Miguel A., Asia Castro i Martha Avilés-Robles. "#31: Risk Factors Associated with Mortality due to Multidrug-Resistant Organisms in Pediatric Oncology Patients with Febrile Neutropenia". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S15—S16. http://dx.doi.org/10.1093/jpids/piaa170.048.
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Abstract Background Infectious processes are frequent complications presented in pediatric patients with cancer. Currently, the indiscriminate use of antibiotics induces resistance to available treatments, creating the emergence of multi-drug-resistant organisms (MDROs). Due to the impact in morbidity and mortality secondary to MDRO infection, we aimed to identify risk factors associated with mortality in infections due to MDROs in pediatric patients with cancer. Methods Case–control study nested in a prospective cohort of pediatric oncology patients with febrile neutropenia (FN) at Hospital Infantil de México Federico Gómez (HIMFG) in Mexico City from March 2015 to September 2017. MDRO was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Patients with FN episodes who died from an infection due to MDROs were defined as cases and patients with FN episodes of an infection due to MDROs who did not die were defined as controls. Mucositis, septic shock, PICU stay, and bacterial prophylaxis (Trimethoprim/Sulfamethoxazole) were compared between groups. Descriptive statistics was performed and Pearson χ 2 or Student’s t-test were used to compare risk factors between groups. Results A total of 929 FN episodes were documented, 44.4% episodes occurred in male patients, mean age was 7.9 years, with the population under 5 years being the most represented (68.2%). The most frequent diagnosis was acute lymphoblastic leukemia in 75% followed by rhabdomyosarcoma in 10.5% and acute myeloid leukemia in 9.6%. Prophylaxis (trimethoprim/sulfamethoxazole) was used in 86%, mucositis was present in 9.2% of episodes. 12.1% had septic shock and 4.7% were admitted to PICU. In 148 FN episodes (15.9%) a microorganism was identified, of these 50 (33.7%) were due to an MDROs. Urinary tract infection was the most frequent site (49%), followed by bloodstream infections (47%). K. pneumoniae was the most frequent MDRO in 22.8%, followed by E. coli in 19.2% and P. aeruginosa in 14%. Septic shock was presented in 26% of MDROs infections. Overall mortality was 1.94% and only 0.86% (8) were secondary to MDROs. Of patients with MDRO isolated mortality was 30% (15/50). Mortality associated with bloodstream infection due to MDROs was 25% compared with other source of MDROs infections (3%) (P = 0.01). Septic shock was present in 40% of patients with death due to MDROs infection (P = 0.001). Conclusions In our population of children with FN episodes who had an isolated microorganism, infection due to MDROs are high (33.7%) and MDROs infection-directed mortality was as high as 30%. Bloodstream infections and septic shock were risk factors associated with mortality due to MDROs.
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Estrada, A., V. Cornejo, S. Mukkada, C. A. Villegas, M. Vazquez i J. P. Rodriguez-Auad. "#32: Quality Improvement Strategies in the Management of Fever in Children with Cancer in a Third-level Hospital in Bolivia". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S19. http://dx.doi.org/10.1093/jpids/piaa170.060.
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Abstract Background The care of children with cancer requires systematic and standardized management to avoid complications associated with treatment, one of which is infection. Fever is an important sign of infection in a neutropenic patient and requires early management to avoid unfavorable outcomes. Many factors contribute to delays in recommended steps of fever management. The objective of this project was to measure the delay times associated with key steps in fever management and identify challenges and opportunities to improve this care process. Methods A prospective quality improvement project was initiated between June and November 2019 at the 25-bed oncology service of the Dr. Ovidio Aliaga Uria Children’s Hospital in La Paz. A data collection sheet was constructed and implemented including times for fever identification, blood culture collection, antibiotic order, and antibiotic administration. In parallel, we worked with the health personnel of this unit to deconstruct the process of fever management using block and flow diagrams. We jointly constructed an impact/effort matrix to prioritize key interventions. These interventions were developed to be implemented to improve this process. Results During these 6 months, data from 29 neutropenic patients who had a fever was collected. The average time elapsed from fever identification until blood culture collection was 4.9 hours (n = 28), time elapsed from fever to antibiotic initiation was 7.3 hours (n = 27), time between antibiotic order and administration was 1.6 hours (n = 26), and time between blood culture collection and antibiotic administration was 2.3 hours (n = 26). The interventions proposed through the effort/impact matrix as low effort and of high impact were: priority attention of pediatric oncology patients in the emergency department through the implementation of a patient identification card to expedite the admission process, development of a fever management flowchart with a record of action schedule and improve the availability of bottles for blood culture. Conclusions Our results demonstrate that delays exist in the management of fever in children with cancer in our hospital. Identifying the gaps and pivotal steps in the process, and opportunities for improvement are the first key steps toward implementing strategies to improve the quality of care. Categorization, testing, and execution of standardized interventions will help to improve fever management and must be done as a collaborative effort between departments involved in pediatric neutropenic patient care such as infectious diseases, pediatrics, and oncology. Our next steps include (1) training of medical and nonmedical staff involved in the admission and discharge processes to implement the patient identification card distribution and usage, (2) improving interdepartmental communication, and (3) identification of new opportunities for quality improvement to be tested and implemented.
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Mortel, Maika Kamille, Ana Patricia Alcasabas i Anna Lisa Ong-Lim. "#95: Clinical Profile and Outcome of Pediatric Acute Lymphoblastic Leukemia Patients with Tuberculosis at the Philippine General Hospital". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S17. http://dx.doi.org/10.1093/jpids/piaa170.054.
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Abstract Background The Philippines remains one of the countries on the WHO list of high-burden countries for tuberculosis (TB), and malignancy has long been recognized as a risk factor for this disease. This report describes the clinical profile and outcomes of pediatric patients with acute lymphoblastic leukemia (ALL) diagnosed with tuberculosis. Methods Medical records of pediatric patients with ALL consulting at the University of the Philippines – Philippines General Hospital diagnosed from January 2015 to December 2017 (excluding those with concomitant HIV infection) were reviewed. Those diagnosed with tuberculosis infection were further analyzed, obtaining demographic data, results of diagnostics, and treatment. Results Out of 102 patients, 5 were found to have tuberculosis, all of them being male, with an average age of 7.2 years old. All cases were pulmonary, with one patient having multi-drug-resistant TB. PPD was positive in 4 cases, with indurations measuring >10mm, while chest radiographs showed nonspecific findings for 3 patients. Of 3 patients who underwent sputum AFB testing, one had a positive result. While 1 patient was diagnosed with TB and ALL concurrently, majority of patients were diagnosed after entering remission. Three patients completed 6 months of TB treatment, while 1 patient is still on medication for multi-drug-resistant tuberculosis. One patient abandoned treatment. Conclusion In this group of ALL patients, malnutrition and corticosteroid use were not found to be independent risk factors for TB. As TB disease may be due to reactivation of latent TB infection (LTBI) during immunosuppression, screening for LTBI may be a worthwhile strategy to decrease morbidity. Transmission precautions are emphasized to reduce acquired TB infection in immunocompromised populations.
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Kenneth, Gunasekera, Warren Joshua i Cohen Ted. "#59: Children as Sentinels for Active Transmission of Tuberculosis: Disease Mapping Modeling of Programmatic Data in a High-Burden Setting". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S16—S17. http://dx.doi.org/10.1093/jpids/piaa170.052.
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Abstract Background To meet the transmission reduction goals of the End TB strategy, there is a growing interest in identifying and targeting case-finding efforts to tuberculosis“hotspots,” geographic regions of active transmission. Collecting and interpreting spatial and pathogenic genetic information, the most reliable evidence of active transmission, is prohibitively resource-intensive under routine conditions in high-burden settings. Many countries maintain case-notification registers under routine conditions, representing an attractive source of data to investigate for transmission. However, notification data are imperfect. Areas of high incidence may reflect other underlying patterns, and individual-level covariate information and other information that may aid in its interpretation, such as baseline census data or other healthcare utilization data, is often unavailable. Despite imperfections, the accessibility of notification data demands further investigation. We examined notification data from 2005 to 2007 in a South American, high-burden setting where the household address of each case was geocoded. Subsequent investigation of notification data in the same setting from 2009 to 2012 additionally provided pathogen genetic evidence from all culture-positive cases suggesting regions of active transmission of tuberculosis. We investigated a disease mapping modeling approach leveraging only age-specified tuberculosis notification data to suggest hotspots of active tuberculosis transmission. Methods Given the absence of baseline population data at a comparable spatial resolution, we aggregated the point-referenced cases reported to the Peruvian National Tuberculosis Program from 2005 to 2007 within two of Lima’s four health districts into a grid with 400 m × 400 m cells. We used Bayesian hierarchical spatial modeling methodology to model the proportion of children cases of the total number of adult and child cases in each cell. Where the modeled proportion of child cases is higher than expected, we suggest that case notification is driven primarily by active transmission. Results This method identified several grid cells in which the proportion of child cases is higher than expected. The location of these grid cells was found to approximate the location of active transmission evidenced by a later genotyping study. Conclusions This evidence suggests that age-specified notification data, with all its limitations, may be sufficient to suggest hotspots of active transmission of tuberculosis. We additionally provide the first spatial evidence to support the long-cited belief that with respect to tuberculosis transmission, childhood cases may truly be “the canary in the coal mine.”
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Ocwieja, K. E., T. K. Hughes, J. M. Antonucci, A. L. Richards, A. C. Stanton, A. Shalek, R. Jaenisch i L. Gehrke. "#71: Single-cell RNA Sequencing Analysis of Zika Virus Infection in Human Stem Cell-Derived Neuroprogenitor Cells and Cerebral Organoids". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S14. http://dx.doi.org/10.1093/jpids/piaa170.042.
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Abstract Background The molecular mechanisms underpinning the neurologic and congenital pathologies caused by Zika virus (ZIKV) infection remain poorly understood. It is also unclear why congenital ZIKV disease was not observed prior to the recent epidemics in French Polynesia and the Americas, despite evidence that the Zika virus has actively circulated in parts of Africa and Asia since 1947 and 1966, respectively. Methods Due to advances in stem cell-based technologies, we can now model ZIKV infections of the central nervous system in human stem cell-derived neuroprogenitor cells and cerebral organoids, which recapitulate complex three-dimensional neural architecture. We apply Seq-Well—a simple, portable platform for massively parallel single-cell RNA sequencing—to characterize these neural models infected with ZIKV. We detect and quantify host mRNA transcripts and viral RNA with single-cell resolution, thereby defining transcriptional features of both uninfected and infected cells. Results In neuroprogenitor cells, single-cell sequencing reveals that while uninfected bystander cells strongly upregulate interferon pathway genes, these are largely suppressed in cells infected with ZIKV within the same culture dish. In our organoid model, single-cell sequencing allows us to identify multiple cellular populations, including neuroprogenitor cells, intermediate progenitor cells, and terminally differentiated neurons. In this model of the developing brain, we identify preferred tropisms of ZIKV infection. Our data additionally reveal differences in cell-type frequencies and gene expression within organoids infected by historic and contemporary ZIKV strains from a variety of geographic locations. Conclusions These findings may help explain phenotypic differences attributed to the viruses, including variable propensities to cause microcephaly. Overall, our work provides insight into normal and diseased human brain development and suggests that both virus replication and host response mechanisms underlie the neuropathology of ZIKV infection.
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Gomez, Sergio M., Claudia M. Ruiz, Daniela Iglesias i Marcela Varela. "#45: Reopening a Successful Stem-cell Transplantation Unit in a Public Children’s Hospital in La Plata, Argentina". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S19—S20. http://dx.doi.org/10.1093/jpids/piaa170.062.
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Abstract Background Hematopoietic stem cell transplantation (HSCT) is challenging because of economic, educational, and organizational reasons. Argentina is a middle-income country. HSML is a public pediatric hospital with an HSCT unit halted its services in July 2014. Among the reasons for suspending the services were healthcare providers(HCP) burn out, miscommunication, and tasks breakdown. The HSCT service resumed in December 2014. Objectives The primary objective was to describe and share the experiences in resuming the HSCT service by using a multicomponent strategic plan and interventions. The secondary objective was to review the outcomes. Methods Our strategic plan consisted of four main components: (1) Use of quality improvement tools for quality assessment and management (Six Sigma quality improvement processes, root-cause analysis, process maps, and brain storming); (2) participate in international collaborative networks (St. Jude Global Alliance and PRINCIPAL networks, the BFM-Forum-SCT, Sick-Kids Hospital, Canada); (3) participate in national and international training programs; and (4) improve healthcare delivery and organization processes, including infection care and prevention (develop and standardize all HSCT care delivery procedures). Results and Outcomes Healthcare facilities and services auditing and accreditation: An infection prevention and control program was started. This program managed: air and ventilation system improvement (air-conditioning, HEPA filters, positive pressure) and the creation of 47 standardized operating procedures. The HSCT wards were audited 3 times, and received accreditation (2018) by a national accreditation agency in Argentina. Human resources: 7 new doctors and 4 nurses were hired, the nurse:patient ratio was 1:2. 4 doctors attended a course for SPSS software®management; 6 doctors attended different American Society of Hematology H-Clinical Research Institute meetings. Personnel felt a reduction in the level of burn-out after the implementation of a plan designed by all stakeholders. Family information: 28 families received training for management of immunosuppressed patients. Scientific production: 4 clinical trials were accepted in indexed journals, 23 abstracts were presented in scientific meetings, and 27 educational national and international meetings were attended by personnel. Data management: Creation of a patient database (n = 310 patients), and registration of infection episodes for monthly assessment and monitoring patterns of infections (n = 776 events). Outcomes: During 2015–2019, 73 children were transplanted: autologous 11 (15%), match sibling donor (MSD) 35 (48%) and match unrelated donors (MUD) 27 (37%) Median age was 6 years of age (IQR 2–9), 53% were male, and 60% were acute leukemias. At a mean median time of 12 months (IQR 5–18), the overall survival by Kaplan–Meier for MSD and MUD was similar (62.3 ± 10.7% and 54.2 ± 15.0%, log-rank P = 0.54). The cumulative incidence of treatment-related mortality (log-rank P = 0.31), cumulative incidence of relapse (LR P = 0.99) were comparable as well. Infection rates were 40.5% and 69.6% in MSD vs. MUD (OR 3.36; 95% CI 1.14–9.98; P = 0.038). Conclusion The strategic plan implemented allowed us to offer optimal care to children in a public hospital without further financial cost and more satisfied HCPs. Results are comparable to published literature. Implementation of quality improvement interventions leads to the success of our program. Education and collaboration with national and international networks assisted improvement of the standard of care.
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Halford, K., A. Suliman, J. A. Ferrolino, R. H. Dallas, G. Maron-Alfaro i D. R. Hijano. "#94: BK Virus (BKV) Infections in Pediatric Allogeneic Hematopoietic Cell Transplant (Allo-HCT) Patients: A Single-center Experience". Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (1.03.2021): S5. http://dx.doi.org/10.1093/jpids/piaa170.014.
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Abstract Background BK virus infection in Allo-HCT pediatric patients is associated with the development of hemorrhagic cystitis (HC) leading to increased morbidity and prolonged hospitalization. We described the baseline characteristics, clinical presentation, and outcomes associated with recent BK virus infections at St. Jude Children’s Research Hospital. Methods We identified all pediatric Allo-HCT recipients with a positive blood or urine test for BKV at St. Jude between 2010 and 2018. A retrospective review of the electronic medical records (EMR) was conducted for demographics, signs, and symptoms associated with BKV infection, complications, and outcomes. Descriptive statistics were used to summarize the cohort. Results Of 475 patients who received an Allo-HCT during the study period, 209 (44%) had at least one positive test for BKV. Most were male (60%) and mean age was 12.4 years. BKV was most common in haploidentical transplants (n = 65), followed by match unrelated donor and matched sibling donor. Sixty-seven (32%) had only viruria, 5 (2%) had only viremia, and 137 (66%) had both. Of those with a positive result for BKV, 169 (80%) presented with hematuria or were diagnosed with HC. Urologic interventions were required by 22% of the patients; 40 required continuous bladder irrigation and 9 underwent cystoscopy. Despite having BKV detected in urine and/or blood, 17% had no symptoms. Conclusions A large proportion of Allo-HCT patients developed BKV associated HC. Morbidity associated with HC is important, with 1 in 5 patients requiring urology intervention.