First name
Lisa
Last name
Saiman

Title

Healthcare-associated Respiratory Syncytial Virus in Children's Hospitals.

Year of Publication

2023

Date Published

05/2023

ISSN Number

2048-7207

Abstract

BACKGROUND: Outbreaks of healthcare-associated respiratory syncytial virus (HA-RSV) infections in children are well described, but less is known about sporadic HA-RSV infections. We assessed the epidemiology and clinical outcomes associated with sporadic HA-RSV infections.

METHODS: We retrospectively identified hospitalized children <18 years old with HA-RSV infections in six children's hospitals in the United States during the respiratory viral seasons October-April in 2016-2017, 2017-2018, and 2018-2019 and prospectively from October 2020 through November 2021. We evaluated outcomes temporally associated with HA-RSV infections including escalation of respiratory support, transfer to the pediatric intensive care unit (PICU), and in-hospital mortality. We assessed demographic characteristics and comorbid conditions associated with escalation of respiratory support.

RESULTS: We identified 122 children (median age 16.0 months [IQR 6, 60 months]) with HA-RSV. The median onset of HA-RSV infections was hospital day 14 (IQR 7, 34 days). Overall, 78 (63.9%) children had two or more comorbid conditions; cardiovascular, gastrointestinal, neurologic/neuromuscular, respiratory, and premature/ neonatal comorbidities were most common. Fifty-five (45.1%) children required escalation of respiratory support and 18 (14.8%) were transferred to the PICU. Five (4.1%) died during hospitalization. In the multivariable analysis, respiratory comorbidities (aOR: 3.36 [CI95 1.41, 8.01]) were associated with increased odds of escalation of respiratory support.

CONCLUSIONS: HA-RSV infections cause preventable morbidity and increase healthcare resource utilization. Further study of effective mitigation strategies for HA-respiratory viral infections should be prioritized; this priority is further supported by the impact of the COVID-19 pandemic on seasonal viral infections.

DOI

10.1093/jpids/piad030

Alternate Title

J Pediatric Infect Dis Soc

PMID

37144945
Featured Publication
No

Title

Pediatric research priorities in healthcare-associated infections and antimicrobial stewardship.

Year of Publication

2020

Number of Pages

1-4

Date Published

2020 Nov 26

ISSN Number

1559-6834

Abstract

<p><strong>OBJECTIVE: </strong>To develop a pediatric research agenda focused on pediatric healthcare-associated infections and antimicrobial stewardship topics that will yield the highest impact on child health.</p>

<p><strong>PARTICIPANTS: </strong>The study included 26 geographically diverse adult and pediatric infectious diseases clinicians with expertise in healthcare-associated infection prevention and/or antimicrobial stewardship (topic identification and ranking of priorities), as well as members of the Division of Healthcare Quality and Promotion at the Centers for Disease Control and Prevention (topic identification).</p>

<p><strong>METHODS: </strong>Using a modified Delphi approach, expert recommendations were generated through an iterative process for identifying pediatric research priorities in healthcare associated infection prevention and antimicrobial stewardship. The multistep, 7-month process included a literature review, interactive teleconferences, web-based surveys, and 2 in-person meetings.</p>

<p><strong>RESULTS: </strong>A final list of 12 high-priority research topics were generated in the 2 domains. High-priority healthcare-associated infection topics included judicious testing for Clostridioides difficile infection, chlorhexidine (CHG) bathing, measuring and preventing hospital-onset bloodstream infection rates, surgical site infection prevention, surveillance and prevention of multidrug resistant gram-negative rod infections. Antimicrobial stewardship topics included β-lactam allergy de-labeling, judicious use of perioperative antibiotics, intravenous to oral conversion of antimicrobial therapy, developing a patient-level "harm index" for antibiotic exposure, and benchmarking and or peer comparison of antibiotic use for common inpatient conditions.</p>

<p><strong>CONCLUSIONS: </strong>We identified 6 healthcare-associated infection topics and 6 antimicrobial stewardship topics as potentially high-impact targets for pediatric research.</p>

DOI

10.1017/ice.2020.1267

Alternate Title

Infect Control Hosp Epidemiol

PMID

33239122

Title

Expanding Existing Antimicrobial Stewardship Programs in Pediatrics: What Comes Next.

Year of Publication

2017

Date Published

2017 Dec 18

ISSN Number

2048-7207

Abstract

<p>The prevalence of pediatric antimicrobial stewardship programs (ASPs) is increasing in acute care facilities across the United States. Over the past several years, the evidence base used to inform effective stewardship practices has expanded, and regulatory interest in stewardship programs has increased. Here, we review approaches for established, hospital-based pediatric ASPs to adapt and report standardized metrics, broaden their reach to specialized populations, expand to undertake novel stewardship initiatives, and implement rapid diagnostics to continue their evolution in improving antimicrobial use and patient outcomes.</p>

DOI

10.1093/jpids/pix104

Alternate Title

J Pediatric Infect Dis Soc

PMID

29267871

Title

Infant Colonization with Methicillin-Resistant Staphylococcus aureus or Vancomycin-Resistant Enterococci Preceding Neonatal Intensive Care Unit Discharge.

Year of Publication

2017

Date Published

2017 Mar 01

ISSN Number

2048-7207

Abstract

<p>Rates of colonization with methicillin-resistant Staphylococcus aureus (MRSA) and/or vancomycin-resistant enterococci (VRE) were determined for 1320 infants within 7 days of neonatal intensive care unit discharge. Overall, 4% and 1% of the infants were colonized with MRSA or VRE, respectively. Predictors identified in fixed-effects models were surgery during hospitalization (for MRSA colonization) and prolonged antimicrobial treatment (for VRE colonization).</p>

DOI

10.1093/jpids/pix003

Alternate Title

J Pediatric Infect Dis Soc

PMID

28339914

Title

Multicenter Study of Hand Carriage of Potential Pathogens by Neonatal ICU Healthcare Personnel.

Year of Publication

2015

Number of Pages

276-9

Date Published

2015 Sep

ISSN Number

2048-7207

Abstract

<p>A multicenter surveillance study was performed to determine the rates of hand carriage of potential pathogens among healthcare personnel in four neonatal intensive care units. Staphylococcus aureus, enterococci, and gram-negative bacilli were recovered from 8%, 3%, and 2% of 1000 hand culture samples, respectively.</p>

DOI

10.1093/jpids/piu022

Alternate Title

J Pediatric Infect Dis Soc

PMID

26336605

Title

Surgical site infections in a longitudinal cohort of neonatal intensive care unit patients.

Year of Publication

2016

Number of Pages

300-5

Date Published

2016 Apr

ISSN Number

1476-5543

Abstract

<p><strong>OBJECTIVE: </strong>To estimate the incidence and identify risk factors for surgical site infections (SSIs) among infants in the neonatal intensive care unit (NICU).</p>

<p><strong>STUDY DESIGN: </strong>A prospective cohort study of infants undergoing surgical procedures from May 2009 to April 2012 in three NICUs was performed. SSI was identified if documented by an attending neonatologist and treated with intravenous antibiotics. Independent risk factors were identified using logistic regression, adjusting for NICU.</p>

<p><strong>RESULT: </strong>A total of 902 infants underwent 1346 procedures and experienced 60 SSIs (incidence: 4.46/100 surgeries). Risk factors for SSIs included younger chronological age (odds ratio (OR) 1.03 per day decrease, 95% confidence interval (CI) 1.01, 1.04), lower gestational age (OR 1.09 per week decrease, CI 1.02, 1.18), male sex (OR 1.17, CI 1.04, 1.34) and use of central venous catheter (OR 4.40, CI 1.19, 9.62). Only 43% had surgical site cultures obtained and Staphylococcus aureus was most commonly isolated.</p>

<p><strong>CONCLUSION: </strong>SSIs complicated 4.46% of procedures performed in the NICU. Although few modifiable risk factors for SSIs were identified, future efforts should focus on evaluating the impact of current prevention strategies on the incidence of neonatal SSI.</p>

DOI

10.1038/jp.2015.191

Alternate Title

J Perinatol

PMID

26658124

Title

Colonization With Antimicrobial-Resistant Gram-Negative Bacilli at Neonatal Intensive Care Unit Discharge.

Year of Publication

2016

Date Published

2016 Mar 28

ISSN Number

2048-7207

Abstract

<p>In multivariable analysis, prolonged antimicrobial treatment was a predictor of infant colonization with antimicrobial-resistant Gram-negative bacilli within 7 days of discharge from a neonatal intensive care unit.</p>

<p><strong>BACKGROUND: </strong>The epidemiology of the colonization of infants with antimicrobial-resistant Gram-negative bacilli (GNB) at discharge from the neonatal intensive care unit (NICU) is not well understood.</p>

<p><strong>METHODS: </strong>A multicenter study in which rectal surveillance samples for culture were obtained at NICU discharge from infants hospitalized ≥14 days was performed. Factors associated with colonization with GNB resistant to gentamicin, third/fourth-generation cephalosporin agents, or carbapenem agents were assessed by using a fixed-effects model.</p>

<p><strong>RESULTS: </strong>Of these infants, 9% (119 of 1320) were colonized with ≥1 antimicrobial-resistant GNB. Prolonged treatment (≥10 days) with meropenem or third/fourth-generation cephalosporin agents or treatment for ≥5 days with a β-lactam/β-lactamase combination agent were associated with an increased risk of colonization with GNB resistant to gentamicin. Surgery and ≥5 days of treatment with third/fourth-generation cephalosporin agents, a β-lactam/β-lactamase combination agent, or metronidazole were associated with an increased risk of colonization with GNB resistant to third/fourth-generation cephalosporin agents. Female sex and prolonged treatment (≥10 days) with meropenem were associated with colonization with GNB resistant to carbapenem agents.</p>

<p><strong>CONCLUSIONS: </strong>Prolonged treatment with broad-spectrum antibiotics was associated with the colonization of infants with antimicrobial-resistant GNB within 7 days of NICU discharge. These findings suggest the potential for dissemination of resistant GNB from colonized infants to other NICUs, the community, or pediatric long-term care facilities. Antimicrobial stewardship efforts aimed at improving appropriate antibiotic use could have a beneficial effect on the emergence of antimicrobial-resistant GNB in the NICU population.</p>

DOI

10.1093/jpids/piw014

Alternate Title

J Pediatric Infect Dis Soc

PMID

27021036

Title

Costs of Antimicrobial Stewardship Programs at US Children's Hospitals.

Year of Publication

2016

Number of Pages

1-3

Date Published

2016 Mar 29

ISSN Number

1559-6834

Abstract

<p>The costs of antimicrobial stewardship programs (ASPs) in children's hospitals have not been described previously. We assessed ASP costs using an online survey administered to ASP leaders at U.S. children's hospitals. ASP costs varied from $17,000 to $388,500 annually (median, $187,400). Overall costs were not correlated with hospital size. Infect. Control Hosp. Epidemiol. 2016;1-3.</p>

DOI

10.1017/ice.2016.62

Alternate Title

Infect Control Hosp Epidemiol

PMID

27020133

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