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Miele K, Rock RB, LaCourse SM, Ashkin D, Armitige LY, Pomputius W, Goswami ND. Notes from the Field: Undiagnosed Tuberculosis During Pregnancy Resulting in a Neonatal Death - United States, 2021. MMWR Morb Mortal Wkly Rep 2023; 72:1331-1332. [PMID: 38060433 PMCID: PMC10715820 DOI: 10.15585/mmwr.mm7249a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
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Newland JG, Gerber JS, Kronman MP, Meredith G, Lee BR, Thurm C, Hersh AL, Berman DM, Handy L, Chan S, Tribble AC, Klein K, Maples H, Stahl D, Flett KB, Shapiro C, Fernandez AJ, Child J, Hurst AL, Parker SK, Pearce K, Mongkolrattanothai K, Metjian T, Grapentine S, Pomputius W, Goldman J, Yu D, Patel K, Yarbrough A, Cassady KA, Courter J, Haslam D, Thurman R, Mazade M, Varman M, Green A, Zwiener J, Simonsen K, Stec R, Bennett N, Girotto JE, Nolt D, Thomas J, Olivero R, Van Dyke C, Smith MJ, Lee K, Arnold SR, Schwenk H, Lee B, Patel SJ, Patel R, Calderon R, Dixon TC, Jaggi P, Tansmore J, Olson J, Thorell EM, Pong A, Nichols K, Cox E, Weissman S, Brothers A, Pak D, Bridger K, Poole N, Nelson M, Hymes S, Taylor R, Palazzi D, Wattier R, Faldasz J, Naeem F, Kuzmic B, Islam S. Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS): A Quality Improvement Collaborative. J Pediatric Infect Dis Soc 2018; 7:124-128. [PMID: 28379408 DOI: 10.1093/jpids/pix020] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/22/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND Although many children's hospitals have established antimicrobial stewardship programs (ASPs), data-driven benchmarks for optimizing antimicrobial use across centers are lacking. We developed a multicenter quality improvement collaborative focused on sharing data reports and benchmarking antimicrobial use to improve antimicrobial prescribing among hospitalized children. METHODS A national antimicrobial stewardship collaborative among children's hospitals, Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS), was established in 2013. Characteristics of the hospitals and their ASPs were obtained through a standardized survey. Antimicrobial-use data reports were developed on the basis of input from the participating hospitals. Collaborative learning opportunities were provided through monthly webinars and annual meetings. RESULTS Since 2013, 36 US hospitals have participated in the SHARPS collaborative. The median full-time equivalent (pharmacist and physician) dedicated to 30 of these ASPs was 0.75 (interquartile range, 0.45-1.4). To date, the collaborative has developed 26 data reports that include benchmarking reports according to specific antimicrobial agents, indications, and clinical service lines. The collaborative has conducted 27 webinars and 3 in-person meetings to highlight the stewardship work being conducted in the hospitals. The data reports and learning opportunities have resulted in approximately 36 distinct stewardship interventions. CONCLUSION A pediatric antimicrobial stewardship collaborative has been successful in promoting the development of and innovation among pediatric ASPs. Additional research is needed to determine the impact of these efforts.
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Affiliation(s)
- Jason G Newland
- Division of Pediatric Infectious Diseases, Washington University in St. Louis School of Medicine, Missouri
| | - Jeffrey S Gerber
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Pennsylvania.,Department of Biostatistics and Epidemiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia
| | - Matthew P Kronman
- Division of Pediatric Infectious Diseases, University of Washington, Seattle.,Center for Clinical and Translational Research, Seattle Children's Hospital Research Institute, Washington
| | - Georgann Meredith
- Division of Pediatric Infectious Diseases, Children's Mercy Hospital and Clinics, Kansas City, Missouri
| | - Brian R Lee
- Division of Pediatric Infectious Diseases, Children's Mercy Hospital and Clinics, Kansas City, Missouri.,Health Services and Outcomes Research, Children's Mercy Hospital and Clinics, Kansas City, Missouri
| | - Cary Thurm
- Children's Hospital Association, Statistical Analysis Services, Washington, DC
| | - Adam L Hersh
- Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City
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Johnson JR, Davis G, Clabots C, Johnston BD, Porter S, DebRoy C, Pomputius W, Ender PT, Cooperstock M, Slater BS, Banerjee R, Miller S, Kisiela D, Sokurenko EV, Aziz M, Price LB. Household Clustering of Escherichia coli Sequence Type 131 Clinical and Fecal Isolates According to Whole Genome Sequence Analysis. Open Forum Infect Dis 2016; 3:ofw129. [PMID: 27703993 PMCID: PMC5047392 DOI: 10.1093/ofid/ofw129] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/14/2016] [Indexed: 01/08/2023] Open
Abstract
In a whole genome-based phylogeny, clinical and fecal isolates of Escherichia coli sequence type 131 (H30R1 and H30Rx subclones) from six households formed household-specific clusters, interspersed among reference ST131 genomes. This supported the fecal-urethral hypothesis and confirmed within-household strain sharing. Background. Within-household sharing of strains from the resistance-associated H30R1 and H30Rx subclones of Escherichia coli sequence type 131 (ST131) has been inferred based on conventional typing data, but it has been assessed minimally using whole genome sequence (WGS) analysis. Methods. Thirty-three clinical and fecal isolates of ST131-H30R1 and ST131-H30Rx, from 20 humans and pets in 6 households, underwent WGS analysis for comparison with 52 published ST131 genomes. Phylogenetic relationships were inferred using a bootstrapped maximum likelihood tree based on core genome sequence polymorphisms. Accessory traits were compared between phylogenetically similar isolates. Results. In the WGS-based phylogeny, isolates clustered strictly by household, in clades that were distributed widely across the phylogeny, interspersed between H30R1 and H30Rx comparison genomes. For only 1 household did the core genome phylogeny place epidemiologically unlinked isolates together with household isolates, but even there multiple differences in accessory genome content clearly differentiated these 2 groups. The core genome phylogeny supported within-household strain sharing, fecal-urethral urinary tract infection pathogenesis (with the entire household potentially providing the fecal reservoir), and instances of host-specific microevolution. In 1 instance, the household's index strain persisted for 6 years before causing a new infection in a different household member. Conclusions. Within-household sharing of E coli ST131 strains was confirmed extensively at the genome level, as was long-term colonization and repeated infections due to an ST131-H30Rx strain. Future efforts toward surveillance and decolonization may need to address not just the affected patient but also other human and animal household members.
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Affiliation(s)
- James R Johnson
- Minneapolis Veterans Affairs Health Care System, Minnesota; University of Minnesota, Minneapolis
| | - Gregg Davis
- George Washington University , Washington, District of Columbia
| | - Connie Clabots
- Minneapolis Veterans Affairs Health Care System , Minnesota
| | - Brian D Johnston
- Minneapolis Veterans Affairs Health Care System, Minnesota; University of Minnesota, Minneapolis
| | - Stephen Porter
- Minneapolis Veterans Affairs Health Care System , Minnesota
| | | | | | - Peter T Ender
- St. Luke's University Hospital and Health Network , Bethlehem, Pennsylvania
| | | | | | | | | | | | | | - Maliha Aziz
- George Washington University , Washington, District of Columbia
| | - Lance B Price
- George Washington University , Washington, District of Columbia
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