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Sekar VD, Joshi K, Bhide S, Rao S, Phirke C, Patil S, Kothari R, Patel M, Shankar A. Adverse Drug Reactions and Prescription Patterns of Antiretroviral Drugs: A Longitudinal Observational Study From a Tertiary Care Hospital in Western India. Cureus 2024; 16:e56424. [PMID: 38638708 PMCID: PMC11024481 DOI: 10.7759/cureus.56424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Background In 2018, the World Health Organisation (WHO) released interim guidelines, advising a change of regimens to dolutegravir-based first- and second-line antiretroviral therapy (ART), based on which, in 2021, the National Aids Control Organisation (NACO) updated its guidelines to include the tenofovir + lamivudine + dolutegravir (TLD) regimen as a first line of therapy for all people living with HIV (PLHIV) and second- and third-line regimens to dolutegravir-based regimens. Considering this change of regimen, the adverse drug reaction (ADR) profiling and longitudinal prescription pattern of antiretroviral and concomitant medications in adult patients at the ART centre of a tertiary care hospital were assessed in this study. Methods Ninety-seven PLHIV out of all the patients who attended the ART centre from September 2021 to July 2022 were enrolled and followed up for six months. The ADRs that occurred during this period were collected along with details of prescription patterns and analyzed by descriptive statistics. Causality assessment for ADR was done using the World Health Organisation-Uppsala Monitoring Centre (WHO-UMC) scale. Results Seventy-eight percent (n=76 out of 97) of patients experienced at least one ADR, and 128 ADRs were seen in 97 patients. The most common ADRs were increased alkaline phosphatase (39.0%, n=128), dyslipidaemia (12.5%, n=128), and nephrotoxicity (10.1%, n=128). The drug most suspected of causing ADRs was dolutegravir (27.5%, n=342). The most common therapeutic regimen was TLD (71.2%, n=97). The most prescribed drug was lamivudine (30.6%, n=1183). The most prescribed concomitant medication was cotrimoxazole (15%, n=312). Conclusions Dolutegravir-based regimens have been implemented for PLHIV in a phased-out manner from previous non-dolutegravir-based ART regimens, which is in line with the recent NACO guidelines. However, it has also led to an increase in dolutegravir-associated ADRs like increased alkaline phosphatase, dyslipidaemia, and nephrotoxicity. Continuous monitoring of prescriptions and ADRs can add to our knowledge regarding their use and ADRs.
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Affiliation(s)
- Vijaya Dhaarani Sekar
- Department of Pharmacology and Therapeutics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Kavita Joshi
- Department of Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Shruti Bhide
- Department of Pharmacology and Therapeutics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Shirish Rao
- Department of Research, Association for Socially Applicable Research, Pune, IND
- Department of Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Chetan Phirke
- Department of Pharmacology, Hinduhridaysamrat Balasaheb Thackeray Medical College and Dr. R. N. Cooper Municipal General Hospital, Mumbai, IND
| | - Saurabh Patil
- Department of Pharmacology and Therapeutics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Rahul Kothari
- Department of Pharmacology and Therapeutics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Mudra Patel
- Department of Pharmacology and Therapeutics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
| | - Arun Shankar
- Department of Pharmacology and Therapeutics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, IND
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Huang N, Murphy L, Kandasamy S, Wahi G, Pernica JM. Caregiver knowledge and attitudes relating to paediatric pneumonia and antimicrobial stewardship: a qualitative study. Arch Dis Child 2024; 109:222-226. [PMID: 38041668 DOI: 10.1136/archdischild-2023-326080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/17/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE The objective of this study was to understand caregiver perspectives and experiences relating to the treatment of paediatric community-acquired pneumonia (CAP). DESIGN, SETTING AND PATIENTS This was a phenomenological qualitative study involving interviews with caregivers of young children in Hamilton, Ontario. Caregivers were asked open-ended questions relating to germ theory, pneumonia and the role of antibiotic treatment. The principles of conventional content analysis guided the coding and synthesis of the transcribed interviews. RESULTS Eleven caregivers were interviewed. Many knew that antibiotics were not effective against all types of infections and stated that there was an increased risk of developing resistance with frequent use. However, there were misconceptions that probiotics effectively mitigated antibiotic side effects, and few were familiar with the potential long-term consequences of antibiotic use in children.There was variability in the perceived severity of paediatric CAP. Some participants thought that antibiotic treatment would accelerate recovery and prevent caregivers from feeling helpless. However, others also thought it was inappropriate for physicians to prescribe antibiotics solely to make the caregiver feel better. Many caregivers also felt strongly that clinical follow-up and discussions on treatment risks/benefits would be desirable to counteract feelings of helplessness that result from being sent home without a prescription. CONCLUSION Recognising that parents may have misperceptions about antibiotic use for CAP (and may seek antibiotics without strong rationale) can inform clinicians' efforts to better educate and support caregivers in the emergency department. Care strategies informed by caregiver experiences can improve parent-provider communication and reduce antibiotic misuse.
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Affiliation(s)
- Nelson Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lara Murphy
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sujane Kandasamy
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Child and Youth Studies, Brock University, St Catherines, Ontario, Canada
| | - Gita Wahi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Jeffrey M Pernica
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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Vaezipour N, Evers K, Schmid H, Ritz N, Goischke A. Is shorter antibiotic treatment duration increasing the risk of relapse in paediatric acute focal bacterial nephritis? Arch Dis Child 2024; 109:248-250. [PMID: 37949642 DOI: 10.1136/archdischild-2023-326054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Nina Vaezipour
- Department of Paediatric Infectious Diseases and Vaccinology, University Childrens Hospital Basel, Basel, Switzerland
- Mycobacterial and Migrant Health Research Group, University of Basel and Department of Clinical Research, Basel, Switzerland
| | - Katrina Evers
- Department of Paediatric Nephrology, University Childrens Hospital Basel, Basel, Switzerland
| | - Hanna Schmid
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, UK
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University of Basel and Department of Clinical Research, Basel, Switzerland
- Department of Paediatrics and Paediatric Infectious Diseases, Childrens Hospital Lucerne and Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Paediatrics, The Royal Childrens Hospital Melbourne, University of Melbourne, Parkville, Victoria, Australia
| | - Alexandra Goischke
- Department of Paediatric Nephrology, University Childrens Hospital Basel, Basel, Switzerland
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Pillay T, Toldi G, Hussain A, Magwenzi MM, Satodia P, Radcliffe R. Neonatal BCG: a time for change. Arch Dis Child Educ Pract Ed 2024; 109:19-24. [PMID: 36008111 PMCID: PMC10850640 DOI: 10.1136/archdischild-2021-323239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 07/27/2022] [Indexed: 11/03/2022]
Abstract
The BCG vaccination programme in the UK is risk based and has usually been given to eligible babies soon after birth. On advice from the Joint Committee on Vaccination and Immunisation, NHS England and Improvement recently revised the timing of this vaccination to 28 days after birth or soon thereafter. In this article, we highlight the change in timing of vaccination, the rationale and barriers to BCG uptake that this change may pose.
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Affiliation(s)
- Thillagavathie Pillay
- Neonatology, University Hospitals of Leicester NHS Trust, Leicester, UK
- Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, UK
| | - Gergely Toldi
- Starship Children's Health Neonatal Intensive Care Unit, The University of Auckland Liggins Institute, Auckland, New Zealand
| | - Abid Hussain
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mercy Murinye Magwenzi
- Birmingham Community Healthcare Trust, Birmingham Heartlands Hospital, Birmingham, West Midlands, UK
| | - Prakash Satodia
- Neonatal Intensive Care Unit, University of Warwick Warwick Medical School, Coventry, UK
- Warwick Medical School, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Ruth Radcliffe
- Department of Paediatrics, University Hospitals of Leicester NHS Trust, Leicester, UK
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Garcia A, Grundmann O. The Utilization and Development of Viral Vectors in Vaccines as a Prophylactic Treatment Against Ebola Virus as an Emerging and Zoonotic Infectious Disease. Mini Rev Med Chem 2024; 24:289-299. [PMID: 37489781 DOI: 10.2174/1389557523666230725115324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/26/2023] [Accepted: 03/15/2023] [Indexed: 07/26/2023]
Abstract
Alongside the prescription of commonly used antivirals, such as acyclovir, remdesivir, oseltamivir, and ciprofloxacin, the most efficient way to prevent or treat communicable diseases is by vaccination. Vaccines have been the most efficient way to prevent or treat highly transmissible infectious agents, such as Ebola, Anthrax, and Dengue Fever. Most epidemics of these highly transmissible infectious agents occur in places, such as South America, Central America, Tropical Asia, and Africa, where the availability of resources and access to adequate healthcare are limited. However, recent events in history have proven that even with access to resources and proper healthcare, those in firstworld countries are not invincible when it comes to infectious diseases and epidemics. The Ebola virus outbreak in West Africa highlighted the gaps in therapeutic advancement and readiness and led to the rapid development of novel vaccine approaches. Viral vectors, in the case of the Ebola vaccine the Vesicular Stomatitis Virus (VSV), can be safely used to activate or initiate the innate adaptive immune response to protect against viral infection. When developed properly and with extensive study, novel vaccine approaches allow physicians and health experts to control the rate at which viruses spread or prevent transmission. This review will discuss the advantages of viral vector vaccines, their chemistry and development, and the pathophysiology of the Ebola virus to develop advantageous and efficacious treatments.
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Affiliation(s)
- Anthony Garcia
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, 1345 Center Drive, Room P3-20, Gainesville, FL 32611, USA
| | - Oliver Grundmann
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, 1345 Center Drive, Room P3-20, Gainesville, FL 32611, USA
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Munoz NR, Ghorbani A, Agwuegbo CC, Vincent Coralde JM. Dental Infection Causing Methicillin-Resistant Staphylococcus aureus Bacteremia and Spinal Infection: A Case Report. Cureus 2023; 15:e51136. [PMID: 38283534 PMCID: PMC10811413 DOI: 10.7759/cureus.51136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
Poor dentition as a source of infection causing bacteremia and spinal infections (such as paraspinal abscess, and discitis) should be considered even in the absence of recent dental surgery. The case presents a patient found to have an infection in the cervical and thoracic spine, methicillin-resistant Staphylococcus aureus bacteremia, and poor dentition. Although the patient had a history of drug use, he denied a history of intravenous drug use. He had Crohn's disease that resulted in periodontal and endodontal tooth disease. The patient was found to have poor dentition with erythematous gums. He had not been to the dentist in over 24 years and had active dental caries. Since he presented with bacteremia and a spinal infection, it is likely the patient had an infection in the oral cavity that spread hematogenously to the blood, and then the spine. This report highlights the importance of considering tooth infections as the source of bacteremia and spinal infections.
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Affiliation(s)
| | - Ali Ghorbani
- Internal Medicine, Southwest Healthcare, Temecula, USA
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Fifolt M, McCormick LC, Crosby JC, Gaghen MG, Nafziger S. Priority Distribution of COVID-19 Vaccine to Health Care Workers in Phase 1a of Emergency Use Authorization. Disaster Med Public Health Prep 2023; 17:e529. [PMID: 37974490 DOI: 10.1017/dmp.2023.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Matthew Fifolt
- University of Alabama at Birmingham, Health Policy and Organization, Birmingham, United States, US, Alabama
| | - Lisa C McCormick
- University of Alabama at Birmingham, Department of Health Policy and Organization, Birmingham, United States, US, Alabama
| | - James Cameron Crosby
- UAB Medicine, Department of Emergency Medicine, Birmingham, United States, US, Alabama
| | - Morgan G Gaghen
- UAB Highlands, University of Alabama at Birmingham, Birmingham, United States, US, Alabama
| | - Sarah Nafziger
- University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, United States, US, Alabama
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8
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Dungu KHS, Lund S, Malchau Carlsen EL, Hartling UB, Matthesen AT, Franck KT, Thomsen MK, Justesen US, Nielsen HL, Nielsen ACY, Henriksen TB, Nygaard U. Herpes simplex virus infection among neonates suspected of invasive bacterial infection: a population-based cohort study. Arch Dis Child Fetal Neonatal Ed 2023; 108:655-660. [PMID: 37225392 DOI: 10.1136/archdischild-2023-325583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To estimate the incidence of neonatal herpes simplex virus (HSV) infection and the number of neonates with suspected invasive bacterial infection (IBI) needed to treat (NNT) with acyclovir to ensure prompt treatment of invasive HSV infections. DESIGN A nationwide population-based cohort study. SETTING All neonatal and paediatric emergency departments in Denmark from 1 January 2010 to 31 December 2019. PATIENTS Neonates aged 0-28 days with HSV infection. MAIN OUTCOME MEASURES The main outcome measures were incidence and NNT. The NNT was calculated based on neonates with invasive HSV infection whose onset symptoms resembled IBI and the estimated number of Danish neonates who received antibiotics for suspected IBI. RESULTS Fifty-four neonates with HSV infection were identified, that is, an incidence of 9 per 100 000 live births. Twenty presented with symptoms resembling IBI, all within the first 14 days of life. Of 18 (78%) neonates, 14 had elevated C reactive protein, 14 of 19 (74%) had elevated alanine aminotransferase and 11 of 17 (65%) had thrombocytopaenia. The estimated NNTs with empiric acyclovir at postnatal ages 0-3, 4-7 and 8-14 days were 1139 (95% CI 523 to 3103), 168 (95% CI 101 to 726) and 117 (95% CI 48 to 198), respectively. CONCLUSIONS The incidence of neonatal HSV infection was higher than in previous decades; however, the estimated NNT with empiric acyclovir was high. Therefore, we propose not to treat all neonates suspected of IBI with empiric acyclovir, as current European guidelines suggest. However, HSV should be considered in neonates with signs of infection, especially after the third postnatal day and in neonates with high alanine aminotransferases and thrombocytopaenia.
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Affiliation(s)
- Kia Hee Schultz Dungu
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stine Lund
- Department of Neonatology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ulla Birgitte Hartling
- Department of Paediatrics and Adolescent Medicine, Odense University Hospital, Odense, Denmark
| | - Astrid Thaarup Matthesen
- Department of Paediatrics and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Kristina Træholt Franck
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | | | - Ulrik Stenz Justesen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Hans Linde Nielsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Tine Brink Henriksen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulrikka Nygaard
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
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Jeyaraj R, Alexander E, Cutino-Moguel T, Li S, Kainth R. Postexposure prophylaxis for varicella/shingles: a review of the UKHSA guidelines. Arch Dis Child Educ Pract Ed 2023; 108:355-359. [PMID: 37236770 DOI: 10.1136/archdischild-2022-324738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/18/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Rebecca Jeyaraj
- Department of Paediatrics, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Eliza Alexander
- Virology Department, Division of Infection, Barts Health NHS Trust, London, UK
| | | | - Susan Li
- Department of Paediatrics, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Ranjev Kainth
- Department of Paediatrics, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
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Yalcin N, Demirkan K. Management of drug-related problems including drug-drug interactions caused by nirmatrelvir/ritonavir in paediatric patients with SARS-CoV-2. Arch Dis Child 2023; 108:e16. [PMID: 36180113 DOI: 10.1136/archdischild-2022-324168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 09/22/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Nadir Yalcin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
- Department of Clinical Pharmacy, Erasmus MC, Rotterdam, The Netherlands
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey
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11
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Healy J, Longbottom K, Kent A, Whittaker E, Parks T. On the lookout for post-streptococcal complications in the UK. Arch Dis Child 2023:archdischild-2023-326198. [PMID: 37775145 DOI: 10.1136/archdischild-2023-326198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Justin Healy
- Department of Infectious Disease, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Katherine Longbottom
- Department of Microbiology, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Alison Kent
- Department of Paediatrics, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Elizabeth Whittaker
- Department of Paediatrics, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Tom Parks
- Department of Infectious Disease, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
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Affiliation(s)
- Tracy Beth Høeg
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Shamez Ladhani
- Public Health England, London, UK
- St George's University of London, London, UK
| | - Vinay Prasad
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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Hallmaier-Wacker LK, Andrews A, Hope R, Demirjian A, Lamagni TL, Collin SM. Incidence of infant Gram-negative invasive bacterial infections in England, 2011-2019: an observational study using population-wide surveillance data. Arch Dis Child 2023; 108:762-767. [PMID: 37280043 DOI: 10.1136/archdischild-2023-325569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Invasive bacterial infections account for an estimated 15% of infant deaths worldwide. We aimed to estimate the incidence and trends in invasive bacterial infections in infants caused by Gram-negative pathogens in England during 2011-2019. METHODS Laboratory-confirmed invasive bacterial infections in infants (<1 year old) were identified in the UK Health Security Agency national laboratory surveillance data from April 2011 to March 2019. Polymicrobial infections were defined as two or more bacterial species from the same normally sterile sample site. Early-onset infections were defined as <7 days from birth and late-onset as ≥7 days (neonates 7-28 days; infants ≥29 days). Trend analyses were carried out using Poisson (for episodes/incidence) and beta (for proportions) regression. RESULTS The annual incidence of invasive bacterial infections increased by 35.9%, from 189.8 to 258.0 cases per 100 000 live births (p<0.001). Late-onset infections in both neonates and infants increased substantially over the study period (p<0.001), whereas early-onset infections increased slightly (p=0.002). Escherichia coli was the most common Gram-negative pathogen isolated and accounted for 27.2% of the overall rise in Gram-negative infant disease incidence. Polymicrobial infections almost doubled, increasing from 29.2 to 57.7 per 100 000 live births (p<0.001), and mostly involved two species (81.3%, 1604/1974 episodes). CONCLUSIONS The incidence of Gram-negative invasive bacterial infections in infants increased between 2011/2012 and 2018/2019 in England, driven mainly by an increase in late-onset infections. Further work is required to elucidate the risk factors and drivers of this increased incidence so that opportunities for prevention can be identified.
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Affiliation(s)
- Luisa K Hallmaier-Wacker
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, UK Health Security Agency, London, UK
| | - Amelia Andrews
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, UK Health Security Agency, London, UK
| | - Russell Hope
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, UK Health Security Agency, London, UK
| | - Alicia Demirjian
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, UK Health Security Agency, London, UK
- Department of Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Theresa L Lamagni
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, UK Health Security Agency, London, UK
| | - Simon M Collin
- Healthcare-Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, UK Health Security Agency, London, UK
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Tsan K, Mulcahy B, Malhotra A. Long bone radiographic abnormalities of congenital syphilis in a preterm infant. Arch Dis Child Fetal Neonatal Ed 2023; 108:451. [PMID: 35078780 DOI: 10.1136/archdischild-2021-323134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/13/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Kirsten Tsan
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | | | - Atul Malhotra
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Monash Children's Hospital, Melbourne, Victoria, Australia
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15
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Khoury F, Campos JE. A Difficult-To-Diagnose Case of American Tegumentary Leishmaniasis. Cureus 2023; 15:e44971. [PMID: 37701165 PMCID: PMC10493468 DOI: 10.7759/cureus.44971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 09/14/2023] Open
Abstract
This case report presents a difficult-to-diagnose case of American tegumentary leishmaniasis (ATL) caused by Leishmania (Viannia) guyanensis in a 24-year-old Hispanic male with a travel history to the Panama jungle, an endemic region for tropical infectious diseases. The patient initially presented with persistent skin lesions that progressed to abscesses with ulceration. Despite negative initial diagnostic tests, including microbiological investigations and histopathological examination, a comprehensive diagnostic workup and subsequent polymerase chain reaction (PCR) confirmed the presence of Leishmania parasites. This case underscores the need to consider tropical infectious diseases despite initial negative tests. Accurate species identification is vital for proper drug treatment, with miltefosine as an emerging option. Early, precise diagnosis and tailored management are essential for successful treatment. This report emphasizes the significance of conducting a comprehensive diagnostic workup, including PCR, in individuals with a history of travel to endemic regions, to accurately diagnose and effectively manage complex infectious diseases.
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Affiliation(s)
- Fady Khoury
- Medical School, American University of Antigua, St. John's, ATG
- Clinical Sciences, Florida International University, Miami, USA
- Public Health, Florida International University, Miami, USA
- Infectious Disease, Hialeah Hospital, Hialeah, USA
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Chaudhary S, Rijal A, Rajbhandari P, Acharya AB. The First Reported Case of Elizabethkingia anophelis From Nepal. Cureus 2023; 15:e45346. [PMID: 37849601 PMCID: PMC10577804 DOI: 10.7759/cureus.45346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 10/19/2023] Open
Abstract
Elizabethkingia anophelis, a gram-negative bacillus belonging to the Flavobacteriaceae family, is found in various environmental sources and has been associated with community and hospital outbreaks. Correct identification is crucial, guided by advanced genomic techniques, i.e., matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) system with an updated database. The case fatality rate, ranging from 24 to 60%, underscores the need for timely recognition and appropriate management. Additionally, Elizabethkingia presents a challenge due to its recent discovery, misidentification history, and drug resistance. Here, we present a case of fatal infection in a 30-year-old male, who presented with pneumonia. It gradually progressed and ultimately proved fatal underscoring the virulence of the pathogen involved. It was a diagnostic challenge as it likely is the first reported instance of Elizabethkingia anophelis infection from Nepal.
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Affiliation(s)
- Sharmila Chaudhary
- Critical Care Medicine, Patan Academy of Health Sciences, Kathmandu, NPL
| | - Ashes Rijal
- Anesthesiology and Critical Care, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, NPL
- Public Health Sciences, Nepal Health Frontiers, Kathmandu, NPL
| | | | - Achyut Bhakta Acharya
- Pulmonary, Critical Care & Sleep Medicine, B.P. Koirala Institute of Health Sciences, Dharan, NPL
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17
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Konrad E, Robinson JL, Hawkes MT. Cerebrospinal fluid shunt infections in children. Arch Dis Child 2023; 108:693-697. [PMID: 36450441 DOI: 10.1136/archdischild-2022-324559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/12/2022] [Indexed: 12/02/2022]
Abstract
Cerebrospinal fluid (CSF) shunts are commonly used for the long-term management of hydrocephalus in children. Shunt infection remains a common complication, occurring in about 5%-15% of CSF shunts. This narrative review summarises key evidence from recent literature on the epidemiology, pathogenesis, clinical presentation, diagnosis, management, outcomes and prevention of CSF shunt infections in children. The majority of shunt infections occur due to contamination at the time of surgery, with coagulase-negative staphylococci and Staphylococcus aureus being the most common infecting organisms. Clinical presentations of shunt infection can be varied and difficult to recognise. CSF cultures are the primary test used for diagnosis. Other CSF and blood parameters may aid in diagnosis but lack sensitivity and specificity. Core aspects of management of shunt infections include systemic antimicrobial therapy and surgical removal of the shunt. However, many specific treatment recommendations are limited by a lack of robust evidence from large studies or controlled trials. Shunt infections may result in long hospital stays, worsening hydrocephalus, neurological sequelae and other complications, as well as death. Therefore, reducing the incidence of infection and optimising management are high priorities. Antibiotic prophylaxis at the time of shunt placement, improved surgical protocols and antibiotic-impregnated shunts are key strategies to prevent shunt infections. Nevertheless, further work is needed to identify additional strategies to prevent complications and improve outcomes.
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Affiliation(s)
- Emily Konrad
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Joan L Robinson
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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18
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ENVER C, ERTÜRK ŞENGEL B, SANCAR M, KORTEN V, OKUYAN B. Medication Reconciliation Service in Hospitalized Patients with Infectious Diseases During Coronavirus Disease-2019 Pandemic: An Observational Study. Turk J Pharm Sci 2023; 20:210-217. [PMID: 37605897 PMCID: PMC10445224 DOI: 10.4274/tjps.galenos.2022.08455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
Objectives To determine the prevalence and type of medication discrepancies and factors associated with unintentional discrepancies and identify the rate of hospital readmission and emergency service visit within 30 days after discharge among hospitalized patients with infectious diseases and receiving clinical pharmacist-led medication reconciliation during the coronavirus disease-2019 (COVID-19) pandemic. Materials and Methods This observational study was conducted in the internal medicine and infectious diseases wards of a tertiary university hospital between July 2020 and February 2021 among hospitalized adult patients with infectious diseases. Medication reconciliation service (including patient counseling) was provided in person or by telephone. The number and type of medication discrepancies detected during the medication reconciliation services, the acceptance rate of pharmacists' recommendation, and factors associated with having at least one unintentional medication discrepancy at admission were evaluated. At follow-up, hospital readmission and emergency service visit within 30 days after discharge were assessed by telephone. Results Among 146 patients, 84 (57.5%) had at least one unintentional discrepancy at admission. Only three unintentional discrepancies were determined in three patients at hospital discharge. All the pharmacists' recommendations for medication discrepancies were accepted by the physicians. Having COVID-19 [odds ratio (OR): 2.25, 95% confidence interval (CI): 1.15-4.40; p<0.05], being at a high risk for medication error (OR: 2.01, 95% CI: 1.03-3.92; p<0.05), and higher number of medications used at home (OR: 1.41, 95% CI: 1.23-1.61; p<0.001) were associated with having at least one unintentional discrepancy at admission. The rates of 30 day hospital readmission and admission to the emergency medical service were 12.3% and 15.8%, respectively. Conclusion Medication reconciliation service provided by in-person or by telephone was useful for detecting and solving unintentional medication discrepancies during the COVID-19 pandemic.
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Affiliation(s)
- Cüneyd ENVER
- Marmara University, Faculty of Pharmacy, Department of Clinical Pharmacy, İstanbul, Türkiye
| | - Buket ERTÜRK ŞENGEL
- Marmara University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Türkiye
| | - Mesut SANCAR
- Marmara University, Faculty of Pharmacy, Department of Clinical Pharmacy, İstanbul, Türkiye
| | - Volkan KORTEN
- Marmara University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, İstanbul, Türkiye
| | - Betül OKUYAN
- Marmara University, Faculty of Pharmacy, Department of Clinical Pharmacy, İstanbul, Türkiye
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19
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Sulaiman ZI, Reddy MP, Samra H, Askar G. De Novo Cytomegalovirus Colitis in a Donor-Seronegative/Recipient-Seronegative Kidney Transplant Recipient. Cureus 2023; 15:e43509. [PMID: 37719577 PMCID: PMC10500616 DOI: 10.7759/cureus.43509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
Cytomegalovirus (CMV) is one of the most frequent microbes linked with kidney transplant recipients. CMV infection is typically classified as CMV virus isolation in any body fluid or specimen. We present a 43-year-old man who underwent a deceased donor kidney transplant with CMV donor-seronegative and recipient-seronegative (CMV D-/R-) status and completed three months of CMV prophylaxis with high-dose acyclovir given his low-risk status. He was admitted for complaints of profuse watery diarrhea and persistent fevers lasting one week in duration. His infectious workup led to a CMV quantitative nucleic acid amplification test (QNAT) polymerase chain reaction (PCR) of 239,977 IU/mL with a biopsy-proven diagnosis of invasive CMV colitis. He was treated inpatient with intravenous ganciclovir for two weeks and then de-escalated to oral valganciclovir until achieving viremia resolution with undetectable CMV QNAT PCR as an outpatient. This case illustrates the importance of the changing epidemiology and clinical presentation of CMV disease in solid organ transplant (SOT) recipients in an era of new immunosuppression regimens and improved CMV disease detection in the early post-transplant period.
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Affiliation(s)
- Zoheb I Sulaiman
- Infectious Diseases, Augusta University Medical College of Georgia, Augusta, USA
| | - Maithri P Reddy
- Internal Medicine, Dwight D. Eisenhower Army Medical Center, Augusta, USA
| | - Hasan Samra
- Pathology, Augusta University Medical College of Georgia, Augusta, USA
| | - Gina Askar
- Infectious Diseases, Augusta University Medical College of Georgia, Augusta, USA
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20
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Foo D, Sarna M, Pereira G, Moore HC, Regan AK. Association between maternal influenza vaccination and neurodevelopmental disorders in childhood: a longitudinal, population-based linked cohort study. Arch Dis Child 2023; 108:647-653. [PMID: 37001967 PMCID: PMC10423464 DOI: 10.1136/archdischild-2022-324269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 03/02/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE To assess the association between in utero exposure to seasonal inactivated influenza vaccine (IIV) and the risk of a diagnosis of a neurodevelopmental disorder in early childhood. DESIGN Retrospective cohort study. SETTING Population-based birth registry linked with health administrative databases in Western Australia (WA). PARTICIPANTS Singleton, liveborn children born between 1 April 2012 and 1 July 2016 in WA. EXPOSURE Receipt of seasonal IIV during pregnancy obtained from a state-wide antenatal vaccination database. MAIN OUTCOME MEASURES Clinical diagnosis of a neurodevelopmental disorder was recorded from hospital inpatient and emergency department records. We used Cox proportional hazard regression, weighted by the inverse-probability of treatment (vaccination), to estimate the hazard ratio (HR) of neurodevelopmental disorders associated with in utero exposure to seasonal IIV. RESULTS The study included 140 514 children of whom, 15 663 (11.2%) were exposed to seasonal IIV in utero. The prevalence of neurodevelopmental disorders was 5.4%, including mental or behavioural (0.4%), neurological (5.1%), seizure (2.2%) and sleep disorders (2.7%). Maternal IIV was not associated with increased risk of neurodevelopmental disorders (HR 1.00; 95% CI 0.91 to 1.08). Children exposed in the first trimester had a lower risk of seizure disorders (adjusted HR [aHR] 0.73; 95% CI 0.54 to 0.998), and preterm children exposed any time during pregnancy had a lower risk of sleep disorders (aHR 0.63; 95% CI 0.41 to 0.98). CONCLUSIONS We did not observe increased risk of neurodevelopmental disorders following in utero exposure to seasonal IIV. Although we observed some evidence for lower risk of seizure and sleep disorders, additional studies are required to confirm.
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Affiliation(s)
- Damien Foo
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Mohinder Sarna
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- eNable Institute, Curtin University, Perth, Western Australia, Australia
| | - Hannah C Moore
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, California, USA
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
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21
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Lin KY, Streicher A, Wheeler J. When the Cure Becomes the Problem: A Case Report of Immune Reconstitution Inflammatory Syndrome Associated With Varicella Encephalitis. Cureus 2023; 15:e44223. [PMID: 37772202 PMCID: PMC10531033 DOI: 10.7759/cureus.44223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/30/2023] Open
Abstract
Immune reconstitution inflammatory syndrome (IRIS) describes a constellation of inflammatory symptoms that develop following the initiation of antiretroviral therapy (ART) in patients with advanced human immunodeficiency virus (HIV). Here, we present a case of a 39-year-old male-to-female transgender patient with advanced HIV who was started on ART during a hospitalization for acute encephalopathy due to a combination of methicillin-resistant Staphylococcus aureus (MRSA) meningitis and varicella encephalitis. After adequate treatment of these infections and five weeks after initiation of ART, she developed inflammatory symptoms of malaise, fever, and tachycardia, as well as laboratory findings of leukocytosis consistent with an inflammatory process. Infectious workup did not reveal any evidence of a new infection, and no other undiagnosed inflammatory processes were discovered to explain these symptoms. A diagnosis of IRIS was suspected, possibly induced by a prior varicella infection. Diagnosis of IRIS can be difficult due to heterogeneous symptoms, differing etiologies, variable patient presentations, and the lack of universal diagnostic criteria. As instances of IRIS are not uncommon in patients with a low CD4 count who start on ART, there should be a high index of suspicion when patients present with inflammatory symptoms after initiation of ART. With increased recognition of the disease and improved standardization of diagnostic criteria, more could be understood about the underlying disease process which may allow for better targeted therapies and individualized treatments for patients who develop the immune reconstitution inflammatory syndrome.
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Affiliation(s)
- Kuan-Yu Lin
- Medical School, Saint Louis University School of Medicine, St. Louis, USA
| | - Adam Streicher
- Internal Medicine, SSM Health Saint Louis University Hospital, St. Louis, USA
| | - Joseph Wheeler
- Internal Medicine, SSM Health Saint Louis University Hospital, St. Louis, USA
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22
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Lo Re V, Dutcher SK, Connolly JG, Perez-Vilar S, Carbonari DM, DeFor TA, Djibo DA, Harrington LB, Hou L, Hennessy S, Hubbard RA, Kempner ME, Kuntz JL, McMahill-Walraven CN, Mosley J, Pawloski PA, Petrone AB, Pishko AM, Rogers Driscoll M, Steiner CA, Zhou Y, Cocoros NM. Risk of admission to hospital with arterial or venous thromboembolism among patients diagnosed in the ambulatory setting with covid-19 compared with influenza: retrospective cohort study. BMJ Med 2023; 2:e000421. [PMID: 37303490 PMCID: PMC10254785 DOI: 10.1136/bmjmed-2022-000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/03/2023] [Indexed: 06/13/2023]
Abstract
Objective To measure the 90 day risk of arterial thromboembolism and venous thromboembolism among patients diagnosed with covid-19 in the ambulatory (ie, outpatient, emergency department, or institutional) setting during periods before and during covid-19 vaccine availability and compare results to patients with ambulatory diagnosed influenza. Design Retrospective cohort study. Setting Four integrated health systems and two national health insurers in the US Food and Drug Administration's Sentinel System. Participants Patients with ambulatory diagnosed covid-19 when vaccines were unavailable in the US (period 1, 1 April-30 November 2020; n=272 065) and when vaccines were available in the US (period 2, 1 December 2020-31 May 2021; n=342 103), and patients with ambulatory diagnosed influenza (1 October 2018-30 April 2019; n=118 618). Main outcome measures Arterial thromboembolism (hospital diagnosis of acute myocardial infarction or ischemic stroke) and venous thromboembolism (hospital diagnosis of acute deep venous thrombosis or pulmonary embolism) within 90 days after ambulatory covid-19 or influenza diagnosis. We developed propensity scores to account for differences between the cohorts and used weighted Cox regression to estimate adjusted hazard ratios of outcomes with 95% confidence intervals for covid-19 during periods 1 and 2 versus influenza. Results 90 day absolute risk of arterial thromboembolism with covid-19 was 1.01% (95% confidence interval 0.97% to 1.05%) during period 1, 1.06% (1.03% to 1.10%) during period 2, and with influenza was 0.45% (0.41% to 0.49%). The risk of arterial thromboembolism was higher for patients with covid-19 during period 1 (adjusted hazard ratio 1.53 (95% confidence interval 1.38 to 1.69)) and period 2 (1.69 (1.53 to 1.86)) than for patients with influenza. 90 day absolute risk of venous thromboembolism with covid-19 was 0.73% (0.70% to 0.77%) during period 1, 0.88% (0.84 to 0.91%) during period 2, and with influenza was 0.18% (0.16% to 0.21%). Risk of venous thromboembolism was higher with covid-19 during period 1 (adjusted hazard ratio 2.86 (2.46 to 3.32)) and period 2 (3.56 (3.08 to 4.12)) than with influenza. Conclusions Patients diagnosed with covid-19 in the ambulatory setting had a higher 90 day risk of admission to hospital with arterial thromboembolism and venous thromboembolism both before and after covid-19 vaccine availability compared with patients with influenza.
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Affiliation(s)
- Vincent Lo Re
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah K Dutcher
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - John G Connolly
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
- Department of Population Medicine, Harvard Pilgrim Health Care Inc, Wellesley, MA, USA
| | - Silvia Perez-Vilar
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Dena M Carbonari
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Djeneba Audrey Djibo
- CVS Health Clinical Trial Services, an affiliate of Aetna, CVS Health Company, Blue Bell, PA, USA
| | - Laura B Harrington
- Kaiser Permanente Washington Health Research Institute and Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Laura Hou
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
- Department of Population Medicine, Harvard Pilgrim Health Care Inc, Wellesley, MA, USA
| | - Sean Hennessy
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maria E Kempner
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
- Department of Population Medicine, Harvard Pilgrim Health Care Inc, Wellesley, MA, USA
| | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | | | - Jolene Mosley
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
- Department of Population Medicine, Harvard Pilgrim Health Care Inc, Wellesley, MA, USA
| | | | - Andrew B Petrone
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
- Department of Population Medicine, Harvard Pilgrim Health Care Inc, Wellesley, MA, USA
| | - Allyson M Pishko
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Meighan Rogers Driscoll
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
- Department of Population Medicine, Harvard Pilgrim Health Care Inc, Wellesley, MA, USA
| | - Claudia A Steiner
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
| | - Yunping Zhou
- Humana Healthcare Research, Inc, Louisville, KY, USA
| | - Noelle M Cocoros
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
- Department of Population Medicine, Harvard Pilgrim Health Care Inc, Wellesley, MA, USA
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Warren A, Amin A, Elsaygh J, Pink K. Granulicatella adiacens Endocarditis of a Bioprosthetic Aortic Valve. Cureus 2023; 15:e40720. [PMID: 37485169 PMCID: PMC10360141 DOI: 10.7759/cureus.40720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
Infective endocarditis (IE) is relatively uncommon; however, when it is diagnosed, it is usually among those with known cardiac valvular abnormalities. The most common pathogens that cause endocarditis are streptococci (mainly viridans), enterococci, and other streptococci species. An extremely rare pathogen that could cause IE is Granulicatella. This gram-positive coccus classically inhabits human mucosal surfaces and only rarely causes disease. We present an incredibly rare case of a 74-year-old female with a bioprosthetic aortic valve replacement, who presented with headache and weakness and was subsequently found to have recurrent Granulicatella adiacens infective endocarditis.
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Affiliation(s)
- Amanda Warren
- Internal Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Adina Amin
- Internal Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Jude Elsaygh
- Internal Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
| | - Kevin Pink
- Internal Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, USA
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24
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Fätkenheuer G, Sander LE, Slevogt H, Salzberger B. [The specialty of infectious diseases in German hospitals: position paper of the German Society for Infectiology (DGI)]. Ger Med Sci 2023; 21:Doc05. [PMID: 37426883 PMCID: PMC10326742 DOI: 10.3205/000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Indexed: 07/11/2023]
Abstract
Spezifische infektiologische Kompetenz verbessert die stationäre Versorgung von Patienten mit Infektionskrankrankheiten. Mit der neuen Facharztbezeichnung Innere Medizin und Infektiologie wird diese Expertise auch in Deutschland zugänglich. Die strukturelle Einbindung der Infektiologie und die Definition einer Leistungsgruppe in Kliniken der Level 2 und 3 werden dargestellt.
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Affiliation(s)
- Gerd Fätkenheuer
- Infektiologie, Medizinische Klinik I, Universitätsklinikum Köln, Deutschland
| | - Leif Erik Sander
- Klinik für Infektiologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Deutschland
| | - Hortense Slevogt
- Klinische Infektiologie, Klinik für Pneumologie, MH Hannover, Deutschland
| | - Bernd Salzberger
- Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Deutschland
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25
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Storch-De-Gracia P, Fernández JL, Velasco R, Saez I, Rodrigo R, Yañez S, Castellarnau E, Gil E, Del Rio P, Garrido E, Castaño A, Perez Á, Cabrerizo M, Hernández M, Pérez JJ, de la Torre MJ, Nadal G, Martínez J, Sánchez-Tatay V. Invasive bacterial infection in children with fever and petechial rash in the emergency department: a national prospective observational study. Arch Dis Child 2023; 108:445-450. [PMID: 37019466 DOI: 10.1136/archdischild-2022-325281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/28/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE To determine the incidence and clinical predictors of invasive bacterial infection (IBI) in well-appearing children who present to the emergency department (ED) with fever and petechiae. DESIGN A prospective, observational, multicentre study was conducted in 18 hospitals between November 2017 and October 2019. PATIENTS A total of 688 patients were recruited. MAIN OUTCOME MEASURES The primary outcome was the presence of IBI. Clinical features and laboratory test results were described and related to the presence of IBI. RESULTS Ten IBIs were found (1.5%), comprising eight cases of meningococcal disease and two of occult pneumococcal bacteraemia. Median age was 26.2 months (IQR 15.3-51.2). Blood samples were obtained from 575 patients (83.3%). Patients with an IBI had a shorter time from fever to ED visit (13.5 hours vs 24 hours) and between fever and rash onset (3.5 hours vs 24 hours). Values for absolute leucocyte count, total neutrophil count, C reactive protein and procalcitonin were significantly higher in patients with an IBI. Significantly fewer patients with a favourable clinical status while in the observation unit were found to have an IBI (2/408 patients, 0.5%) than when clinical status was unfavourable (3/18, 16.7%). CONCLUSIONS The incidence of IBI among children with fever and petechial rash is lower than previously reported (1.5%). The time from fever to ED visit and to rash onset was shorter in patients with an IBI. Patients with a favourable clinical course during observation in the ED are at lower risk of IBI.
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Affiliation(s)
| | - Jose Luis Fernández
- Pediatric Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Roberto Velasco
- Pediatric Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Itsaso Saez
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain
| | - Rocío Rodrigo
- Pediatric Emergency Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sandra Yañez
- Pediatric Emergency Department, Complejo Hospitalario Universitario A Coruña, Oleiros, Spain
| | - Ester Castellarnau
- Department of Pediatrics, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Elena Gil
- Department of Pediatrics, Hospital Comarcal de Laredo, Laredo, Spain
| | | | - Estíbaliz Garrido
- Pediatric Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Antón Castaño
- Pediatric Emergency Department, Hospital Universitario de Cabueñes, Gijon, Spain
| | - Álvaro Perez
- Department of Pediatrics, Hospital Del Tajo, Aranjuez, Spain
| | - María Cabrerizo
- Department of Pediatrics, Hospital Infanta Leonor, Madrid, Spain
| | - María Hernández
- Department of Pediatrics, Hospital Materno Infantil de Las Palmas, Las Palmas, Spain
| | | | | | - Gemma Nadal
- Department of Pediatrics, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Javier Martínez
- Department of Pediatrics, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Spain
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Palmer J, Ghuman K, Suhail K, Nagib ND. Atrial Flutter and Left Hemidiaphragmatic Paralysis in the Setting of Lyme Disease. Cureus 2023; 15:e37374. [PMID: 37182078 PMCID: PMC10171121 DOI: 10.7759/cureus.37374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Lyme disease, caused by a tick-borne spirochete, Borrelia burgdorferi, is the most common vector-borne disease in the United States. Clinical manifestations can include erythema migrans, carditis, facial nerve palsy, or arthritis. A rare complication of Lyme disease is hemidiaphragmatic paralysis. The first case of this complication was documented in 1986, and since then, there have been 16 case reports associating hemidiaphragmatic paralysis with Lyme disease. This is a case of a patient found to be in atrial flutter likely resulting from left hemidiaphragmatic paralysis as a complication of Lyme disease. The patient was a 49-year-old male recently diagnosed with Lyme disease who was treated with a 10-day course of doxycycline and who presented with dyspnea and chest pain. He appeared in acute distress with tachypnea and tachycardia to 169 beats/minute but was not hypoxic. Electrocardiogram (EKG) showed atrial flutter with a rapid ventricular response (RVR). The patient was sent to the emergency department and was treated with intravenous (IV) metoprolol, followed by an IV diltiazem drip, and ultimately converted to normal sinus rhythm. Chest X-ray demonstrated an elevated left hemidiaphragm. Due to concern for Lyme carditis causing tachyarrhythmia, the patient was started on IV ceftriaxone 2 g daily. A transthoracic echocardiogram showed no valvular abnormalities and a normal ejection fraction, thus indicating a low likelihood of carditis. The patient was transitioned to oral doxycycline for an additional 17 days. During the hospital course, a fluoroscopic chest sniff test confirmed the left hemidiaphragmatic paralysis. A chest X-ray completed after two months showed persistent elevation of the left hemidiaphragm and the patient continued to have mild dyspnea. The main lesson from this case is to consider hemidiaphragmatic paralysis as a possible complication of Lyme disease.
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Affiliation(s)
- Jeremy Palmer
- Family Medicine, Wellspan Health York Hospital, York, USA
| | - Kearn Ghuman
- Family Medicine, Wellspan Health York Hospital, York, USA
- Family Medicine, Fauquier Health, Warrenton, USA
| | - Kiran Suhail
- Family Medicine, Edward Via College of Osteopathic Medicine, Blacksburg, USA
| | - Nancy D Nagib
- Family Medicine, WellSpan Health York Hospital, York, USA
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Affiliation(s)
- Cathal Roarty
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | - Thomas Waterfield
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
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De Nardi L, Naviglio S, Battistuz E, Kiren V, Cattaruzzi E, Barbi E, Rabusin M. A child with multiple liver and spleen nodules during therapy for acute lymphoblastic leukaemia. Arch Dis Child Educ Pract Ed 2023; 108:154-156. [PMID: 35177488 DOI: 10.1136/archdischild-2021-322976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/05/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Laura De Nardi
- Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Samuele Naviglio
- Department of Oncohematology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Elena Battistuz
- Clinical Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Valentina Kiren
- Department of Oncohematology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Elisabetta Cattaruzzi
- Department of Radiology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Friuli-Venezia Giulia, Italy
| | - Egidio Barbi
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Marco Rabusin
- Department of Oncohematology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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Einhorn N, Lamphier I, Klinkova O, Baluch A, Pasikhova Y, Greene J. Intestinal Coccidian Infections in Cancer Patients: A Case Series. Cureus 2023; 15:e38256. [PMID: 37252590 PMCID: PMC10225162 DOI: 10.7759/cureus.38256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Coccidian protozoa and microsporidian fungi are opportunistic pathogens increasingly implicated in infections in immunosuppressed individuals. These parasites typically infect the intestinal epithelium, resulting in secretory diarrhea and malabsorption. The disease burden and timeline are both greater and longer among immunosuppressed patients. Therapeutic options for immunocompromised individuals are limited. As a result, we wanted to better characterize the disease course and treatment efficacy of these parasitic gastrointestinal infections. Methods We performed a single-center, retrospective MedMined (BD Healthsight Analytics, Birmingham, AL, USA) chart review of patients between January 2012 and June 2022 diagnosed with coccidian or microsporidian infections. Relevant data were collected from Cerner's PowerChart (Oracle Cerner, Austin, TX, USA). Descriptive analysis was performed with IBM SPSS Statistics (IBM Corp., Armonk, NY, USA), and Microsoft Excel (Microsoft, Redmond, WA, USA) was used to generate graphs and tables. Results In these 10 years, there were 17 patients with Cryptosporidium infections, four with Cyclospora infections, and no positive cultures for Cystoisospora belli or microsporidian infections. In both infections, the majority of patients experienced diarrhea, fatigue, and nausea, with vomiting, abdominal pain, appetite loss, weight loss, and fever occurring to a lesser degree. Nitazoxanide was the most common treatment for Cryptosporidium, while trimethoprim-sulfamethoxazole or ciprofloxacin were the treatments of choice for Cyclospora. Of the Cryptosporidium infections, three received combination therapy with azithromycin, immunoreconstitution, or IV immunoglobulins. Among the four Cyclospora-infected patients, one received combination therapy of ciprofloxacin and trimethoprim-sulfamethoxazole. Treatment lasted around two weeks, and 88% of Cryptosporidium patients and 75% of Cyclospora patients had a resolution of symptoms. Conclusion The most detected coccidian infection was Cryptosporidium, followed by Cyclospora, with the lack of Cystoisospora or microsporidian infections likely due to diagnostic limitations and prevalence. Cryptosporidium and Cyclospora likely caused their associated symptoms in most cases, with other possible etiologies, including graft-versus-host disease, medications, and feeding tubes. The small number of patients receiving combination therapy prohibited a comparison with monotherapy. In our patient population, though, there was a clinical response to treatment despite immunosuppression. While promising, additional randomized control experiments are required to fully understand the efficacy of parasitic treatments.
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Affiliation(s)
- Nathan Einhorn
- Infectious Diseases, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Isis Lamphier
- Infection Control, Moffitt Cancer Center, Tampa, USA
| | - Olga Klinkova
- Infectious Diseases, Moffitt Cancer Center, Tampa, USA
| | - Aliyah Baluch
- Infectious Diseases, Moffitt Cancer Center, Tampa, USA
| | | | - John Greene
- Internal Medicine, Moffitt Cancer Center, Tampa, USA
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Dykes JKB, Lawton A, Burchett S, Gupta A. Fifteen-minute consultation: A structured approach to children with parapneumonic effusion and empyema thoracis. Arch Dis Child Educ Pract Ed 2023; 108:86-90. [PMID: 34772669 DOI: 10.1136/archdischild-2021-322621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/29/2021] [Indexed: 11/04/2022]
Abstract
Parapneumonic effusion is defined as the accumulation of pleural fluid associated with lung infection/pneumonia. Parapneumonic effusions can be uncomplicated or complicated. They are caused by the spread of infection and inflammation to the pleural space, and can develop into empyema thoracis-frank pus in the pleural space. Chest radiograph and thoracic ultrasound are the key imaging modalities for the diagnosis of parapneumonic effusion. Management aims are reducing inflammation and bacteria in the pleural cavity, and enabling full lung expansion. Broad-spectrum intravenous antibiotics, with the addition of chest tube drainage and fibrinolytic therapy for larger collections, are the mainstays of management. This article provides a clear, evidence-based and structured approach to the assessment and management of parapneumonic effusion/empyema thoracis in children and young people.
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Affiliation(s)
- Joanna Kirstin B Dykes
- Paediatric Respiratory Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- South Bristol Academy, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Adam Lawton
- Department of Paediatrics, North Middlesex University Hospital NHS Trust, London, UK
| | - Saskia Burchett
- Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Atul Gupta
- Respiratory Pediatrics, King's College Hospital NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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Kim SY, Shin JS, Jang MS, Kim J. Clinical characteristics of patients with recurrent Kawasaki disease: a nationwide cohort study of 19 456 patients with minimum 3-year follow up. Arch Dis Child 2023; 108:307-312. [PMID: 36549869 DOI: 10.1136/archdischild-2022-324467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To identify the clinical characteristics of patients with recurrent Kawasaki disease (KD). DESIGN A nationwide, population-based, cohort study using the Korean National Health Insurance claims database between 2013 and 2016. PATIENTS A total of 19 456 patients under the age of 5 years who were diagnosed with initial episode of KD were included. A minimum follow-up period of 3 years was mandatory for inclusion. MAIN OUTCOME MEASURES The epidemiological and clinical profiles were compared between KD patients with and without recurrence. RESULTS The overall recurrence rate of KD was 3.84% (n=748), and the median interval to recurrence was 498 days (IQR: 257-860 days). Approximately 70% of all recurrences occurred within 2 years of the initial diagnosis. The annual proportions of recurrence were 40%, 28%, 18%, 8% and 4% from the first to the fifth year following the initial episode, respectively. Recurrence rates were significantly higher in patients aged <1 year than in those aged 4-5 years (4.65% vs 2.22%) and those who showed resistance to an initial dose of intravenous immunoglobulin (IVIG) (10.00% vs 3.18%). Allergic comorbidities and coronary artery complications at the initial episode were not associated with increased rates of recurrence. CONCLUSIONS We clearly identified the annual recurrence rates and their intervals from the initial episode according to the various factors identified, including young age and resistance to initial IVIG. Our results, based on a nationwide cohort, can be used as reference for follow-up management in patients with KD and in future studies.
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Affiliation(s)
- Sin Young Kim
- Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Ji Seong Shin
- Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Min Sik Jang
- Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Jihye Kim
- Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Seoul, Korea
- College of Medicine, Hallym University, Chuncheon, Korea
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Odeberg G, Bläckberg A, Sunnerhagen T. Infection or Contamination with Rothia, Kocuria, Arthrobacter and Pseudoglutamicibacter-a Retrospective Observational Study of Non- Micrococcus Micrococcaceae in the Clinic. J Clin Microbiol 2023; 61:e0148422. [PMID: 36946723 PMCID: PMC10117143 DOI: 10.1128/jcm.01484-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
Rothia, Kocuria, Arthrobacter, and Pseudoglutamicibacter are bacterial species within the family Micrococcaeae. Knowledge of human infections due to these bacteria is limited. This study aimed to examine features of infections caused by non-Micrococcus Micrococcaeae (NMM). Findings of NMM from blood cultures and other sterile cultures from 2012 to 2021 were identified from the records of the Department of Clinical Microbiology in Region Skåne, Lund, Sweden. Medical records were retrospectively reviewed. True infection was defined as having signs of infection, no other more likely pathogen, and no other focal infection, together with two positive blood cultures or one positive blood culture and an intravascular device. A total of 197 patients with findings of NMM in blood cultures were included. Among adult patients with bacteremia, 29 patients (22%) were considered to have a true infection. Adults with true infection were significantly more likely to have malignancy (69%), leukopenia (62%), and treatment with chemotherapeutics (66%) compared to patients with contaminated samples (24%, 3%, and 8%, respectively) (P < 0.001). A total of 31 patients had findings of NMM in other sterile cultures, and infections were considered true in joints (n = 4), a pacemaker (n = 1), and peritoneal dialysis fluid (n = 1). Infections due to NMM occur but are rare. Growth of NMM in blood cultures should be suspected to be a true infection mainly in immunocompromised patients.
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Affiliation(s)
- Görel Odeberg
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Anna Bläckberg
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Clinical Microbiology and Disease Control, Region Skåne Office for Medical Services, Lund, Sweden
- Department of Clinical Microbiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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Jarraya A, Kammoun M, Ammar S, Feki W, Kolsi K. Predictors of perioperative respiratory adverse events among children with upper respiratory tract infection undergoing pediatric ambulatory ilioinguinal surgery: a prospective observational research. World J Pediatr Surg 2023; 6:e000524. [PMID: 36969907 PMCID: PMC10032407 DOI: 10.1136/wjps-2022-000524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/27/2023] [Indexed: 03/24/2023] Open
Abstract
Objectives Anesthesia for children with an upper respiratory tract infection (URI) has an increased risk of perioperative respiratory adverse events (PRAEs) that may be predicted according to the COLDS score. The aims of this study were to evaluate the validity of the COLDS score in children undergoing ilioinguinal ambulatory surgery with mild to moderate URI and to investigate new predictors of PRAEs. Methods This was a prospective observational study including children aged 1–5 years with mild to moderate symptoms of URI who were proposed for ambulatory ilioinguinal surgery. The anesthesia protocol was standardized. Patients were divided into two groups according to the incidence of PRAEs. Multivariate logistic regression was performed to assess predictors for PRAEs. Results In this observational study, 216 children were included. The incidence of PRAEs was 21%. Predictors of PRAEs were respiratory comorbidities (adjusted OR (aOR)=6.3, 95% CI 1.19 to 33.2; p=0.003), patients postponed before 15 days (aOR=4.3, 95% CI 0.83 to 22.4; p=0.029), passive smoking (aOR=5.31, 95% CI 2.07 to 13.6; p=0.001), and COLDS score of >10 (aOR=3.7, 95% CI 0.2 to 53.4; p=0.036). Conclusions Even in ambulatory surgery, the COLDS score was effective in predicting the risks of PRAEs. Passive smoking and previous comorbidities were the main predictors of PRAEs in our population. It seems that children with severe URI should be postponed to receive surgery for more than 15 days.
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Affiliation(s)
- Anouar Jarraya
- The anesthesiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Manel Kammoun
- The anesthesiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Saloua Ammar
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
| | - Wiem Feki
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Kamel Kolsi
- The anesthesiology Department, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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Carrel M, Clore GS, Goto M, Kim S, Perencevich EN, Vaughan-Sarrazin M. Impacts of Hurricane Matthew Exposure on Infections and Antimicrobial Prescribing in North Carolina Veterans. Disaster Med Public Health Prep 2023; 17:e357. [PMID: 36938923 DOI: 10.1017/dmp.2023.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
The impact of hurricane-related flooding on infectious diseases in the US is not well understood. Using geocoded electronic health records for 62,762 veterans living in North Carolina counties impacted by Hurricane Matthew coupled with flood maps, we explore the impact of hurricane and flood exposure on infectious outcomes in outpatient settings and emergency departments as well as antimicrobial prescribing. Declines in outpatient visits and antimicrobial prescribing are observed in weeks 0-2 following the hurricane as compared with the baseline period and the year prior, while increases in antimicrobial prescribing are observed 3+ weeks following the hurricane. Taken together, hurricane and flood exposure appear to have had minor impacts on infectious outcomes in North Carolina veterans, not resulting in large increases in infections or antimicrobial prescribing.
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Affiliation(s)
- Margaret Carrel
- Department of Geographical and Sustainability Sciences, University of Iowa, Iowa, United States
| | - Gosia S Clore
- Department of Internal Medicine, University of Iowa, Iowa, United States
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, United States
| | - Michihiko Goto
- Department of Internal Medicine, University of Iowa, Iowa, United States
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, United States
| | - Seungwon Kim
- Department of Pathology, Johns Hopkins University, Baltimore, MD, United States
| | - Eli N Perencevich
- Department of Internal Medicine, University of Iowa, Iowa, United States
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, United States
| | - Mary Vaughan-Sarrazin
- Department of Internal Medicine, University of Iowa, Iowa, United States
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, United States
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McAlister P, Irvine S, Beckett R, O'Hagan E, Marshall D. Epilogue: Anaemia + abdominal mass = is it cancer? Arch Dis Child Educ Pract Ed 2023. [PMID: 36863858 DOI: 10.1136/archdischild-2022-325065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
| | | | | | - Emma O'Hagan
- Paediatric Nephrology, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - David Marshall
- Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, UK
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36
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Sikias P, Biran V, Foix-L'Hélias L, Plainvert C, Boileau P, Bonacorsi S. Early-onset neonatal sepsis in the Paris area: a population-based surveillance study from 2019 to 2021. Arch Dis Child Fetal Neonatal Ed 2023; 108:114-120. [PMID: 35902218 PMCID: PMC9985718 DOI: 10.1136/archdischild-2022-324080] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/07/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Early-onset neonatal sepsis (EOS) is a rare condition but an important cause of severe morbidity and mortality in neonates. METHODS This is a prospective observational study in neonates born at ≥34 weeks of gestation (WG). The primary endpoint was EOS, defined by isolation of pathogenic species from blood culture and/or cerebrospinal fluid culture within 72 hours after birth. Data on EOS were collected exhaustively from all maternity wards in Paris area (April 2019-March 2021). RESULTS 108 EOS were recorded (annual incidence, 0.32 per 1000 live births; 95% CI 0.26 to 0.38). In term infants, the most frequent pathogens were group B Streptococcus (GBS) (n=47) and Escherichia coli (n=20); in late preterm infants, the most frequent pathogens were E. coli (n=15) and GBS (n=7). Fifteen meningitis cases were diagnosed. Five E. coli strains (14%) were resistant to both amoxicillin and gentamicin, which is an empiric treatment for EOS. Of the 54 infants with GBS infections, 35 were born from mothers with negative GBS prepartum screening test and 8 from mothers with no screening. Two deaths were reported, both in term infants (Proteus mirabilis and E. coli). CONCLUSION In neonates ≥34 WG born in the Paris area, GBS was twice as frequent as E. coli in term infants. EOS was six times more frequent in late preterm than in term infants and was due to E. coli in 60% of cases. Prevention of GBS EOS and empiric antibiotic treatment of EOS could be improved.
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Affiliation(s)
- Paola Sikias
- Hôpital Privé d' Antony, Ramsay Santé, Antony, France
| | - Valérie Biran
- Neonatal Intensive Care Unit, Hôpital Universitaire Robert Debré, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.,FHU I2D2, UMR 1131, INSERM, Paris, France
| | - Laurence Foix-L'Hélias
- Department of Neonatology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Sorbonne University, Paris, France
| | - Céline Plainvert
- Service de Bactériologie ; Centre National de Référence des Streptocoques, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre Site Cochin, Paris, France.,Université de Paris, Paris, France
| | - Pascal Boileau
- Department of Neonatal Pediatrics, Poissy Saint-Germain Hospital, Versailles Saint-Quentin en Yvelines University, Poissy, France.,UFR des sciences de la santé Simone Veil, Versailles Saint-Quentin en Yvelines University, Montigny le Bretonneux, France
| | - Stéphane Bonacorsi
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, CNR Escherichia coli, Paris, France.,Université de Paris, IAME, INSERM, Université Paris Diderot, Paris, France
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Jackson TJ, Napper R, Haeusler GM, Pizer B, Bate J, Grundy RG, Samarasinghe S, Angelini P, Ball-Gamble A, Phillips B, Morgan JE. Can I go home now? The safety and efficacy of a new UK paediatric febrile neutropenia protocol for risk-stratified early discharge on oral antibiotics. Arch Dis Child 2023; 108:192-197. [PMID: 36600323 PMCID: PMC9985710 DOI: 10.1136/archdischild-2021-323254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/26/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate a new protocol of risk stratification and early discharge for children with febrile neutropenia (FN). DESIGN Prospective service evaluation from 17 April 2020 to 16 April 2021. SETTING 13 specialist centres in the UK. PATIENTS 405 children presenting with FN. INTERVENTION All children received intravenous antibiotics at presentation. Risk stratification was determined using the Australian-UK-Swiss (AUS) rule and eligibility for homecare assessed using criteria including disease, chemotherapy, presenting features and social factors. Those eligible for homecare could be discharged on oral antibiotics after a period of observation proportional to their risk group. MAIN OUTCOME MEASURES Median duration of admission and of intravenous antibiotics, and percentage of patients with positive blood cultures, significant infection, readmission within 7 days of initial presentation, intensive care unit (ICU) admission, death from infection and death from other causes. RESULTS 13 centres contributed 729 initial presentations of 405 patients. AUS rule scores were positively correlated with positive blood cultures, significant infection, ICU admission and death. 20% of children were eligible for homecare with oral antibiotics, of which 55% were low risk (AUS 0-1). 46% low-risk homecare eligible patients were discharged by 24 hours vs 2% homecare ineligible. Homecare readmission rates were 14% overall and 16% for low-risk cases (similar to a meta-analysis of previous studies). No child eligible for homecare was admitted to ICU or died. CONCLUSIONS Use of the AUS rule and homecare criteria allow for safe early outpatient management of children with FN.
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Affiliation(s)
- Thomas John Jackson
- Paediatric Oncology, University College London Hospital, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rachel Napper
- Regional Department of Paediatric Haematology and Oncology, Leeds Children's Hospital, Leeds, UK
| | - Gabrielle M Haeusler
- Infectious Diseases and Infection Control, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Barry Pizer
- Paediatric Oncology, Royal Liverpool Children's Hospital, Liverpool, UK
| | - Jessica Bate
- Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
| | - Richard G Grundy
- Children's Cancer Leukaemia Group Chair, University of Nottingham, Nottingham, UK
| | - Sujith Samarasinghe
- Paediatric Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Paola Angelini
- Children and Young People Unit, Royal Marsden Hospital Sutton, Sutton, UK
| | | | - Bob Phillips
- Leeds Children's Hospital, Leeds, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Jessica Elizabeth Morgan
- Leeds Children's Hospital, Leeds, UK
- Centre for Reviews and Dissemination, University of York, York, UK
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38
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Harwood R, Rad L, Kelly C, Shelton C, Shepherd E, Roderick M, Whittaker E, Dyke S, Patel SV, Gent N, Kenny SE. Lateral flow test performance in children for SARS-CoV-2 using anterior nasal and buccal swabbing: sensitivity, specificity, negative and positive predictive values. Arch Dis Child 2023; 108:137-140. [PMID: 36657801 PMCID: PMC9887373 DOI: 10.1136/archdischild-2022-324353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/16/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine if the sensitivity of the lateral flow test is dependent on the viral load and on the location of swabbing in the respiratory tract in children. DESIGN Phase 1: Routinely performed reverse transcriptase PCR (RT-PCR) using nose and throat (NT) swabs or endotracheal (ET) aspirates were compared with Innova lateral flow tests (LFTs) using anterior nasal (AN) swabs. Phase 2: RT-PCR-positive children underwent paired AN RT-PCR and LFT and/or paired AN RT-PCR and buccal LFT. SETTING Tertiary paediatric hospitals. PATIENTS Children under the age of 18 years. Phase 1: undergoing routine testing, phase 2: known SARS-CoV-2 positive. RESULTS Phase 1: 435 paired swabs taken in 431 asymptomatic patients resulted in 8 positive RT-PCRs, 9 PCR test failures and 418 negative RT-PCRs from NT or ET swabs. The test performance of AN LFT demonstrated sensitivity: 25% (4%-59%), specificity: 100% (99%-100%), positive predictive value (PPV): 100% (18%-100%) and negative predictive value (NPV): 99% (97%-99%).Phase 2: 14 AN RT-PCR-positive results demonstrated a sensitivity of 77% (50%-92%) of LFTs performed on AN swabs. 15/16 paired buccal LFT swabs were negative. CONCLUSION The NPV, PPV and specificity of LFTs are excellent. The sensitivity of LFTs compared with RT-PCR is good when the samples are colocated but may be reduced when the LFT swab is taken from the AN. Buccal swabs are not appropriate for LFT testing. Careful consideration of the swabbing reason, the tolerance of the child and the requirements for test processing (eg, rapidity of results) should be undertaken within hospital settings. TRIAL REGISTRATION NUMBER NCT04629157.
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Affiliation(s)
- Rachel Harwood
- Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK .,Cellular and Molecular Physiology, University of Liverpool, Liverpool, UK
| | - Laura Rad
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | | | - Cliff Shelton
- Wythenshawe Hospital, Manchester, Greater Manchester, UK
| | | | - Marion Roderick
- Paediatric Infectious Diseases and Immunology, Bristol Royal Hospital for Children, Bristol, UK
| | - Elizabeth Whittaker
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | | | - Sanjay Vallabh Patel
- Paediatric Infectious Diseases and Immunology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nick Gent
- Mathematical modelling, UKHSA, London, UK
| | - Simon E Kenny
- Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK,Medical Director for Children and Young People, NHS England and NHS Improvement North West, Manchester, UK
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Stewart EJ. Delayed antibiotic prescription did not delay recovery in children with respiratory tract infections. Arch Dis Child Educ Pract Ed 2023; 108:53. [PMID: 34413123 DOI: 10.1136/archdischild-2021-322607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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40
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Wenke R, Stehlik P, Gerrard J, Mickan S, Henry D. Using a journal club to navigate a maze of COVID-19 papers in a front-line hospital service. BMJ Evid Based Med 2023; 28:210-211. [PMID: 36657798 DOI: 10.1136/bmjebm-2022-112130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/26/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Rachel Wenke
- Allied Health & Rehabilitation Services, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Paulina Stehlik
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
- Evidence-Based Practice Professorial Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - John Gerrard
- Queensland Health, Brisbane, Queensland, Australia
| | - Sharon Mickan
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - David Henry
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
- Evidence-Based Practice Professorial Unit, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
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41
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Henriques BL, Vidal JE, Gamba C, Avelino-Silva VI. Lumbar puncture for neurosyphilis investigation in asymptomatic patients with HIV-syphilis coinfection: a cross-sectional study among infectious disease specialists. SAO PAULO MED J 2023; 141:20-29. [PMID: 36043668 PMCID: PMC9808987 DOI: 10.1590/1516-3180.2021.0744.r1.03032022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/03/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Syphilis is a major public health issue worldwide. In people living with human immunodeficiency virus (PLHIV), there are higher incidences of both syphilis and neurosyphilis. The criteria for referring PLHIV with syphilis for lumbar puncture is controversial, and the diagnosis of neurosyphilis is challenging. OBJECTIVE To describe the knowledge, attitudes, and practices of infectious disease specialists and residents in the context of care for asymptomatic HIV-syphilis coinfection using close-ended questions and case vignettes. DESIGN AND SETTING Cross-sectional study conducted in three public health institutions in São Paulo (SP), Brazil. METHODS In this cross-sectional study, we invited infectious disease specialists and residents at three academic healthcare institutions to answer a self-completion questionnaire available online or in paper form. RESULTS Of 98 participants, only 23.5% provided answers that were in line with the current Brazilian recommendation. Most participants believed that the criteria for lumbar puncture should be extended for people living with HIV with low CD4+ cell counts (52.0%); in addition, participants also believed that late latent syphilis (29.6%) and Venereal Disease Research Laboratory (VDRL) titers ≥ 1:32 (22.4%) should be conditions for lumbar puncture in PLHIV with no neurologic symptoms. CONCLUSION This study highlights heterogeneities in the clinical management of HIV-syphilis coinfection. Most infectious disease specialists still consider syphilis stage, VDRL titers and CD4+ cell counts as important parameters when deciding which patients need lumbar puncture for investigating neurosyphilis.
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Affiliation(s)
- Bárbara Labella Henriques
- MD. Doctoral Student, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - José Ernesto Vidal
- MD. PhD. Infectious Disease Specialist, Department of Neurology, Instituto de Infectologia Emilio Ribas, São Paulo (SP), Brazil; Infectious Disease Specialist, Department of Infectious Diseases, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Cristiano Gamba
- MD. Infectious Disease Specialist, Centro de Referência e Treinamento DST AIDS (CRT), São Paulo (SP), Brazil
| | - Vivian Iida Avelino-Silva
- MD, PhD. Infectious Disease Specialist, Department of Infectious Disease, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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42
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Azmi YA, Alkaff FF, Purba AKR, Renaldo J, Yogiswara N, Postma MJ. Factors for In-Hospital Mortality in 145 Male Patients with Fournier's Gangrene: A 10-Year Observational Study from a Single Tertiary Referral Center in Indonesia. Med Sci Monit 2022; 28:e938578. [PMID: 36560855 PMCID: PMC9793639 DOI: 10.12659/msm.938578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Fournier's gangrene (FG) is a potentially fatal necrotizing infection. Due to the rapid progression of the disease, the fatality rate remains high despite advances in therapy. This 10-year observational study from a single tertiary referral center in Indonesia aimed to identify the risk factors for in-hospital mortality from 145 male patients diagnosed with FG. MATERIAL AND METHODS This retrospective cohort study was conducted at one of Indonesia's largest tertiary referral hospitals. The risk factors of in-hospital mortality were analysed using data collected through hospital medical records. All patients diagnosed with FG from January 2012 until December 2021 were included. Outcome measured was sociodemographic factors, comorbidities, laboratory findings, length of stay, culture results, and disease outcome. The microbiological culture was performed on FG lesions isolates. The statistical analysis was conducted using SPSS version 26.0. RESULTS The analysis included 145 male patients with a median age of 52 (IQR, 43-61) years. Of them, 38 (26.20%) patients died. There were more patients with diabetes mellitus (DM) in non-survivor groups compared to survivor groups (76.3% vs 57%, p=0.035). On multivariate analysis, DM and Clostridium perfringens infection were found to be independent factors of in-hospital mortality [adjusted odds ratio (aOR)2.583, 95% confidence interval (CI)=1.061-6.289, aOR 5.982,95% CI=1.241-28.828, respectively]. CONCLUSIONS The mortality rate for FG was considerably high. DM and Clostridium perfringens infection were shown to be independent risk factors for mortality among men.
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Affiliation(s)
- Yufi Aulia Azmi
- Department of Urology, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia,Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Firas Farisi Alkaff
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands,Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Abdul Khairul Rizki Purba
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands,Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Johan Renaldo
- Department of Urology, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Niwanda Yogiswara
- Department of Urology, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Maarten J. Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands,Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia,Institute of Science in Healthy Ageing & healthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,Unit of PharmacoTherapy, Epidemiology and Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands,Department of Economics, Econometrics and Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
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43
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Affiliation(s)
- Jonathan Cohen
- Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, London, UK
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44
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Muacevic A, Adler JR. Fever of Unknown Origin and Atrial Fibrillation: A Case Report. Cureus 2022; 14:e32472. [PMID: 36644072 PMCID: PMC9835392 DOI: 10.7759/cureus.32472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
Fever of unknown origin describes a temperature greater than 100.9°F which is present on multiple instances for a period over three weeks with no confirmed diagnosis despite a minimum of three outpatient visits, three days of inpatient testing, or one week of extensive outpatient testing. This diagnosis presents challenges in clinical management due to the unknown etiology. This case highlights a fever of unknown origin presenting with new-onset atrial fibrillation in a patient with no previous cardiac history. A 62-year-old Caucasian male presented to the ED with a nine-day history of intermittent fevers and chills. He returned from a rafting trip in North Carolina two weeks ago but reported no tick bites, animal encounters, or river water ingestion. Further evaluation was significant for an elevated white blood cell count and elevated inflammatory markers. Laboratory and radiologic testing for a wide array of infectious and malignant etiologies were unremarkable. Soon after hospital presentation, he developed a fever of 102.9°F with new onset palpitations and chest tightness due to atrial fibrillation. Episodes of atrial fibrillation continued for his seven-day hospital course with more severe symptoms in the evenings. He was administered broad-spectrum antibiotics and tested extensively with no definitive etiology. His fever curve downtrended with max temperatures below 100.9°F on hospital days six and seven with asymptomatic episodes of atrial fibrillation, prompting discharge. He continued to have low-grade fevers measured below 100.9°F for several days post-discharge with no associated symptoms, resulting in a diagnosis of fever of unknown origin following the 21st day. Fever of unknown origin is a clinical challenge, particularly in cases with no diagnosis discovered and cases with potentially life-threatening complications such as atrial fibrillation. This patient had multiple potential etiologies for his condition, but none had sufficient evidence for diagnosis, resulting in uncertainty regarding the ideal management. As a result, constant monitoring with supportive treatments and broad-spectrum antibiotics was utilized. These measures allowed for symptom remission and hospital discharge for outpatient follow-up. This case highlights a rare presentation of fever of unknown origin with new-onset atrial fibrillation in an otherwise healthy adult.
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45
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Bittaye M, Usuf E, Clarke E. Viewpoint: vaccine inequity in the spotlight. Arch Dis Child 2022; 107:e35. [PMID: 34620601 PMCID: PMC9685692 DOI: 10.1136/archdischild-2021-322940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/21/2021] [Indexed: 12/14/2022]
Affiliation(s)
| | - Effua Usuf
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Ed Clarke
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, PO Box 273, Banjul, The Gambia, Banjul, Gambia
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46
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Viscardi RM, Magder LS, Terrin ML, Davis NL. Predicting the likelihood of lower respiratory tract Ureaplasma infection in preterms. Arch Dis Child Fetal Neonatal Ed 2022; 108:250-255. [PMID: 36261143 PMCID: PMC10113605 DOI: 10.1136/archdischild-2022-324192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/06/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop predictive models of Ureaplasma spp lower airway tract infection in preterm infants. METHODS A dataset was assembled from five cohorts of infants born <33 weeks gestational age (GA) enrolled over 17 years (1999-2016) with culture and/or PCR-confirmed tracheal aspirate Ureaplasma status in the first week of life (n=415). Seventeen demographic, obstetric and neonatal factors were analysed including admission white blood cell (WBC) counts. Best subset regression was used to develop three risk scores for lower airway Ureaplasma infection: (1) including admission laboratory values, (2) excluding admission laboratory values and (3) using only data known prenatally. RESULTS GA and rupture of membranes >72 hours were significant predictors in all 3 models. When all variables including admission laboratory values were included in the regression, WBC count was also predictive in the resulting model. When laboratory values were excluded, delivery route was found to be an additional predictive factor. The area under the curve for the receiver operating characteristic indicated high predictive ability of each model to identify infants with lower airway Ureaplasma infection (range 0.73-0.77). CONCLUSION We developed predictive models based on clinical and limited laboratory information available in the perinatal period that can distinguish between low risk (<10%) and high risk (>40%) of lower airway Ureaplasma infection. These may be useful in the design of phase III trials of therapeutic interventions to prevent Ureaplasma-mediated lung disease in preterm infants and in clinical management of at-risk infants.
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Affiliation(s)
- Rose Marie Viscardi
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Laurence S Magder
- Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael L Terrin
- Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Natalie L Davis
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
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47
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Otunla A, Rees K, Dennison P, Hobbs R, Suklan J, Schofield E, Gunnell J, Mighiu A, Hartmann-Boyce J. Risks of infection, hospital and ICU admission, and death from COVID-19 in people with asthma: systematic review and meta-analyses. BMJ Evid Based Med 2022; 27:263-273. [PMID: 34933924 DOI: 10.1136/bmjebm-2021-111788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine if and to what degree asthma may predispose to worse COVID-19 outcomes in order to inform treatment and prevention decisions, including shielding and vaccine prioritisation. DESIGN Systematic review and meta-analysis. SETTING Electronic databases were searched (October 2020) for clinical studies reporting at least one of the following stratified by asthma status: risk of infection with SARS-CoV-2; hospitalisation, intensive care unit (ICU) admission or mortality with COVID-19. PARTICIPANTS Adults and children who tested positive for or were suspected to have COVID-19. MAIN OUTCOME MEASURES Main outcome measures were the following stratified by asthma status: risk of infection with SARS-CoV-2; hospitalisation, ICU admission or mortality with COVID-19. We pooled odds ratios (ORs) and presented these with 95% confidence intervals (CI). Certainty was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). RESULTS 30 (n=112 420) studies were included (12 judged high quality, 15 medium, 3 low). Few provided indication of asthma severity. Point estimates indicated reduced risks in people with asthma for all outcomes, but in all cases the evidence was judged to be of very low certainty and 95% CIs all included no difference and the possibility of increased risk (death: OR 0.90, 95% CI 0.72 to 1.13, I2=58%; hospitalisation: OR 0.95, 95% CI 0.71 to 1.26; ICU admission: OR 0.96, 95% CI 0.75 to 1.24). Findings on hospitalisation are also limited by substantial unexplained statistical heterogeneity. Within people with asthma, allergic asthma was associated with less COVID-19 risk and concurrent chronic obstructive pulmonary disease was associated with increased risk. In some studies, corticosteroids were associated with increased risk, but this may reflect increased risk in people with more severe asthma. CONCLUSIONS Though absence of evidence of a clear association between asthma and worse outcomes from COVID-19 should not be interpreted as evidence of absence, the data reviewed indicate that risks from COVID-19 in people with asthma, as a whole, may be less than originally anticipated.
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Affiliation(s)
| | - Karen Rees
- Freelance systematic reviewer, Warwickshire, UK
| | - Paddy Dennison
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jana Suklan
- NIHR Newcastle In Vitro Diagnostics, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Ella Schofield
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - James Gunnell
- Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Hirt J, Janiaud P, Gloy VL, Schandelmaier S, Pereira TV, Contopoulos-Ioannidis D, Goodman SN, Ioannidis J, Munkholm K, Hemkens LG. Robustness of reported postacute health outcomes in children with SARS-CoV-2 infection: a systematic review. Arch Dis Child 2022; 108:498-505. [PMID: 36719840 DOI: 10.1136/archdischild-2022-324455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/31/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To systematically assess the robustness of reported postacute SARS-CoV-2 infection health outcomes in children. METHODS A search on PubMed and Web of Science was conducted to identify studies published up to 22 January 2022 that reported on postacute SARS-CoV-2 infection health outcomes in children (<18 years) with follow-up of ≥2 months since detection of infection or ≥1 month since recovery from acute illness. We assessed the consideration of confounding bias and causality, as well as the risk of bias. RESULTS 21 studies including 81 896 children reported up to 97 symptoms with follow-up periods of 2.0-11.5 months. Fifteen studies had no control group. The reported proportion of children with post-COVID syndrome was between 0% and 66.5% in children with SARS-CoV-2 infection (n=16 986) and between 2.0% and 53.3% in children without SARS-CoV-2 infection (n=64 910). Only two studies made a clear causal interpretation of an association between SARS-CoV-2 infection and the main outcome of 'post-COVID syndrome' and provided recommendations regarding prevention measures. The robustness of all 21 studies was seriously limited due to an overall critical risk of bias. CONCLUSIONS The robustness of reported postacute SARS-CoV-2 infection health outcomes in children is seriously limited, at least in all the published articles we could identify. None of the studies provided evidence with reasonable certainty on whether SARS-CoV-2 infection has an impact on postacute health outcomes, let alone to what extent. Children and their families urgently need much more reliable and methodologically robust evidence to address their concerns and improve care.
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Affiliation(s)
- Julian Hirt
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,International Graduate Academy, Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Perrine Janiaud
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Viktoria Luise Gloy
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Schandelmaier
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Clinical Epidemiology and Biostatistics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Tiago V Pereira
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Health Sciences, College of Medicine, University of Leicester, Leicester, UK
| | - Despina Contopoulos-Ioannidis
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Steven N Goodman
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA.,Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - John Ioannidis
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA.,Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA.,Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California, USA.,Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Klaus Munkholm
- Department of Clinical Research, Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, University of Southern Denmark, Odense, Denmark.,Open Patient Data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Lars G Hemkens
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland .,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA.,Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
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Coggins SA, Harris MC, Srinivasan L. Dual-site blood culture yield and time to positivity in neonatal late-onset sepsis. Arch Dis Child Fetal Neonatal Ed 2022; 107:475-480. [PMID: 34753783 DOI: 10.1136/archdischild-2021-322844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/26/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether culture yield and time to positivity (TTP) differ between peripheral and central vascular catheter-derived blood cultures (BCx) in neonatal intensive care unit (NICU) patients evaluated for late-onset sepsis. DESIGN Single-centre, retrospective, observational study. SETTING Level IV NICU. PARTICIPANTS The study included infants >72 hours old admitted to NICU in 2007-2019 with culture-confirmed bacteraemia. All episodes had simultaneous BCx drawn from a peripheral site and a vascular catheter ('catheter culture'). MAIN OUTCOME MEASURES Dual-site culture yield and TTP. RESULTS Among 179 episodes of late-onset bacteraemia (among 167 infants) with concurrently drawn peripheral and catheter BCx, the majority (67%, 120 of 179) were positive from both sites, compared with 17% (30 of 179) with positive catheter cultures only and 16% (29 of 179) with positive peripheral cultures only. 66% (19 of 29) of episodes with only positive peripheral BCx grew coagulase-negative Staphylococcus, while 34% (10 of 29) were recognised bacterial pathogens. Among 120 episodes with both peripheral and catheter BCx growth, catheter cultures demonstrated bacterial growth prior to paired peripheral cultures in 78% of episodes (93 of 120, p<0.001). The median TTP was significantly shorter in catheter compared with peripheral cultures (15.0 hours vs 16.8 hours, p<0.001). The median elapsed time between paired catheter and peripheral culture growth was 1.3 hours. CONCLUSION Concurrently drawn peripheral and catheter BCx had similar yield. While a majority of episodes demonstrated dual-site BCx growth, a small but important minority of episodes grew virulent pathogens from either culture site alone. While dual-site culture practices may be useful, clinicians should balance the gain in sensitivity of bacteraemia detection against additive contamination risk.
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Affiliation(s)
- Sarah A Coggins
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mary Catherine Harris
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lakshmi Srinivasan
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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50
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Paul SP, Khattak H, Kini PK, Heaton PA, Goel N. NICE guideline review: neonatal infection: antibiotics for prevention and treatment (NG195). Arch Dis Child Educ Pract Ed 2022; 107:292-297. [PMID: 34772670 DOI: 10.1136/archdischild-2021-322349] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/25/2021] [Indexed: 01/21/2023]
Affiliation(s)
| | | | | | | | - Nitin Goel
- Neonatal Medicine, University Hospital of Wales, Cardiff, UK
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