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Gokhale RH, Sapiano M, Dantes R, Abanyie-Bimbo F, Wilson LE, Thompson N, Perlmuter R, Nadle J, Frank L, Brousseau G, Johnston H, Bamberg WM, Dumyati G, Lynfield R, DaSilva M, Kainer MA, Zhang AY, Ocampo V, Samper M, Irizarry L, Sievers MM, Maloney M, Ray S, Magill S, Katz D, Epstein L. 111. Pediatric and Adolescent Sepsis Epidemiology and Clinical Characteristics, Emerging Infections Program, 2014–2015. Open Forum Infect Dis 2019. [PMCID: PMC6809396 DOI: 10.1093/ofid/ofz360.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Sepsis is an important contributor to mortality among children and young adults. However, recent studies focused on hospital management and burden estimation do not provide critical data to inform prevention efforts. We conducted detailed medical record reviews to describe the epidemiology and clinical characteristics of children and young adults with sepsis to inform prevention and early recognition targets. Methods We utilized the Emerging Infections Program (EIP) to collect comprehensive data via retrospective record review for patients with severe sepsis or septic shock discharge diagnosis codes from a nonrandom sample of hospitals across 10 states. Children and young adults, aged 30 days through 21 years, discharged between September 30, 2014 and October 1, 2015, were randomly selected for inclusion. We performed a descriptive analysis of these data. Results Among 734 patients hospitalized with sepsis, 92% were living in a private residence 4 days before admission, 38% had an outpatient medical encounter in the 7 days before admission, 14% had sepsis onset after hospital day 3, and 11% died within 90 days of sepsis diagnosis. The most frequently identified infection was lower respiratory tract infection (14%); for 317 (43%) no infection was documented as a cause of sepsis. The most frequently identified pathogen was Staphylococcus aureus (10%); for 326 (44%) no pathogen was identified as a cause of sepsis. Among 394 (54%) patients with ≥1 chronic underlying medical condition (CUMC), the most common were pulmonary disease (35%), hematologic/oncologic disease (31%), immune compromise (24%), and cardiovascular disease (20%). Patients with CUMC had a higher percentage of their sepsis onset after hospital day 3, death within 90 days of sepsis diagnosis, and Pseudomonas aeruginosa as a cause of sepsis (table). The percentage of patients with no pathogen identified was similar between those with CUMC and those without. Conclusion In our large cohort of children and young adults with sepsis, most had sepsis onset outside of the hospital and over half had chronic conditions. Our data suggest that distinct approaches may be needed to develop effective prevention and early recognition strategies for children and young adults depending on the presence of chronic conditions. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Matthew Sapiano
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Raymund Dantes
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Lucy E Wilson
- University of Maryland Baltimore County, Baltimore, Maryland
| | - Nicola Thompson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Joelle Nadle
- California Emerging Infections Program, Oakland, California
| | - Linda Frank
- California Emerging Infections Program, Oakland, California
| | - Geoff Brousseau
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Wendy M Bamberg
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Ghinwa Dumyati
- New York Rochester Emerging Infections Program at the University of Rochester Medical Center, Rochester, New York
| | - Ruth Lynfield
- Minnesota Department of Health, Saint Paul, Minnesota
| | | | | | - Alexia Y Zhang
- Oregon Public Health Division-Acute and Communicable Disease Prevention, Portland, Oregon
| | | | | | | | | | | | - Susan Ray
- Emory University School of Medicine, Atlanta, Georgia
| | - Shelley Magill
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David Katz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren Epstein
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Abanyie-Bimbo F, O’Leary E, Nadle J, Thompson DL, Muleta D, Kainer MA, Epstein L, Magill SS. 275. Evaluation of Vancomycin Prescribing Quality in Hospitalized Pediatric Patients. Open Forum Infect Dis 2018. [PMCID: PMC6255663 DOI: 10.1093/ofid/ofy210.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Vancomycin is the most common antimicrobial drug administered to hospitalized patients, including children >90 days old, although the prevalence of β-lactam antibiotic resistance among Gram-positive pathogens is relatively low in children. Reducing inappropriate vancomycin use in children can reduce harm from antibiotic-associated adverse events and antimicrobial resistance (AR). We developed an approach to evaluating pediatric intravenous (IV) vancomycin prescribing quality using medical record data. Methods Hospitals in three Emerging Infections Program (EIP) sites (CA, NM, and TN) were recruited to participate. Patients <18 years who received IV vancomycin in 2013 were identified through pharmacy records, excluding those on IV vancomycin solely for surgical prophylaxis. Trained EIP staff collected medical record data. We created a prescribing quality evaluation pathway using data on infection type, signs, symptoms, penicillin allergy, and AR risk factors. Clinically supported prescribing events were those with a positive culture for a Gram-positive organism with β-lactam resistance or unknown susceptibility; severe penicillin allergy; bone, joint, skin/soft tissue or central nervous system infection; pneumonia with AR risk factors; or events where vancomycin was stopped within 1 day of culture results for an oxacillin or penicillin/ampicillin-susceptible organism. Results Sixty-five patients in 12 hospitals were evaluated. The median age was 7 years (interquartile range [IQR] 4–14), and median hospital stay was 7 days (IQR 3–16). The median vancomycin treatment length was 3 days (IQR 2–6); 41 patients (63%) received ≥3 days. Vancomycin use was clinically supported in 47 patients (72%) and unsupported in 18 (28%) (figure). Most unsupported use was for infections lacking microbiology data and for which vancomycin would not usually be indicated, such as pneumonia without AR risk factors (9/18, 50%). Conclusion The use of IV vancomycin was not supported for >25% of children, indicating opportunities to improve prescribing and reduce unnecessary vancomycin use. Further analysis will utilize this prescribing pathway to evaluate the most recent prevalence survey data to identify areas to target stewardship interventions. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Erin O’Leary
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, California
| | | | - Daniel Muleta
- Tennessee Department of Health, Nashville, Tennessee
| | - Marion A Kainer
- Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Public Health, Nashville, Tennessee
| | - Lauren Epstein
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shelley S Magill
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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