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Feldman K, Suppes SL, Goldman JL. Clarification of adverse drug reactions by a pharmacovigilance team results in increased antibiotic re-prescribing at a freestanding United States children's hospital. PLoS One 2024; 19:e0295410. [PMID: 38215178 PMCID: PMC10786368 DOI: 10.1371/journal.pone.0295410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/21/2023] [Indexed: 01/14/2024] Open
Abstract
Documentation of adverse drug reactions (ADRs) is a key factor in guiding future prescribing. However, incomplete documentation is common and often fails to distinguish implicated drugs as true allergies. This in turn leads to unnecessary avoidance of implicated drug classes and may result in sub-optimal prescribing. Pharmacovigilance (PV) programs utilize a systematic approach to clarify ADR documentation and are known to improve patient safety. Yet it remains unclear if PV alters prescribing. Or, if the existence of the ADR documentation itself continues to prompt avoidance of implicated drugs. To address this, our work presents a retrospective cohort study assessing if clarification of antibiotic ADRs by a hospital-wide PV team was associated with future, safe, re-prescribing at a freestanding pediatric hospital in the midwestern United States. First, we compared the likelihood of future prescribing in an antibiotic class with an active ADR, as compared to alternative drug classes, between PV-clarified and non-clarified patients. Second, we assessed differences in adverse event rates 30-days after future prescribing based on PV clarification status. For robustness, analyses were performed on patients with ADRs in four antibiotic classes: penicillin-based beta-lactams (n = 45,642), sulfonamides/trimethoprim (n = 5,329), macrolides (n = 3,959), and glycopeptides (n = 622). Results illustrate that clarification of an ADR by PV was associated with an increased odds of future prescribing in the same drug class (Odds Ratio [95%-CI]): penicillin-based beta-lactams (1.59 [1.36-1.89]), sulfonamides/trimethoprim (2.29 [0.89-4.91]), macrolides (0.77 [0.33-1.61]), and glycopeptide (1.85 [1.12-3.20]). Notably, patients clarified by PV experienced no increase in the rate of adverse events within 30-days following the prescribing of antibiotics in the same class as an active ADR. Overall, this study provides strong evidence that PV reviews safely increase the rate of re-prescribing antibiotics even in the presence of an existing implicated drug ADR.
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Affiliation(s)
- Keith Feldman
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, United States of America
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States of America
| | - Sarah L. Suppes
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, United States of America
| | - Jennifer L. Goldman
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, United States of America
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States of America
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Miles N, Masters A, Desta Z, Goldman JL, Suppes SL, Tillman EM. Multidisciplinary Approach to Deciphering Etoposide Infusion Reactions and Potential Role of Polyethersulfone Filter Membranes. J Pediatr Pharmacol Ther 2023; 28:643-648. [PMID: 38025152 PMCID: PMC10681083 DOI: 10.5863/1551-6776-28.7.643] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/07/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE Etoposide, a topoisomerase II inhibitor used clinically to treat cancer, has been associated with severe anaphylactic infusion related adverse drug reactions (ADRs). In a previous study we identified a hydrophilic polyethersulfone filter as a possible cause of increased rates of pediatric etoposide infusion reactions. In this multidisciplinary follow-up analytical study, we aimed to assess the chemical structure of etoposide after passing through the same hydrophilic polyethersulfone filter. METHODS An etoposide 0.4 mg/mL infusion was prepared under aseptic conditions and then passed through a standard IV infusion set with an in-line filter in place. Samples were taken in triplicate using a needle-less access system to include sampling sites directly from the IV bag port and from the IV tubing both before and after the in-line filter. Samples were diluted into mobile phase, then an aliquot was injected into a high-performance liquid chromatography mass spectrometry HPLC-MS (Thermo TSQ Quantum Ultra) system coupled to a Diode Array Detector (DAD) (Thermo Dionex Ultimate 3000). Etoposide was monitored using a selected reaction monitoring scan (SRM) of 606.2/228.8 and wavelengths of 210, 220, 254, and 280 nm for 30 minutes. RESULTS No detectable differences were observed upon comparing the three samples. Based on these results, a chemical change in etoposide resulting from an in-line filter is unlikely to be the primary cause of increased rates of infusion reactions. CONCLUSION Pharmacists working in healthcare systems, observe many ADRs, but rarely have the resources necessary to investigate the potential etiology or causality. This report highlights importance of multi-disciplinary collaboration to investigate serious ADRs.
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Affiliation(s)
- Nicholas Miles
- Division of Clinical Pharmacology (NM, ZD, ET), Indiana University School of Medicine, Indianapolis, IN
| | - Andi Masters
- Indiana University Comprehensive Cancer Center (AM), Indiana University School of Medicine, Indianapolis, IN
| | - Zeruesenay Desta
- Division of Clinical Pharmacology (NM, ZD, ET), Indiana University School of Medicine, Indianapolis, IN
| | - Jennifer L. Goldman
- Department of Pediatrics (JLG), Children's Mercy Hospital and the University of Missouri-Kansas City, Kansas City, MO
| | - Sarah L. Suppes
- Division of Clinical Pharmacology (SLS), Toxicology, and Therapeutic Innovation, Children's Mercy Hospital, Kansas City, MO
| | - Emma M. Tillman
- Division of Clinical Pharmacology (NM, ZD, ET), Indiana University School of Medicine, Indianapolis, IN
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3
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Bradley JS, Goldman JL, James LP, Kaelin B, Gibson BHY, Arrieta A. Pharmacokinetics and safety of a single dose of telavancin in pediatric subjects 2-17 years of age. Antimicrob Agents Chemother 2023; 67:e0098723. [PMID: 37815398 PMCID: PMC10649008 DOI: 10.1128/aac.00987-23] [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] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/25/2023] [Indexed: 10/11/2023] Open
Abstract
Antimicrobial resistance increases infection morbidity in both adults and children, necessitating the development of new therapeutic options. Telavancin, an antibiotic approved in the United States for certain bacterial infections in adults, has not been examined in pediatric patients. The objectives of this study were to evaluate the short-term safety and pharmacokinetics (PK) of a single intravenous infusion of telavancin in pediatric patients. Single-dose safety and PK of 10 mg/kg telavancin was investigated in pediatric subjects >12 months to ≤17 years of age with known or suspected bacterial infection. Plasma was collected up to 24-h post-infusion and analyzed for concentrations of telavancin and its metabolite for noncompartmental PK analysis. Safety was monitored by physical exams, vital signs, laboratory values, and adverse events following telavancin administration. Twenty-two subjects were enrolled: 14 subjects in Cohort 1 (12-17 years), 7 subjects in Cohort 2 (6-11 years), and 1 subject in Cohort 3 (2-5 years). A single dose of telavancin was well-tolerated in all pediatric age cohorts without clinically significant effects. All age groups exhibited increased clearance of telavancin and reduced exposure to telavancin compared to adults, with mean peak plasma concentrations of 58.3 µg/mL (Cohort 1), 60.1 µg/mL (Cohort 2), and 53.1 µg/mL (Cohort 3). A 10 mg/kg dose of telavancin was well tolerated in pediatric subjects. Telavancin exposure was lower in pediatric subjects compared to adult subjects. Further studies are needed to determine the dose required in phase 3 clinical trials in pediatrics.
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Affiliation(s)
- John S. Bradley
- Department of Pediatrics, University of California San Diego School of Medicine and Rady Children’s Hospital, San Diego, California, USA
| | - Jennifer L. Goldman
- Department of Pediatrics, University of Missouri-Kansas City and Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Laura P. James
- Department of Pediatrics, Arkansas Children’s Hospital Research Institute, Little Rock, Arkansas, USA
| | - Byron Kaelin
- Product Development, Cumberland Pharmaceuticals Inc., Nashville, Tennessee, USA
| | | | - Antonio Arrieta
- Division of Infectious Diseases, Children’s Hospital of Orange County, Orange County, California, USA
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Antoon JW, Feinstein JA, Goldman JL, Kyler KE, Shah SS. Advancing pediatric medication safety using real-world data: Current problems and potential solutions. J Hosp Med 2023; 18:865-869. [PMID: 36855275 PMCID: PMC10460821 DOI: 10.1002/jhm.13068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/17/2023] [Accepted: 02/03/2023] [Indexed: 03/02/2023]
Affiliation(s)
- James W. Antoon
- Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee, USA
- Department of Pediatrics, Division of Hospital Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James A. Feinstein
- Adult and Child Consortium for Health Outcomes Research & Delivery Science, Children’s Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Jennifer L. Goldman
- Divisions of Infectious Diseases and Clinical Pharmacology, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Kathryn E. Kyler
- Division of Hospital Medicine, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Samir S. Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children’s Hospital Medical Center & Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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5
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Goldman JL, Lee BR, Porter J, Deliu A, Tilsworth S, Almendares OM, Sleweon S, Kirking HL, Selvarangan R, Schuster JE. Notes from the Field: Multipathogen Respiratory Virus Testing Among Primary and Secondary School Students and Staff Members in a Large Metropolitan School District - Missouri, November 2, 2022-April 19, 2023. MMWR Morb Mortal Wkly Rep 2023; 72:772-774. [PMID: 37440445 PMCID: PMC10360606 DOI: 10.15585/mmwr.mm7228a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
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Abstract
OBJECTIVES The Centers for Disease Control and Prevention identifies in-school COVID-19 testing as a key mitigation strategy to protect students and staff during the COVID-19 pandemic. Both nasal and saliva samples are acceptable, but existing school guidance does not state a preferred test method. METHODS From May 2021 through July 2021, we performed a randomized, crossover study in kindergarten through 12th grade (K-12) schools to evaluate student and staff preference for self-collected nasal or saliva testing. Participants performed both collection types and participated in a standardized questionnaire assessing the preferred method. RESULTS A total of 135 students and staff participated. Staff, middle school, and high school students preferred the nasal swab (80/96, 83%), whereas elementary students were mixed (20/39, 51% preferred saliva). Reasons reported for preferring the nasal swab included being faster and easier. Reasons reported for preferring saliva included being easier and more fun. Despite their preference, 126 (93%) and 109 (81%) participants would take the nasal swab or saliva test again, respectively. CONCLUSIONS The anterior nasal test was the preferred testing method by students and staff, although preference varied by age group. Willingness to perform both tests again in the future was high. Identifying the preferred testing modality is important to increase acceptance and participation in COVID-19 in-school testing programs.
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7
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Schuster JE, Erickson TR, Goldman JL, Benjamin DK, Brookhart MA, Dewhurst S, Fist A, Foxe J, Godambe M, Gwynn L, Kiene SM, Keener Mast D, McDaniels-Davidson C, Newland JG, Oren E, Selvarangan R, Shinde N, Walsh T, Watterson T, Zand M, Zimmerman KO, Kalu IC. Utilization and Impact of Symptomatic and Exposure SARS-CoV-2 Testing in K-12 Schools. Pediatrics 2023; 152:e2022060352I. [PMID: 37394504 PMCID: PMC10312273 DOI: 10.1542/peds.2022-060352i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES The Centers for Disease Control and Prevention recommend that schools can offer severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic (on-demand) testing for students and staff with coronavirus disease 2019 symptoms or exposures. Data related to the uptake, implementation, and effect of school-associated on-demand diagnostic testing have not been described. METHODS The Rapid Acceleration of Diagnostics Underserved Populations Return to School program provided resources to researchers to implement on-demand SARS-CoV-2 testing in schools. This study describes the strategies used and uptake among the different testing programs. Risk of positivity was compared for symptomatic and exposure testing during the δ and ο variant periods. We estimated the number of school absence days saved with school-based diagnostic testing. RESULTS Of the 16 eligible programs, 7 provided school-based on-demand testing. The number of persons that participated in these testing programs is 8281, with 4134 (49.9%) receiving >1 test during the school year. Risk of positivity was higher for symptomatic testing compared with exposure testing and higher during the ο variant predominant period compared with the δ variant predominant period. Overall, access to testing saved an estimated 13 806 absent school days. CONCLUSIONS School-based on-demand SARS-CoV-2 testing was used throughout the school year, and nearly half the participants accessed testing on more than 1 occasion. Future studies should work to understand participant preferences around school-based testing and how these strategies can be used both during and outside of pandemics.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Maya Godambe
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri
| | - Lisa Gwynn
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California
| | | | - Corinne McDaniels-Davidson
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California
| | - Jason G. Newland
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri
| | - Eyal Oren
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California
| | - Rangaraj Selvarangan
- Pathology and Laboratory Medicine, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | - Nidhi Shinde
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri
| | - Tyler Walsh
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri
| | - Treymayne Watterson
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri
| | - Martin Zand
- Division of Nephrology, School of Medicine and Dentistry, University of Rochester, Rochester, New York
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8
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Uthappa DM, Mann TK, Goldman JL, Schuster JE, Newland JG, Anderson WB, Dozier A, Inkelas M, Foxe JJ, Gwynn L, Gurnett CA, McDaniels-Davidson C, Walsh T, Watterson T, Holden-Wiltse J, Potts JM, D’Agostino EM, Zandi K, Corbett A, Spallina S, DeMuri GP, Wu YP, Pulgaron ER, Kiene SM, Oren E, Allison-Burbank JD, Okihiro M, Lee RE, Johnson SB, Stump TK, Coller RJ, Mast DK, Haroz EE, Kemp S, Benjamin DK, Zimmerman KO. Common Data Element Collection in Underserved School Communities: Challenges and Recommendations. Pediatrics 2023; 152:e2022060352N. [PMID: 37394503 PMCID: PMC10312277 DOI: 10.1542/peds.2022-060352n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES To provide recommendations for future common data element (CDE) development and collection that increases community partnership, harmonizes data interpretation, and continues to reduce barriers of mistrust between researchers and underserved communities. METHODS We conducted a cross-sectional qualitative and quantitative evaluation of mandatory CDE collection among Rapid Acceleration of Diagnostics-Underserved Populations Return to School project teams with various priority populations and geographic locations in the United States to: (1) compare racial and ethnic representativeness of participants completing CDE questions relative to participants enrolled in project-level testing initiatives and (2) identify the amount of missing CDE data by CDE domain. Additionally, we conducted analyses stratified by aim-level variables characterizing CDE collection strategies. RESULTS There were 15 study aims reported across the 13 participating Return to School projects, of which 7 (47%) were structured so that CDEs were fully uncoupled from the testing initiative, 4 (27%) were fully coupled, and 4 (27%) were partially coupled. In 9 (60%) study aims, participant incentives were provided in the form of monetary compensation. Most project teams modified CDE questions (8/13; 62%) to fit their population. Across all 13 projects, there was minimal variation in the racial and ethnic distribution of CDE survey participants from those who participated in testing; however, fully uncoupling CDE questions from testing increased the proportion of Black and Hispanic individuals participating in both initiatives. CONCLUSIONS Collaboration with underrepresented populations from the early study design process may improve interest and participation in CDE collection efforts.
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Affiliation(s)
- Diya M. Uthappa
- Duke University School of Medicine, Doctor of Medicine Program
| | - Tara K. Mann
- Duke Clinical Research Institute, Duke University School of Medicine
| | - Jennifer L. Goldman
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | | | | | | | - Moira Inkelas
- Department of Health Policy and Management, UCLA Fielding School of Public Health UCLA Clinical and Translational Science Institute, Los Angeles, California
| | - John J. Foxe
- The Del Monte Institute for Neuroscience and The Department of Neuroscience, University of Rochester School of Medicine, Rochester, New York
| | - Lisa Gwynn
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida USA
| | - Christina A. Gurnett
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
| | | | - Tyler Walsh
- Department of Pediatrics, Division of Infectious Diseases
| | | | | | | | | | | | | | | | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Yelena P. Wu
- Department of Dermatology
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Susan M. Kiene
- School of Public Health, San Diego State University, San Diego, California
| | - Eyal Oren
- School of Public Health, San Diego State University, San Diego, California
| | | | - May Okihiro
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii Manoa, Honolulu, Hawaii
| | - Rebecca E. Lee
- Edson College of Nursing & Health Innovation, Center for Health Promotion and Disease Prevention, Senior Global Futures Scientist, Julie Ann Wrigley Global Futures Laboratory, Arizona State University, Phoenix, Arizona
| | - Sara B. Johnson
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Tammy K. Stump
- Department of Dermatology
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Emily E. Haroz
- Department of International Health & Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Steven Kemp
- Duke Clinical Research Institute, Duke University School of Medicine
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | - Kanecia O. Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
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Keener Mast D, Gwynn L, Johnson SB, McDaniels-Davidson C, Hoffman R, Pulgaron ER, D’Agostino EM, Ko LK, Goldman JL, Drain PK, Schuster JE, Duran MC, Kiene SM, Oren E, Corneli A. A Multi-Study Synthesis of Facilitators and Barriers to SARS-CoV-2 Testing Enrollment in School Settings. Pediatrics 2023; 152:e2022060352J. [PMID: 37394502 PMCID: PMC10312272 DOI: 10.1542/peds.2022-060352j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES Understanding the motivators and barriers to testing enrollment from different stakeholder perspectives is essential to increasing participation in school-based testing programs, particularly among underserved populations. This multistudy analysis aimed to identify facilitators and barriers to enrollment in school-based testing for coronavirus disease 2019 (COVID-19). METHODS Four independent studies collected and analyzed qualitative data from study participants regarding: (1) motivators, benefits, and/or reasons for enrolling and/or participating in COVID-19 testing in schools; and/or (2) concerns, barriers, and/or negative outcomes related to COVID-19 testing in schools. Study authors conducted a retrospective review of findings from the independent studies to identify themes related to testing motivators and concerns that emerged across the studies. RESULTS The analysis identified 10 distinct themes regarding the perceived motivators of COVID-19 testing in schools and 15 distinct themes regarding concerns and barriers to COVID-19 testing in schools. Common motivators across multiple studies included convenience of testing in school and the desire to keep self and others safe from COVID-19. Concerns about the implications of receiving a positive test result was a barrier identified by multiple studies. CONCLUSIONS Themes from 4 independent studies revealed insights about the motivations and barriers to enrolling and participating in COVID-19 testing programs in kindergarten through 12th grade school settings. Study findings can be used to improve enrollment and participation in new and existing school-based testing programs to reduce transmission of COVID-19 and other infectious diseases in schools.
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Affiliation(s)
| | - Lisa Gwynn
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Sara B. Johnson
- Johns Hopkins Schools of Medicine, Dept. of Pediatrics, Division of General Pediatrics, Baltimore, Maryland
| | | | | | - Elizabeth R. Pulgaron
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Linda K. Ko
- Departments of Health Systems and Population Health
| | - Jennifer L. Goldman
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | - Paul K. Drain
- Global Health, Medicine, Epidemiology, University of Washington, Seattle, Washington
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Susan M. Kiene
- San Diego State University School of Public Health, San Diego, California
| | - Eyal Oren
- San Diego State University School of Public Health, San Diego, California
| | - Amy Corneli
- Population Health Sciences
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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10
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Goldman JL, Kalu IC, Schuster JE, Erickson T, Mast DK, Zimmerman K, Benjamin DK, Kalb LG, Gurnett C, Newland JG, Sherby M, Godambe M, Shinde N, Watterson T, Walsh T, Foxe J, Zand M, Dewhurst S, Coller R, DeMuri GP, Archuleta S, Ko LK, Inkelas M, Manuel V, Lee R, Oh H, Murugan V, Kramer J, Okihiro M, Gwynn L, Pulgaron E, McCulloh R, Broadhurst J, McDaniels-Davidson C, Kiene S, Oren E, Wu Y, Wetter DW, Stump T, Brookhart MA, Fist A, Haroz E. Building School-Academic Partnerships to Implement COVID-19 Testing in Underserved Populations. Pediatrics 2023; 152:e2022060352C. [PMID: 37394512 PMCID: PMC10312280 DOI: 10.1542/peds.2022-060352c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE In April 2021, the US government made substantial investments in students' safe return to school by providing resources for school-based coronavirus disease 2019 (COVID-19) mitigation strategies, including COVID-19 diagnostic testing. However, testing uptake and access among vulnerable children and children with medical complexities remained unclear. METHODS The Rapid Acceleration of Diagnostics Underserved Populations program was established by the National Institutes of Health to implement and evaluate COVID-19 testing programs in underserved populations. Researchers partnered with schools to implement COVID-19 testing programs. The authors of this study evaluated COVID-19 testing program implementation and enrollment and sought to determine key implementation strategies. A modified Nominal Group Technique was used to survey program leads to identify and rank testing strategies to provide a consensus of high-priority strategies for infectious disease testing in schools for vulnerable children and children with medical complexities. RESULTS Among the 11 programs responding to the survey, 4 (36%) included prekindergarten and early care education, 8 (73%) worked with socioeconomically disadvantaged populations, and 4 focused on children with developmental disabilities. A total of 81 916 COVID-19 tests were performed. "Adapting testing strategies to meet the needs, preferences, and changing guidelines," "holding regular meetings with school leadership and staff," and "assessing and responding to community needs" were identified as key implementation strategies by program leads. CONCLUSIONS School-academic partnerships helped provide COVID-19 testing in vulnerable children and children with medical complexities using approaches that met the needs of these populations. Additional work is needed to develop best practices for in-school infectious disease testing in all children.
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Affiliation(s)
- Jennifer L. Goldman
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri
| | - Ibukunoluwa C. Kalu
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri
| | - Tyler Erickson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | - Kanecia Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Luther G. Kalb
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Christina Gurnett
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Jason G. Newland
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Michael Sherby
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Maya Godambe
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Nidhi Shinde
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Treymayne Watterson
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Tyler Walsh
- Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - John Foxe
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 31 Baltimore, Maryland
| | - Martin Zand
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 31 Baltimore, Maryland
| | - Stephen Dewhurst
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 31 Baltimore, Maryland
| | - Ryan Coller
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington
| | - Gregory P. DeMuri
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington
| | - Shannon Archuleta
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Linda K. Ko
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- UCLA Clinical and Translational Science Institute, Los Angeles, California
| | - Moira Inkelas
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Vladimir Manuel
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | | | - Hyunsung Oh
- Center for Personalized Diagnostics, ASU Biodesign Clinical Testing Laboratory, Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Vel Murugan
- Division of Primary, Complex, and Adolescent Medicine, Phoenix Children’s Hospital, Phoenix, Arizona
| | | | - May Okihiro
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Lisa Gwynn
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Russell McCulloh
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California
| | - Jana Broadhurst
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California
| | | | - Susan Kiene
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Eyal Oren
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Yelena Wu
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - David W. Wetter
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Tammy Stump
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Alex Fist
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Emily Haroz
- Johns Hopkins Center for Indigenous Health, Baltimore, Maryland
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11
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Kalu IC, Zimmerman KO, Goldman JL, Keener Mast D, Blakemore AM, Moorthy G, Boutzoukas AE, Campbell MM, Uthappa D, DeLaRosa J, Potts JM, Edwards LJ, Selvarangan R, Benjamin DK, Mann TK, Schuster JE. SARS-CoV-2 Screening Testing Programs for Safe In-person Learning in K-12 Schools. J Pediatric Infect Dis Soc 2023; 12:64-72. [PMID: 36412278 PMCID: PMC9969331 DOI: 10.1093/jpids/piac119] [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: 06/27/2022] [Accepted: 11/21/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening testing is a recommended mitigation strategy for schools, although few descriptions of program implementation are available. METHODS Kindergarten through 12th grade (K-12) students and staff practicing universal masking during the delta and omicron variant waves from five schools in Durham, North Carolina and eight schools in Kansas City, Missouri participated; Durham's program was structured as a public health initiative facilitated by school staff, and Kansas City's as a research study facilitated by a research team. Tests included school-based rapid antigen or polymerase chain reaction testing, at-home rapid antigen testing, and off-site nucleic acid amplification testing. RESULTS We performed nearly 5700 screening tests on more than 1600 K-12 school students and staff members. The total cost for the Durham testing program in 5 public charter K-12 schools, each with 500-1000 students, was $246 587 and approximately 752 h per semester; cost per test was $70 and cost per positive result was $7076. The total cost for the Kansas City program in eight public K-12 schools was $292 591 and required approximately 537 h in personnel time for school-based testing; cost per test was $132 and cost per positive result was $4818. SARS-CoV-2 positivity rates were generally lower (0-16.16%) than rates in the community (2.7-36.47%) throughout all testing weeks. CONCLUSIONS AND RELEVANCE Voluntary screening testing programs in K-12 schools are costly and rarely detect asymptomatic positive persons, particularly in universally masked settings. CLINICAL TRIAL REGISTRATION NCT04831866.
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Affiliation(s)
- Ibukunoluwa C Kalu
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kanecia O Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
- The ABC Science Collaborative, Durham, North Carolina, USA
| | | | - Dana Keener Mast
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri, Kansas City, Kansas City, Missouri, USA
| | - Ashley M Blakemore
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ganga Moorthy
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Angelique E Boutzoukas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Melissa M Campbell
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Diya Uthappa
- Duke University School of Medicine, Doctor of Medicine Program, Durham, North Carolina, USA
| | - Jesse DeLaRosa
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Laura J Edwards
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rangaraj Selvarangan
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri, Kansas City, Kansas City, Missouri, USA
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
- The ABC Science Collaborative, Durham, North Carolina, USA
| | - Tara K Mann
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer E Schuster
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri, Kansas City, Kansas City, Missouri, USA
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12
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Antoon JW, Hall M, Feinstein JA, Kyler KE, Shah SS, Girdwood ST, Goldman JL, Grijalva CG, Williams DJ. Guideline-Concordant Antiviral Treatment in Children at High Risk for Influenza Complications. Clin Infect Dis 2023; 76:e1040-e1046. [PMID: 35867691 PMCID: PMC10169402 DOI: 10.1093/cid/ciac606] [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: 05/17/2022] [Revised: 07/05/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND National guidelines recommend antiviral treatment for children with influenza at high risk for complications regardless of symptom duration. Little is known about concordance of clinical practice with this recommendation. METHODS We performed a cross-sectional study of outpatient children (aged 1-18 years) at high risk for complications who were diagnosed with influenza during the 2016-2019 influenza seasons. High-risk status was determined using an existing definition that includes age, comorbidities, and residence in a long-term care facility. The primary outcome was influenza antiviral dispensing within 2 days of influenza diagnosis. We determined patient- and provider-level factors associated with guideline-concordant treatment using multivariable logistic regression. RESULTS Of the 274 213 children with influenza at high risk for influenza complications, 159 350 (58.1%) received antiviral treatment. Antiviral treatment was associated with the presence of asthma (aOR, 1.13; 95% confidence interval [CI], 1.11-1.16), immunosuppression (aOR, 1.10; 95% CI, 1.05-1.16), complex chronic conditions (aOR, 1.04; 95% CI, 1.01-1.07), and index encounter in the urgent care setting (aOR, 1.3; 95% CI, 1.26-1.34). Factors associated with decreased odds of antiviral treatment include age 2-5 years compared with 6-17 years (aOR, 0.95; 95% CI, .93-.97), residing in a chronic care facility (aOR, .61; 95% CI, .46-.81), and index encounter in an emergency department (aOR, 0.66; 95% CI, .63-.71). CONCLUSIONS Among children with influenza at high risk for complications, 42% did not receive guideline-concordant antiviral treatment. Further study is needed to elucidate barriers to appropriate use of antivirals in this vulnerable population.
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Affiliation(s)
- James W Antoon
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.,Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - James A Feinstein
- Department of Pediatrics, Adult and Child Consortium for Health Outcomes Research & Delivery Science, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Kathryn E Kyler
- Department of Pediatrics, Division of Hospital Medicine, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Samir S Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center & Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sonya Tang Girdwood
- Divisions of Hospital Medicine and Clinical Pharmacology, Cincinnati Children's Hospital Medical Center & Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jennifer L Goldman
- Department of Pediatrics, Division of Clinical Pharmacology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA.,Department of Pediatrics, Division of Infectious Diseases, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Carlos G Grijalva
- Division of Pharmacoepidemiology, Departments of Health Policy and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Derek J Williams
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.,Division of Hospital Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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13
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Sivasankar S, Goldman JL, Hoffman MA. Variation in antibiotic resistance patterns for children and adults treated at 166 non-affiliated US facilities using EHR data. JAC Antimicrob Resist 2023; 5:dlac128. [PMID: 36601546 PMCID: PMC9806600 DOI: 10.1093/jacamr/dlac128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/25/2022] [Indexed: 01/03/2023] Open
Abstract
Background Antibiotic resistance (AR) is a global public health threat. Surveillance of baseline AR and trends and emerging resistance among priority bacterial isolates with respect to the age of the patients and the type of healthcare setting are required due to differences in antimicrobial need and use in these populations. Methods We performed a retrospective study using deidentified electronic health record (EHR) data in the Cerner Health Facts™ data warehouse. Antibiotic susceptibility data were extracted for all bacterial isolates of interest at 166 non-affiliated healthcare facilities reporting microbiology susceptibility results of the FDA recommended antibiotics between the years 2012 to 2017. We assessed and visualized the slope coefficient from linear regression to compare changes in resistance over time for the four patient care groups. Results The trends in resistance rates to clinically relevant antibiotics were influenced by age and care setting. For example, ertapenem-resistant Enterobacter cloacae isolates from children overall increased significantly compared with adults (0.7% to 9.8%, 2.1% to 2.8%, P = 0.00013) and isolates from children in paediatric facilities increased significantly compared with facilities treating adults and children (0.1% to 27.1%, 0.9% to 3.8%, P = 0.0002). Conclusions Large-scale analysis of EHR data from 166 facilities shows that AR patterns for some bug-drug combinations vary by care setting and patient age. We describe novel data visualizations to interpret large-scale EHR data on the prevalence and trends of AR that should influence antimicrobial prescribing and antimicrobial stewardship programme interventions.
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Affiliation(s)
- Shivani Sivasankar
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO, USA
| | - Jennifer L Goldman
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO, USA,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Mark A Hoffman
- Corresponding author. E-mail: ; @markhoffmankc, @ShivaniSivasank
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14
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Urban V, Lee BR, Goldman JL, Duty A, Wirtz AL. Adherence to antimicrobial agent recommendations and utilization during drug shortages. Am J Health Syst Pharm 2022; 80:S62-S69. [DOI: 10.1093/ajhp/zxac355] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Indexed: 12/03/2022] Open
Abstract
Abstract
Disclaimer
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
Purpose
Antimicrobial shortages occur frequently, but the impact on antimicrobial use is not well defined. The study objectives were to characterize utilization of antimicrobial agents with established restrictions during a medication shortage, assess utilization of shortage antimicrobials following shortage resolution, and examine use of recommended alternative antimicrobials during the shortage period.
Methods
Five antimicrobials were restricted due to shortages from 2015 through 2020. Chart review of inpatients receiving a shortage medication during each restriction period was performed to determine factors influencing adherence to established restriction criteria. To assess antimicrobial utilization during shortages and following shortage resolution, days of therapy per 1,000 patient days were analyzed for each shortage and alternative antimicrobial.
Results
Across 266 patients receiving shortage antimicrobials, antimicrobial use was adherent to restriction criteria for 151 patients (57%). Meropenem, ampicillin/sulbactam, and piperacillin/tazobactam had the greatest adherence. Median duration of therapy was shorter in the nonadherent group than in the adherent group (4 vs 2 days, P < 0.0001). Shortage antimicrobial use was more likely to be nonadherent for indications such as sepsis rule out, surgical prophylaxis, and urinary tract infection. Adherence increased with use of visual cues in the chart (99% vs 94%, P = 0.03). Utilization of shortage agents decreased during shortage and restriction periods. After shortage resolution, utilization exceeded baseline usage for all agents except meropenem and metronidazole, for which usage returned to baseline. Utilization of 1 to 2 recommended alternative agents for each shortage agent significantly increased during the shortage and restriction periods.
Conclusion
Current strategies for restriction significantly decreased utilization of shortage antimicrobials, but additional opportunities exist. Identifying alternative agents and providing visual cues increased adherence.
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Affiliation(s)
| | - Brian R Lee
- University of Missouri Kansas City School of Medicine, Kansas City, MO, and Division of Health Services and Outcomes Research, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City , MO, USA
| | - Jennifer L Goldman
- Department of Pharmacy, Children’s Mercy Hospital, Kansas City, MO, and Department of Pediatrics, Children’s Mercy Hospitals & Clinics and University of Missouri–Kansas City, Kansas City , MO, USA
| | - Ashley Duty
- Department of Pharmacy, Nationwide Children’s Hospital, Columbus , OH, USA
| | - Ann L Wirtz
- Department of Pharmacy, Children’s Mercy Hospital, Kansas City , MO, USA
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15
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Schuster JE, Kalu IC, Goldman JL. Modeling Cost and Outcomes of SARS-CoV-2 School Testing Programs. JAMA Pediatr 2022; 176:1050. [PMID: 35994276 DOI: 10.1001/jamapediatrics.2022.2976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jennifer E Schuster
- Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Ibukunoluwa C Kalu
- Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer L Goldman
- Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
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16
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Boutzoukas AE, Zimmerman KO, Inkelas M, Brookhart MA, Benjamin DK, Butteris S, Koval S, DeMuri GP, Manuel VG, Smith MJ, McGann KA, Kalu IC, Weber DJ, Falk A, Shane AL, Schuster JE, Goldman JL, Hickerson J, Benjamin V, Edwards L, Erickson TR, Benjamin DK. School Masking Policies and Secondary SARS-CoV-2 Transmission. Pediatrics 2022; 149:e2022056687. [PMID: 35260896 PMCID: PMC9647584 DOI: 10.1542/peds.2022-056687] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Throughout the COVID-19 pandemic, masking has been a widely used mitigation practice in kindergarten through 12th grade (K-12) school districts to limit within-school transmission. Prior studies attempting to quantify the impact of masking have assessed total cases within schools; however, the metric that more optimally defines effectiveness of mitigation practices is within-school transmission, or secondary cases. We estimated the impact of various masking practices on secondary transmission in a cohort of K-12 schools. METHODS We performed a multistate, prospective, observational, open cohort study from July 26, 2021 to December 13, 2021. Districts reported mitigation practices and weekly infection data. Districts that were able to perform contact tracing and adjudicate primary and secondary infections were eligible for inclusion. To estimate the impact of masking on secondary transmission, we used a quasi-Poisson regression model. RESULTS A total of 1 112 899 students and 157 069 staff attended 61 K-12 districts across 9 states that met inclusion criteria. The districts reported 40 601 primary and 3085 secondary infections. Six districts had optional masking policies, 9 had partial masking policies, and 46 had universal masking. In unadjusted analysis, districts that optionally masked throughout the study period had 3.6 times the rate of secondary transmission as universally masked districts; and for every 100 community-acquired cases, universally masked districts had 7.3 predicted secondary infections, whereas optionally masked districts had 26.4. CONCLUSIONS Secondary transmission across the cohort was modest (<10% of total infections) and universal masking was associated with reduced secondary transmission compared with optional masking.
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Affiliation(s)
| | - Kanecia O. Zimmerman
- Duke Clinical Research Institute
- Departments of Pediatrics
- Co-Chair, The ABC Science Collaborative, Durham, North Carolina
| | - Moira Inkelas
- Fielding School of Public Health
- Clinical and Translational Science Institute, University of California Los Angeles, Los Angeles, California
| | - M. Alan Brookhart
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Sabrina Butteris
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Maddison, Wisconsin
| | - Shawn Koval
- University of Wisconsin Health, Healthy Kids Collaborative, Madison, Wisconsin
| | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Maddison, Wisconsin
| | - Vladimir G. Manuel
- Clinical and Translational Science Institute, University of California Los Angeles, Los Angeles, California
- University of California David Geffen School of Medicine, Los Angeles, California
| | | | | | | | - David J. Weber
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Amy Falk
- Department of Pediatrics, Aspirus Doctors Clinic, Wisconsin Rapids, Wisconsin
| | - Andi L. Shane
- Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Jennifer L. Goldman
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | | | | | | | | | - Daniel K. Benjamin
- Duke Clinical Research Institute
- Departments of Pediatrics
- Co-Chair, The ABC Science Collaborative, Durham, North Carolina
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17
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Streck HL, Goldman JL, Lee BR, Sheets JM, Wirtz AL. Evaluation of the Treatment of Aspiration Pneumonia in Hospitalized Children. J Pediatric Infect Dis Soc 2022; 11:102-107. [PMID: 34902014 DOI: 10.1093/jpids/piab122] [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: 04/20/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Aspiration pneumonia (AP) treatment is variable with limited available guidance on optimal antibiotic choice and duration. This study evaluated the impact of antibiotic regimen and duration on treatment failure for AP in children and correlated the effects of antimicrobial stewardship program (ASP) interventions on treatment duration. METHODS Hospitalized children who received antibiotics for AP were identified through an existing ASP repository. Diagnosis was confirmed through ASP documentation with either an international classification of diseases 9/10 code or physician diagnosis of AP. Incidence of treatment failure (necrotizing pneumonia, lung abscess, empyema, or retreatment) was compared between patients receiving shorter (≤7 days) vs longer (>7 days) course of antibiotics and between various empiric/final antibiotic regimens utilized. Duration of treatment was evaluated in patients with or without an ASP intervention. RESULTS Four hundred and nineteen treatment courses for AP were included. Nineteen episodes (4.5%) of treatment failure were identified. No difference in treatment failure was observed between shorter vs longer courses (8 vs 11 episodes). An aminopenicillin plus beta-lactamase inhibitor was most frequently utilized for both empiric (47.2%) and final treatment (67.5%). Treatment failure rates did not differ with length of intravenous therapy nor empiric/final antibiotic regimen chosen. ASP interventions targeting duration were associated with significantly shorter courses (6.28 vs 7.46 days; P = .04). CONCLUSIONS Shorter courses of antibiotics did not result in more treatment failure for AP when compared to longer courses. Neither antibiotic choice nor route impacted treatment failure rates. ASPs may optimize the treatment of pediatric AP.
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Affiliation(s)
- Haley L Streck
- Department of Pharmacy, Children's Mercy, Kansas City, Missouri, USA
| | - Jennifer L Goldman
- Department of Infectious Diseases, Children's Mercy, Kansas City, Missouri, USA
| | - Brian R Lee
- Department of Health Services and Outcomes Research, Children's Mercy, Kansas City, Missouri, USA
| | - Justin M Sheets
- Department of Pharmacy, Children's Mercy, Kansas City, Missouri, USA
| | - Ann L Wirtz
- Department of Pharmacy, Children's Mercy, Kansas City, Missouri, USA
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18
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Goldman JL, Miller JO, Miller N, Eveleigh R, Gibson A, Phillips EJ, Pastinen T. HLA-B*07:02 and HLA-C*07:02 are associated with trimethoprim-sulfamethoxazole respiratory failure. Pharmacogenomics J 2022; 22:124-129. [PMID: 35169303 PMCID: PMC9125581 DOI: 10.1038/s41397-022-00266-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/17/2021] [Accepted: 01/11/2022] [Indexed: 04/28/2023]
Abstract
We have identified an underrecognized severe adverse drug reaction (ADR) of trimethoprim-sulfamethoxazole (TMP-SMX) associated respiratory failure in previously healthy children and young adults. We investigated potential genetic risk factors associated with TMP-SMX induced respiratory failure in a cohort of seven patients. We explored whole genome sequence among seven patients representing nearly half of all reported cases worldwide and 63 unrelated control individuals in two stages: (1) human leukocyte antigen (HLA) locus variation as several other ADRs have been associated HLA genetic variants and (2) coding variation to catalog and explore potential rare variants contributing to this devastating reaction. All cases were either heterozygous (carriers) or homozygous for the common HLA-B*07:02-HLA-C*07:02 haplotype. Despite the small sample size, this observation is statistically significant both in conservative comparison to maximum reported population frequencies (binomial P = 0.00017 for HLA-B and P = 0.00028 for HLA-C) and to our control population assessed by same HLA genotyping approach (binomial P = 0.000001 for HLA-B and P = 0.000018 for HLA-C). No gene elsewhere in the genome harnessed shared rare case enriched coding variation. Our results suggests that HLA-B*07:02 and HLA-C*07:02 are necessary for a patient to develop respiratory failure due to TMP-SMX.
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Affiliation(s)
- Jennifer L Goldman
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA.
| | - Jenna O Miller
- Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Neil Miller
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Robert Eveleigh
- Canadian Center for Computational Genomics, McGill University and Genome Quebec Innovation Center, Montreal, QC, Canada
| | - Andrew Gibson
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, WA, Australia
| | - Elizabeth J Phillips
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, WA, Australia
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tomi Pastinen
- Center for Pediatric Genomic Medicine, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
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19
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Haroz EE, Kalb LG, Newland JG, Goldman JL, Mast DK, Ko LK, Grass R, Shah P, Walsh T, Schuster JE. Implementation of School-Based COVID-19 Testing Programs in Underserved Populations. Pediatrics 2022; 149:e2021054268G. [PMID: 34737173 PMCID: PMC9647741 DOI: 10.1542/peds.2021-054268g] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
Evidence suggests that coronavirus disease 2019 (COVID-19) testing in schools can add a layer of protection to reduce the spread of Severe Acute Respiratory Syndrome Coronavirus 2 and facilitate a safer return to in-person learning. Despite this evidence, implementation of testing in school settings has been challenging initially because of a lack of funding and limited availability of testing, but, as the pandemic has progressed and more funding and resources have been devoted to testing, other implementation challenges have arisen. We describe key implementation barriers and strategies that have been operationalized across 5 projects working to help schools with predominantly underserved populations who have faced significant COVID-19-related health disparities. We leveraged a key framework from the implementation science field to identify the challenges and used a matching tool to align implementation strategies to these challenges. Our findings suggest that the biggest obstacles to COVID-19 testing were the perceived relative advantages versus burden of COVID-19 testing, limited engagement with the target beneficiaries (eg, families, students, staff), and innovation complexity. Common strategies to overcome these challenges included identifying and preparing testing champions, altering incentive and allowance structures, assessing for readiness, and identifying barriers and facilitators. We aim to augment existing implementation guidance for schools by describing common barriers and recommended solutions from the implementation science field. Our results indicate a clear need to provide implementation support to schools to facilitate COVID-19 testing as an added layered mitigation strategy.
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Affiliation(s)
- Emily E. Haroz
- Johns Hopkins Center for American Indian Health, Baltimore, Maryland
| | - Luther G. Kalb
- Kennedy Krieger Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | - Linda K. Ko
- University of Washington, Seattle, Washington
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ryan Grass
- Johns Hopkins Center for American Indian Health, Baltimore, Maryland
| | - Parth Shah
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Tyler Walsh
- Washington University in St Louis, St Louis, Missouri
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20
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Goldman JL, Schuster JE, Maier VF, Anand R, Hill EE, Butteris SM, DeMuri GP, Omidfar SA, Brookhart MA, Pak J, Benjamin DK, Zimmerman KO. Urban Classification, Not COVID-19 Community Rates, Was Associated With Modes of Learning in US K-12 Schools? Pediatrics 2022; 149:e2021054268M. [PMID: 34737176 PMCID: PMC9647778 DOI: 10.1542/peds.2021-054268m] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES To identify factors associated with the decision to provide in-person, hybrid, and remote learning in kindergarten through 12th grade school districts during the 2020-2021 school year. METHODS We performed a retrospective study evaluating school district mode of learning and community coronavirus 2019 (COVID-19) incidence and percentage positivity rates at 3 time points during the pandemic: (1) September 15, 2020 (the beginning of the school year, before Centers for Disease Control and Prevention guidance); (2) November 15, 2020 (midsemester after the release of Centers for Disease Control and Prevention guidance and an increase of COVID-19 cases); and (3) January 15, 2021 (start of the second semester and peak COVID-19 rates). Five states were included in the analysis: Michigan, Missouri, North Carolina, Ohio, and Wisconsin. The primary outcome was mode of learning in elementary, middle, and high schools during 3 time points. The measures included community COVID-19 incidence and percentage positivity rates, school and student demographics, and county size classification of school location. RESULTS No relationship between mode of learning and community COVID-19 rates was observed. County urban classification of school location was associated with mode of learning with school districts in nonmetropolitan and small metropolitan counties more likely to be in-person. CONCLUSIONS Community COVID-19 rates did not appear to influence the decision of when to provide in-person learning. Further understanding of factors driving the decisions to bring children back into the classroom are needed. Standardizing policies on how schools apply national guidance to local decision-making may decrease disparities in emergent crises.
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Affiliation(s)
- Jennifer L. Goldman
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri– Kansas City
| | - Jennifer E. Schuster
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri– Kansas City
| | | | - Rohit Anand
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Elizabeth E. Hill
- Department of Pediatrics, University of Michigan Health, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | | | | | | | | | - Joyce Pak
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Daniel K. Benjamin
- School of Medicine
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
- The ABC Science Collaborative
| | - Kanecia O. Zimmerman
- School of Medicine
- Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina
- The ABC Science Collaborative
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21
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Zimmerman KO, Goldman JL, Schuster JE, Mena A, Quiriconi M, Butteris SM, Koval S, DeMuri GP, Mueller NB, Benjamin DK, Armstrong SC, Kalu IC, Boutzoukas A, Moorthy GS, Lane H, Weber DJ, Newland JG. Building a National Framework to Pair Scientists and Schools During a Global Pandemic. Pediatrics 2022; 149:e2021054268D. [PMID: 34737179 PMCID: PMC9647736 DOI: 10.1542/peds.2021-054268d] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic forced the suspension of in-person education in schools serving students in kindergarten through 12th grade (K-12) across the United States. As time passed, teachers, students, and parents struggled with remote education. With limited guidance at the federal level, physicians and school leaders across the country collaborated to develop local solutions for schools. This article describes the lessons learned from the development of 4 academic-community partnerships and collaboration among these partnerships to provide national leadership on managing COVID-19 mitigation in the K-12 environment. In addition, we describe a pathway forward for using academic-community partnerships to improve child health.
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Affiliation(s)
- Kanecia O. Zimmerman
- Departments of Pediatrics
- Duke Clinical Research Institute, School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | - Jennifer L. Goldman
- Department of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Jennifer E. Schuster
- Department of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Atenas Mena
- Children’s Mercy Kansas City, Kansas City, Missouri
| | | | - Sabrina M. Butteris
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Shawn Koval
- Healthy Kids Collaborative, University of Wisconsin Health, Madison, Wisconsin
| | - Gregory P. DeMuri
- Department of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Nancy B. Mueller
- Brown School Evaluation Center, Washington University in St Louis, St Louis, Missouri
| | - Daniel K. Benjamin
- Departments of Pediatrics
- Duke Clinical Research Institute, School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | - Sarah C. Armstrong
- Departments of Pediatrics
- Duke Clinical Research Institute, School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | - Ibukunoluwa C. Kalu
- Departments of Pediatrics
- The ABC Science Collaborative, Durham, North Carolina
| | - Angelique Boutzoukas
- Departments of Pediatrics
- Duke Clinical Research Institute, School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | | | - Hannah Lane
- Population Health Sciences, School of Medicine, Duke University, Durham, North Carolina
| | - David J. Weber
- Departments of Internal Medicine and Pediatrics, Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
| | - Jason G. Newland
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
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22
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Markham JL, Hackman S, Hall M, Burns A, Goldman JL. Inpatient outcomes for children receiving empiric methicillin-resistant Staphylococcus aureus coverage for complicated pneumonia. J Hosp Med 2022; 17:36-41. [PMID: 35504578 DOI: 10.1002/jhm.2736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/22/2021] [Accepted: 12/09/2021] [Indexed: 11/07/2022]
Abstract
Rigorous evidence for antibiotic management of pediatric complicated pneumonia is lacking, likely contributing to variation in empiric antibiotic(s). Using the Pediatric Health Information System database, we sought to describe use and clinical outcomes of children hospitalized with complicated pneumonia who received empiric antibiotic regimens with and without methicillin-resistant Staphylococcus aureus (MRSA) coverage. We evaluated empiric antibiotic selection on Day 0-1, grouping based on use of an antibiotic with or without MRSA coverage. We used generalized linear mixed effects models to examine the association of MRSA coverage and outcomes. Across 46 children's hospitals, 71.5% of children (N = 1279) received an empiric antibiotic regimen with MRSA coverage. In adjusted analyses, length of stay, need for repeat pleural drainage procedures, 7-day emergency department revisits and 7-day readmissions were similar between groups. Future prospective studies examining the need for MRSA coverage may assist in refining national treatment guidelines for complicated pneumonia in children.
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Affiliation(s)
- Jessica L Markham
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Sophia Hackman
- Department of Graduate Medical Education, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Matt Hall
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Alaina Burns
- Department of Pharmacy, Children's Mercy Kansas City, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri, USA
| | - Jennifer L Goldman
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
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23
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Chang WC, Abe R, Anderson P, Anderson W, Ardern-Jones MR, Beachkofsky TM, Bellón T, Biala AK, Bouchard C, Cavalleri GL, Chapman N, Chodosh J, Choi HK, Cibotti RR, Divito SJ, Dewar K, Dehaeck U, Etminan M, Forbes D, Fuchs E, Goldman JL, Holmes JH, Hope EA, Hung SI, Hsieh CL, Iovieno A, Jagdeo J, Kim MK, Koelle DM, Lacouture ME, Le Pallec S, Lehloenya RJ, Lim R, Lowe A, McCawley J, McCawley J, Micheletti RG, Mockenhaupt M, Niemeyer K, Norcross MA, Oboh D, Olteanu C, Pasieka HB, Peter J, Pirmohamed M, Rieder M, Saeed HN, Shear NH, Shieh C, Straus S, Sukasem C, Sung C, Trubiano JA, Tsou SY, Ueta M, Volpi S, Wan C, Wang H, Wang ZQ, Weintraub J, Whale C, Wheatley LM, Whyte-Croasdaile S, Williams KB, Wright G, Yeung SN, Zhou L, Chung WH, Phillips EJ, Carleton BC. Corrigendum to 'SJS/TEN 2019: From science to translation' [J. Dermatol. Sci. 98/1 (2020) 2-12]. J Dermatol Sci 2021; 104:146-147. [PMID: 34763988 PMCID: PMC9371621 DOI: 10.1016/j.jdermsci.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Wan-Chun Chang
- Division of Translational Therapeutics, Department of
Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC,
Canada,British Columbia Children’s Hospital Research
Institute, Vancouver, BC, Canada
| | - Riichiro Abe
- Niigata University Graduate School of Medical and Dental
Sciences, Niigata, Japan
| | - Paul Anderson
- Stevens-Johnson Syndrome Foundation, Westminster, CO,
USA
| | | | - Michael R. Ardern-Jones
- Faculty of Medicine, University of Southampton, Southampton
General Hospital, Southampton, UK
| | | | - Teresa Bellón
- Drug Hypersensitivity Group. Hospital La Paz Institute for
Health Research (IdiPAZ), Madrid, Spain
| | - Agnieszka K. Biala
- Division of Translational Therapeutics, Department of
Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC,
Canada
| | | | - Gianpiero L. Cavalleri
- School of Pharmacy and Molecular and Cellular Therapeutics,
Royal College of Surgeons in Ireland, Dublin, Ireland,FutureNeuro SFI Research Centre, Royal College of
Surgeons in Ireland, Dublin, Ireland
| | | | - James Chodosh
- Massachusetts Eye and Ear, Harvard Medical School, Boston,
MA, USA
| | - Hyon K. Choi
- Division of Rheumatology, Allergy and Immunology,
Massachusetts General Hospital, Boston, MA, USA
| | - Ricardo R. Cibotti
- National Institute of Arthritis and Musculoskeletal and
Skin Diseases, NIH, USA
| | - Sherrie J. Divito
- Department of Dermatology, Brigham and Women’s
Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Ulrike Dehaeck
- Department of Obstetrics and Gynecology, University of
British Columbia, Vancouver, BC, Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences,
University of British Columbia, Vancouver, BC, Canada
| | - Diane Forbes
- Canadian Institutes of Health Research, Ottawa, ON,
Canada
| | - Esther Fuchs
- Department of Obstetrics and Gynecology, University of
Washington, Seattle, WA, USA
| | | | - James H. Holmes
- Wake Forest University School of Medicine, WFBMC Burn
Center, Winston-Salem, NC, USA
| | | | - Shuen-Iu Hung
- Cancer Vaccine and Immune Cell Therapy Core Laboratory,
Chang Gung Immunology Consortium, Chang Gung Memorial Hospital, Linkou, Taoyuan,
Taiwan,Institute of Pharmacology, National Yang-Ming University,
Taipei, Taiwan
| | | | - Alfonso Iovieno
- Department of Ophthalmology and Visual Sciences,
University of British Columbia, Vancouver General Hospital Eye Care Center,
Vancouver, BC, Canada
| | | | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University
College of Medicine, Seoul, South Korea
| | - David M. Koelle
- Department of Medicine, University of Washington, Seattle,
WA, USA
| | | | - Sophie Le Pallec
- Association des malades des syndromes de Lyell et de
Stevens-Johnson (Amalyste), Paris, France
| | - Rannakoe J. Lehloenya
- Division of Dermatology, Department of Medicine,
University of Cape Town, Cape Town, South Africa
| | - Robyn Lim
- Health Products and Food Branch, Health Canada, Ottawa,
ON, Canada
| | - Angie Lowe
- SJS/TEN International Awareness (STIA), Lucky Lake, SK,
Canada
| | - Jean McCawley
- Stevens-Johnson Syndrome Foundation, Westminster, CO,
USA
| | - Julie McCawley
- Stevens-Johnson Syndrome Foundation, Westminster, CO,
USA
| | - Robert G. Micheletti
- Department of Dermatology, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, PA, USA
| | - Maja Mockenhaupt
- Dokumentationszentrum schwerer Hautreaktionen (dZh),
Department of Dermatology, Medical Center and Medical Faculty, University of
Freiburg, Freiburg, Germany
| | | | - Michael A. Norcross
- Laboratory of Immunology, Division of Biotechnology
Review and Research III (DBRR III), Office of Biotechnology Products (OBP), Office
of Pharmaceutical Quality (OPQ), Center for Drug Evaluation and Research (CDER),
FDA, Silver Spring, MD, USA
| | - Douglas Oboh
- Stevens-Johnson Syndrome Foundation, Westminster, CO,
USA
| | - Cristina Olteanu
- Division of Dermatology, Department of Medicine,
University of Alberta, Edmonton, AB, Canada
| | - Helena B. Pasieka
- Department of Der matology, MedStar Washington Hospital
Center, Washington, DC, USA
| | - Jonathan Peter
- Division of Allergy and Clinical Immunology, Department
of Medicine, University of Cape Town, Cape Town, South Africa
| | - Munir Pirmohamed
- Department of Molecular and Clinical Pharmacology,
University of Liverpool, Liverpool, UK
| | - Michael Rieder
- Department of Paediatrics, Children’s
Hospital/London Health Sciences Centre, Schulich School of Medicine & Dentistry,
Western University, London, ON, Canada
| | - Hajirah N. Saeed
- Massachusetts Eye and Ear, Harvard Medical School, Boston,
MA, USA
| | - Neil H. Shear
- Sunnybrook Health Sciences Centre, University of Toronto,
ON, Canada
| | - Christine Shieh
- Department of Ophthalmology, Vanderbilt Eye Institute,
Nashville, TN, USA
| | - Sabine Straus
- Dutch Medicines Evaluation Board, Pharmacovigilance Risk
Assessment Committee, European Medicines Agency, Utrecht, Netherlands
| | | | - Cynthia Sung
- Health Products Regulation Group, Health Sciences
Authority Singapore, Duke-NUS Medical School, Singapore
| | - Jason A. Trubiano
- Department of Infectious Diseases, Austin Health,
Heidelberg, Germany,Department of Medicine, University of Melbourne,
Victoria, Australia
| | | | - Mayumi Ueta
- Department of Frontier Medical Science and Technology for
Ophthalmology, Kyoto Pre fectural University of Medicine, Kyoto, Japan
| | - Simona Volpi
- National Human Genome Research Institute, NIH, Bethesda,
ML, USA
| | - Chen Wan
- Genome British Columbia, Vancouver, BC, Canada
| | - Hongsheng Wang
- Institute of Dermatology, Chinese Academy of Medical
Sciences, National Center for STD and Leprosy Control, China CDC, Nanjing,
China
| | | | - Jessica Weintraub
- Division of Pharmacovigilance I, Office of Surveillance
and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug
Administration, USA
| | | | - Lisa M. Wheatley
- National Institute of Allergy and Infectious Diseases,
NIH, Bethesda, ML, USA
| | | | - Kristina B. Williams
- Department of Pathology, Microbiology and Immunology,
Vanderbilt University Medical Center, Nashville, TN, USA
| | - Galen Wright
- Division of Translational Therapeutics, Department of
Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC,
Canada
| | - Sonia N. Yeung
- Department of Ophthalmology and Visual Sciences,
University of British Columbia, Vancouver General Hospital Eye Care Center,
Vancouver, BC, Canada
| | - Li Zhou
- Division of General Internal Medicine and Primary Care,
Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical
and Research Center, Chang Gung Memorial Hospital, Linkou, Taipei, Keelung, Taoyuan,
Taiwan,Cancer Vaccine and Immune Cell Therapy Core Laboratory,
Chang Gung Immunology Consortium, Chang Gung Memorial Hospital, Linkou, Taoyuan,
Taiwan,College of Medicine, Chang Gung University, Taoyuan,
Taiwan,Whole-Genome Research Core Laboratory of Human Diseases,
Chang Gung Memorial Hospital, Keelung, Taiwan,Department of Dermatology, Xiamen Chang Gung Hospital,
Xiamen, China
| | - Elizabeth J. Phillips
- Department of Pathology, Microbiology and Immunology,
Vanderbilt University Medical Center, Nashville, TN, USA,Institute for Immunology and Infectious Diseases, Murdoch
University, Murdoch, Australia,Division of Infectious Diseases, Department of Medicine,
Vanderbilt University Medical Center, Nashville, TN, USA,Department of Pharmacology, Vanderbilt University Medical
Center, Nashville, TN, USA
| | - Bruce C. Carleton
- Division of Translational Therapeutics, Department of
Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC,
Canada,British Columbia Children’s Hospital Research
Institute, Vancouver, BC, Canada
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24
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Kyler KE, Lee BR, Glynn EF, Waddell JP, Hoffman MA, Goldman JL. Clinical Outcome and Antibiotic Dosing Differences by Weight in Children With Acute Osteomyelitis. Hosp Pediatr 2021; 11:1112-1120. [PMID: 34593567 DOI: 10.1542/hpeds.2021-005890] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate for weight-based differences in clinical outcomes and antibiotic dosing variability for children hospitalized with acute hematogenous osteomyelitis (AHO). METHODS We performed a retrospective cohort study of children aged 2 to 17 years and hospitalized with a primary AHO International Classification of Diseases, Ninth Revision or International Classification of Diseases, 10th Revision diagnosis code between 2010 and 2017 using the Cerner Health Facts database. Weight categories (healthy, overweight, obesity) were determined by using Centers for Disease Control and Prevention age- and sex-specific BMI percentiles. Rates of procedures, complications, and length of stay (LOS) were compared between groups. Dosing variability between groups was assessed by comparing the initial milligrams per kilogram per day of prescribed antibiotics. RESULTS We identified 755 children with AHO for inclusion. Children with overweight and obesity were more likely to undergo surgical procedures (19% and 17%, respectively) compared with children with a healthy weight (10%; P = .009). They also had a longer LOS (5.7 and 5.8 days) than children with a healthy weight (4.9 days; P = .03). There were no differences in complication rates between weight categories. Mean weight-adjusted daily dose for the most frequently prescribed antibiotics was different by weight category, with children in higher weight categories more likely to receive lower weight-based doses. CONCLUSIONS Children with overweight and obesity hospitalized for AHO were more likely to undergo procedures, have longer LOS, and receive lower weight-based antibiotic dosing compared with children with a healthy weight. Our findings suggest that weight should be carefully considered when treating children with AHO.
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Affiliation(s)
- Kathryn E Kyler
- Children's Mercy Kansas City, Kansas City, Missouri .,Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Brian R Lee
- Children's Mercy Kansas City, Kansas City, Missouri
| | - Earl F Glynn
- Children's Mercy Kansas City, Kansas City, Missouri
| | | | - Mark A Hoffman
- Children's Mercy Kansas City, Kansas City, Missouri.,Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.,University of Kansas Medical Center, Kansas City, Kansas
| | - Jennifer L Goldman
- Children's Mercy Kansas City, Kansas City, Missouri.,Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
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25
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Murphy ME, Tang Girdwood S, Goldman JL, Scheetz MH, Downes KJ. Precision dosing of vancomycin: in defence of AUC-guided therapy in children. J Antimicrob Chemother 2021; 76:2494-2497. [PMID: 34096598 PMCID: PMC8633448 DOI: 10.1093/jac/dkab194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In 2020, new vancomycin guidelines were released, recommending the transition from trough-based to AUC24 monitoring for adult and paediatric patients. Given the resources required to achieve this transition, there has been debate about the costs and benefits of AUC24-based monitoring. A recent narrative review of vancomycin therapeutic drug monitoring in paediatrics claims to have uncovered the methodological weaknesses of the data that informed the guidelines and advises against premature adoption of AUC24-guided monitoring. In this article, we present supporting arguments for AUC24-guided monitoring in children, which include that: (i) troughs alone are inadequate surrogates for AUC24; (ii) vancomycin-associated nephrotoxicity has significant consequences that warrant optimization of dosing; (iii) a substantial portion of children receiving vancomycin are at high risk for poor outcomes and deserve targeted monitoring; and (iv) limited efficacy data in support of AUC24 is not a justification to revert to a less supported monitoring approach.
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Affiliation(s)
- Mark E Murphy
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Division of Clinical Pharmacology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Sonya Tang Girdwood
- Division of Clinical Pharmacology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jennifer L Goldman
- Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children’s Mercy Kansas City, Kansas City, MO, USA
- Division of Infectious Diseases, Children’s Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri—Kansas City, Kansas City, MO, USA
| | - Marc H Scheetz
- Pharmacometrics Center of Excellence, Department of Pharmacy Practice, College of Pharmacy, Chicago, IL, USA
- Department of Pharmacology, College of Graduate Studies, Midwestern University, Chicago, IL, USA
- Department of Pharmacy, Northwestern Medicine, Chicago, IL, USA
| | - Kevin J Downes
- The Center for Clinical Pharmacology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- The Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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26
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Tillman EM, Goldman JL. Evaluating and Mitigating Risk of Acute Kidney Injury with the Combination of Vancomycin and Piperacillin-Tazobactam in Children. Paediatr Drugs 2021; 23:373-380. [PMID: 34235634 DOI: 10.1007/s40272-021-00458-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/27/2022]
Abstract
The antibiotic combination of vancomycin (VAN) and piperacillin-tazobactam (PTZ) has been associated with an increased risk of acute kidney injury (AKI) in both adult and pediatric patients. In this review, we highlight some of the limitations of existing pediatric studies evaluating the combination of VAN/PTZ, focusing on AKI risk in specific pediatric patient populations. We also review the variability in defining AKI in children and provide guidance to clinicians for use of prospective surveillance and stewardship in mitigating the risk of AKI in pediatric patients treated with combination of VAN/PTZ. Based on review of available pediatric studies, if the combination of VAN/PTZ is selected as an empirical antibiotic combination, it should be used in those at low risk for AKI and should be used with extreme caution in patients with additional nephrotoxic risks. Systems should be in place to monitor the use of VAN/PTZ and associated renal function in those receiving this antibiotic combination.
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Affiliation(s)
- Emma M Tillman
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, USA
| | - Jennifer L Goldman
- Divisions of Pediatric Infectious Diseases and Clinical Pharmacology, Department of Pediatrics, Children's Mercy Hospital and the University of Missouri-Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
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27
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Tillman EM, Suppes SL, Miles N, Duty AM, Kelley KL, Goldman JL. Risks and mitigation strategies to prevent etoposide infusion-related reactions in children. Pharmacotherapy 2021; 41:700-706. [PMID: 34129705 DOI: 10.1002/phar.2603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/06/2021] [Revised: 05/13/2021] [Accepted: 05/20/2021] [Indexed: 11/07/2022]
Abstract
Etoposide is an antineoplastic agent widely used for treatment of many pediatric cancers. Etoposide has been associated with infusion-related reactions. In this brief report, we compare etoposide infusion-related reactions that occurred over a 10-year period at two freestanding pediatric hospitals. Infusion reactions occurred in 1% of patients at two hospitals across the study period. Rates of 4.8%, 3.4%, and 7.9% were observed at Children's Mercy Hospital during 2018, 2019, and 2020, respectively, after the implementation of in-line filters during etoposide infusions in late 2017. Of the 32 patients who experienced adverse reactions, 41% were rechallenged after the reaction and all were able to tolerate at least one future dose with either pre-treatment or extending infusion duration. This work highlights the importance of a multicenter approach to investigating adverse drug reactions (ADRs) as variation in practice can provide key information about ADRs and potential risk factors.
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Affiliation(s)
- Emma M Tillman
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sarah L Suppes
- Division of Clinical Pharmacology, Toxicology, and Therapeutic Innovation, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Nicholas Miles
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ashley M Duty
- Department of Pharmacy, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Kelsey L Kelley
- Department of Pharmacy, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Jennifer L Goldman
- Department of Pediatrics, Children's Mercy Hospital and the University of Missouri-Kansas City, Kansas City, Missouri, USA
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28
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El Feghaly RE, Goldman JL. Perceived Harm May Be Helpful: Fear of Fluoroquinolone-Associated Adverse Events in Children. Pediatrics 2021; 147:peds.2021-050321. [PMID: 33990460 DOI: 10.1542/peds.2021-050321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Rana E El Feghaly
- Children's Mercy Kansas City and University of Missouri-Kansas City, Kansas City, Missouri
| | - Jennifer L Goldman
- Children's Mercy Kansas City and University of Missouri-Kansas City, Kansas City, Missouri
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Joyner LM, Alicea LA, Goldman JL, Suppes SL, Tillman EM. Methods for Detecting Pediatric Adverse Drug Reactions From the Electronic Medical Record. J Clin Pharmacol 2021; 61:1479-1484. [PMID: 34031886 DOI: 10.1002/jcph.1916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/17/2021] [Accepted: 05/22/2021] [Indexed: 11/08/2022]
Abstract
Adverse drug reactions (ADRs) are common yet are often underreported, making them difficult to track and study. Prospective pharmacovigilance programs significantly increase detection and reporting of ADRs. The aim of this pilot study was to apply triggers used by a prospective pharmacovigilance program at a freestanding children's hospital to retrospectively detect ADRs at our institution, therefore determining if these methods could be replicated and provide the basis for implementation of a prospective pharmacovigilance program. In 2019, our institution had 22 000 inpatient admissions and 51 000 emergency room visits and had 21 ADRs voluntarily reported in an electronic medication safety tracking system. Additional ADRs were identified by methods including new or modified entries to a patient's allergy profile in the electronic medical record (EMR) and International Classification of Disease (ICD) codes. We identified 754 unique patients with changes to allergy profile and 5719 ICD codes in 3966 unique patients to evaluate. These triggers prompted screening of the EMR to validate the ADR, and we identified 280 ADRs occurring in 2019. Eight (2.8%) were identified solely by the electronic medication safety tracking system, 64 (23%) were identified by the allergy list, 110 (39%) were identified only by ICD coding, and the remaining 98 (35%) were identified by multiple methods. The use of triggers followed by review of the EMR identified 13-fold more ADRs than were voluntarily reported, illustrating the need for an active pharmacovigilance service and the successful use of multimodal methods to detect and track ADRs.
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Affiliation(s)
- Lydia M Joyner
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leah A Alicea
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jennifer L Goldman
- Department of Pediatrics, Children's Mercy Hospital and the University of Missouri-Kansas City, Kansas City, Kansas, USA
| | - Sarah L Suppes
- Division of Clinical Pharmacology, Toxicology, and Therapeutic Innovation, Children's Mercy Hospital, Kansas City, Kansas, USA
| | - Emma M Tillman
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Miller JO, Shih AR, Mino-Kenudson M, Taylor MS, Goldman JL. Trimethoprim-Sulfamethoxazole-associated Fulminant Respiratory Failure in Children and Young Adults. Am J Respir Crit Care Med 2021; 203:918-921. [PMID: 33513317 DOI: 10.1164/rccm.202009-3421le] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jenna O Miller
- University of Missouri-Kansas City and Children's Mercy Hospital Kansas City, Missouri and
| | - Angela R Shih
- Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
| | - Mari Mino-Kenudson
- Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
| | - Martin S Taylor
- Massachusetts General Hospital and Harvard Medical School Boston, Massachusetts
| | - Jennifer L Goldman
- University of Missouri-Kansas City and Children's Mercy Hospital Kansas City, Missouri and
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Markham JL, Hall M, Goldman JL, Bettenhausen JL, Gay JC, Feinstein J, Simmons J, Doupnik SK, Berry JG. Readmissions Following Hospitalization for Infection in Children With or Without Medical Complexity. J Hosp Med 2021; 16:134-141. [PMID: 33617439 PMCID: PMC7929613 DOI: 10.12788/jhm.3505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the prevalence and characteristics of infection-related readmissions in children and to identify opportunities for readmission reduction and estimate associated cost savings. STUDY DESIGN Retrospective analysis of 380,067 nationally representative index hospitalizations for children using the 2014 Nationwide Readmissions Database. We compared 30-day, all-cause unplanned readmissions and costs across 22 infection categories. We used the Inpatient Essentials database to measure hospital-level readmission rates and to establish readmission benchmarks for individual infections. We then estimated the number of readmissions avoided and costs saved if hospitals achieved the 10th percentile of hospitals' readmission rates (ie, readmission benchmark). All analyses were stratified by the presence/absence of a complex chronic condition (CCC). RESULTS The overall 30-day readmission rate was 4.9%. Readmission rates varied substantially across infections and by presence/absence of a CCC (CCC: range, 0%-21.6%; no CCC: range, 1.5%-8.6%). Approximately 42.6% of readmissions (n = 3,576) for children with a CCC and 54.7% of readmissions (n = 5,507) for children without a CCC could have been potentially avoided if hospitals achieved infection-specific benchmark readmission rates, which could result in an estimated savings of $70.8 million and $44.5 million, respectively. Bronchiolitis, pneumonia, and upper respiratory tract infections were among infections with the greatest number of potentially avoidable readmissions and cost savings for children with and without a CCC. CONCLUSION Readmissions following hospitalizations for infection in children vary significantly by infection type. To improve hospital resource use for infections, future preventative measures may prioritize children with complex chronic conditions and those with specific diagnoses (eg, respiratory illnesses).
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Affiliation(s)
- Jessica L Markham
- Department of Pediatrics, Children’s Mercy Kansas City and the University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Kansas
- Corresponding Author: Jessica L Markham, MD, MSc; ; Telephone: 816-302-3493; Twitter: @jmarks614
| | - Matt Hall
- Department of Pediatrics, Children’s Mercy Kansas City and the University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
- Children’s Hospital Association, Lenexa, Kansas
| | - Jennifer L Goldman
- Department of Pediatrics, Children’s Mercy Kansas City and the University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Kansas
| | - Jessica L Bettenhausen
- Department of Pediatrics, Children’s Mercy Kansas City and the University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Kansas
| | - James C Gay
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James Feinstein
- Department of Pediatrics, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Children’s Hospital Colorado, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine at Denver, Aurora, Colorado
| | - Julia Simmons
- Department of Pediatrics, Children’s Mercy Kansas City and the University of Missouri–Kansas City School of Medicine, Kansas City, Missouri
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Kansas
- Department of Pediatrics, Mercy Children’s Hospital St Louis, St Louis, Missouri
| | - Stephanie K Doupnik
- Division of General Pediatrics, PolicyLab, and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jay G Berry
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Wirtz AL, Monsees EA, Gibbs KA, Myers AL, Burns AN, Lee BR, El Feghaly RE, Weddle GM, Day JC, Purandare AV, Goldman JL. Integration of a Lean Daily Management System into an Antimicrobial Stewardship Program. Pediatr Qual Saf 2021; 6:e384. [PMID: 33718745 PMCID: PMC7952113 DOI: 10.1097/pq9.0000000000000384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 04/23/2020] [Accepted: 09/17/2020] [Indexed: 11/27/2022] Open
Abstract
Growing demands and limited guidance on efficient use of resources to advance stewardship initiatives challenge antimicrobial stewardship programs (ASP). METHODS The primary aim was to incorporate a Lean Readiness and Metrics Board (RMB) into ASP and assess team member accountability and satisfaction with weekly 15-minute huddle participation within 1 year of implementation. ASP team survey data were analyzed for comments regarding Lean integration, team communication, and productivity. The second aim was to develop 5 shared metrics associated with quality, people, delivery, safety, and stewardship and evaluate ASP team productivity by assessing the impact of projects targeted at each specific metric. Pharmacist-physician ASP scheduling conflicts were addressed through identified rounding times under the "People" metric. The "Quality" metric assessed ASP intervention disagreement rate and collaborations that occurred to reduce disagreement. ASP tracked the number of individuals educated by ASP monthly through the "Delivery" metric. RESULTS Since August 2018, ASP replaced hour-long monthly meetings with weekly huddles at the RMB. On average, 14 members (88%) of the ASP participate weekly. Team members report improvement in communication and satisfaction with Lean integration. Metric utilization enhanced productivity. For the metrics under "People," "Quality," and "Delivery," reduced scheduling conflicts occurred, the ASP intervention disagreement rate decreased (37.0%-25.6%; P < 0.001), and the ASP educated an average of 79 learners per month. CONCLUSIONS Weekly huddles at the RMB enhanced communication and team accountability while visually displaying program needs, progress, and achievements. The RMB helps to ensure ongoing institutional commitment, and Lean methods show promise for evaluating and improving ASP productivity.
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Affiliation(s)
- Ann L Wirtz
- Department of Pharmacy, Children's Mercy Kansas City, University of Missouri, Kansas City, Mo
| | - Elizabeth A Monsees
- Patient Care Services Research, Children's Mercy Kansas City, University of Missouri, Kansas City, Mo
| | - Kate A Gibbs
- Division of Ophthalmology, Children's Mercy Kansas City, University of Missouri, Kansas City, Mo
| | - Angela L Myers
- Division of Infectious Diseases, Children's Mercy Kansas City, University of Missouri, Kansas City, Mo
| | - Alaina N Burns
- Department of Pharmacy, Children's Mercy Kansas City, University of Missouri, Kansas City, Mo
| | - Brian R Lee
- Division of Infectious Diseases, Children's Mercy Kansas City, University of Missouri, Kansas City, Mo
| | - Rana E El Feghaly
- Division of Infectious Diseases, Children's Mercy Kansas City, University of Missouri, Kansas City, Mo
| | - Gina M Weddle
- Department of Advanced Practice Programs, Children's Mercy Kansas City, University of Missouri, Kansas City, Mo
| | - James C Day
- Division of Infectious Diseases, Children's Mercy Kansas City, University of Missouri, Kansas City, Mo
| | - Amol V Purandare
- Division of Infectious Diseases, Children's Mercy Kansas City, University of Missouri, Kansas City, Mo
| | - Jennifer L Goldman
- Division of Infectious Diseases, Children's Mercy Kansas City, University of Missouri, Kansas City, Mo
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Downes KJ, Goldman JL. Too Much of a Good Thing: Defining Antimicrobial Therapeutic Targets to Minimize Toxicity. Clin Pharmacol Ther 2021; 109:905-917. [PMID: 33539569 DOI: 10.1002/cpt.2190] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/27/2021] [Indexed: 12/19/2022]
Abstract
Antimicrobials are a common cause of drug toxicity. Understanding the relationship between systemic antimicrobial exposure and toxicity is necessary to enable providers to take a proactive approach to prevent undesired drug effects. When an exposure threshold has been defined that predicts drug toxicity, therapeutic drug monitoring (TDM) can be performed to assure drug exposure does not exceed the defined threshold. Although some antimicrobials have well-defined dose-dependent toxicities, many other exposure-toxicity relationships have either not been well-defined or, in some cases, not been evaluated at all. In this review, we examine the relationship between exposures and toxicities for antibiotic, antifungal, and antiviral agents. Furthermore, we classify these relationships into four categories: known association between drug exposure and toxicity such that clinical implementation of a specific exposure threshold associated with toxicity for TDM is supported (category 1), known association between drug exposure and toxicity but the specific exposure threshold associated with toxicity is undefined (category 2), association between drug exposure and toxicity has been suggested but relationship is poorly defined (category 3), and no known association between drug exposure and toxicity (category 4). Further work to define exposure-toxicity thresholds and integrate effective TDM strategies has the potential to minimize many of the observed antimicrobial toxicities.
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Affiliation(s)
- Kevin J Downes
- The Center for Clinical Pharmacology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer L Goldman
- Divisions of Clinical Pharmacology, Toxicology and Therapeutic Innovation and Infectious Diseases, Children's Mercy Kansas City, Kansas City, Missouri, USA.,Department of Pediatrics, University of Missouri - Kansas City, Kansas City, Missouri, USA
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Murali M, Suppes SL, Feldman K, Goldman JL. Utilization of the Naranjo scale to evaluate adverse drug reactions at a free-standing children's hospital. PLoS One 2021; 16:e0245368. [PMID: 33439905 PMCID: PMC7806130 DOI: 10.1371/journal.pone.0245368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/29/2020] [Indexed: 12/30/2022] Open
Abstract
The relationship between the Naranjo scaling system and pediatric adverse drug reactions (ADR) is poorly understood. We performed a retrospective review of 1,676 pediatric ADRs documented at our hospital from 2014–2018. We evaluated patient demographics, implicated medication, ADR severity, calculated Naranjo score, associated symptoms, and location within the hospital in which the ADR was documented. ADR severity was poorly correlated with Naranjo interpretation. Out of the 10 Naranjo scale questions, 4 had a response of “unknown” greater than 85% of the time. Cardiovascular and oncological/immunologic agents were more likely to have a probable or definite Naranjo interpretation compared to antimicrobials. Further strategies are needed to enhance the causality assessment of pediatric ADRs in clinical care.
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Affiliation(s)
- Madhavi Murali
- School of Medicine, University of Missouri–Kansas City, Kansas City, MO, United States of America
| | - Sarah L. Suppes
- Division of Clinical Pharmacology, Children’s Mercy Kansas City, Kansas City, MO, United States of America
| | - Keith Feldman
- Department of Pediatrics, Children’s Mercy Kansas City and the University of Missouri-Kansas City, Kansas City, MO, United States of America
| | - Jennifer L. Goldman
- Department of Pediatrics, Children’s Mercy Kansas City and the University of Missouri-Kansas City, Kansas City, MO, United States of America
- * E-mail:
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35
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Wirtz AL, Burns AN, Lee BR, Frank TS, Fitzmaurice L, Ogden RK, O'Neal BC, Goldman JL. Effectiveness and safety of mandatory antimicrobial indications and durations and a pharmacist-driven 48-hour time-out in a pediatric hospital. Am J Health Syst Pharm 2020; 77:614-621. [PMID: 32236453 DOI: 10.1093/ajhp/zxaa029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 02/06/2023] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of mandatory antimicrobial indications and durations (MAID) and a pharmacist-driven 48-hour time-out in a pediatric hospital. METHODS MAID and a 48-hour time-out were implemented on February 14, 2017. Antibiotic days of therapy (DOT) per 1,000 patient days were compared between the pre- and postperiod for select antibiotics using unadjusted Poisson models. A prepost comparison was used to compare antimicrobial stewardship program (ASP) intervention rates between time periods. A 2-step process, including distribution of a discontinuation (DC) report to pharmacists and ASP-prompted reorders, was instituted to reduce unintentional antimicrobial discontinuation with MAID. ASP-prompted reorders occurred only when a discrepancy persisted between the order and provider-desired duration. Missed antimicrobial doses were identified by ASP and the institutional event reporting system. Safety of MAID was assessed by reviewing the rate and details of ASP-prompted reorders and missed antimicrobial doses. RESULTS A significant decrease in DOT per 1,000 patient days was observed for cefazolin (39.7 to 36.9; P < 0.001), ampicillin (39.9 to 35.7; P < 0.001), clindamycin (38.2 to 35.9; P < 0.001), ceftriaxone (46.5 to 43.4; P < 0.001), and meropenem (8.7 to 6.6; P < 0.001) following implementation. No change in ASP intervention rate occurred between the pre- and postperiod (16.9 vs 16.8%; P = 0.94). With MAID, ASP-prompted reorder occurred on 7.3% of orders. Unintentional discontinuations resulting in missed antimicrobial doses occurred in 3 orders (0.07%); no patient harm resulted. CONCLUSION MAID and a 48-hour time-out significantly reduced DOT of select antibiotics. No patient harm occurred with the 2-step safety process.
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Affiliation(s)
- Ann L Wirtz
- Department of Pharmacy, Children's Mercy Kansas City, Kansas City, MO
| | - Alaina N Burns
- Department of Pharmacy, Children's Mercy Kansas City, Kansas City, MO
| | - Brian R Lee
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO
| | - Tammy S Frank
- Pharmacy Informatics, Children's Mercy Kansas City, Kansas City, MO
| | - Laura Fitzmaurice
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO
| | - Richard K Ogden
- Department of Pharmacy, Children's Mercy Kansas City, Kansas City, MO
| | - Brian C O'Neal
- Department of Pharmacy, Children's Mercy Kansas City, Kansas City, MO
| | - Jennifer L Goldman
- Division of Infectious Diseases, Children's Mercy Kansas City, Kansas City, MO
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Abstract
Therapeutic drug monitoring (TDM) has been a common practice to optimize efficacy and safety of vancomycin. While vancomycin trough-only TDM has widely been integrated into pediatric clinical practice since 2009, recently updated vancomycin TDM guidelines published in March 2020 recommend area under the curve (AUC) based TDM for vancomycin instead of trough-only TDM. In this review, we discuss the rationale behind the change in TDM recommendations, describe two approaches for calculating vancomycin AUC in clinical practice, and address considerations for integrating vancomycin AUC TDM into pediatric clinical practice. Our primary goal is to provide pediatric clinicians with a resource for implementing vancomycin AUC monitoring into clinical care.
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Affiliation(s)
- Alaina N Burns
- Department of Pharmacy, Children's Mercy Hospital, Kansas City, Missouri, USA.,Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Jennifer L Goldman
- Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, Missouri, USA.,Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri, USA
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Abstract
Stevens–Johnson syndrome and toxic epidermal necrolysis are rare severe blistering skin reactions triggered by medications or infections. Over the last 5 to 10 years, a number of important publications have advanced understanding of these diseases and their response to treatment. Importantly, a subset of patients with disease triggered by infection has been identified as having Mycoplasma pneumoniae–induced rash and mucositis, suggesting a reconsideration of the diagnostic paradigm. We present an update on pediatric Stevens–Johnson syndrome and toxic epidermal necrolysis in the broader context of cutaneous adverse drug reactions and focus on challenges and recent advances in diagnosis, management, and prevention.
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Affiliation(s)
- Michele Ramien
- Department of Pediatrics, University of Calgary, Alberta Children's Hospital, 28 Oki Dr NW, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer L Goldman
- Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,Division of Pediatric Infectious Diseases, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
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Tillman EM, Suppes SL, Feldman K, Goldman JL. Enhancing Pediatric Adverse Drug Reaction Documentation in the Electronic Medical Record. J Clin Pharmacol 2020; 61:181-186. [PMID: 32776356 DOI: 10.1002/jcph.1717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/15/2020] [Accepted: 07/23/2020] [Indexed: 12/13/2022]
Abstract
Adverse drug reactions (ADRs) often go unreported or are inaccurately documented in the electronic medical recorded (EMR), even when they are severe and life-threatening. Incomplete reporting can lead to future prescribing challenges and ADR reoccurrence. The aim of this study was to evaluate the documentation of ADRs within the EMR and determine specific factors associated with appropriate and timely ADR documentation. Retrospective data were collected from a pediatric hospital system ADR reports from October 2010 to November 2018. Data included implicated medication, type, and severity of reaction, treatment location, the presence or absence of ADR documentation in the EMR alert profile within 24 hours of the ADR hospital or clinic encounter discharge, ADR identification method, and the presence or absence of pharmacovigilance oversight at the facility where the ADR was treated. A linear regression model was applied to identify factors contributing to optimal ADR documentation. A total of 3065 ADRs requiring medical care were identified. Of these, 961 ADRs (31%) did not have appropriate documentation added to the EMR alert profile prior to discharge. ADRs were documented in the EMR 87% of the time with the presence of pharmacovigilance oversight and only 61% without prospective pharmacovigilance (P < .01). Severity of ADR was not a predictor of ADR documentation in the EMR, yet the implicated medication and location of treatment did impact reporting. An active pharmacovigilance service significantly improved pediatric ADR documentation. Further work is needed to assure timely, accurate ADR documentation.
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Affiliation(s)
- Emma M Tillman
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sarah L Suppes
- Department of Pharmacy, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Keith Feldman
- Department of Pediatrics, Children's Mercy Hospital and the University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Jennifer L Goldman
- Department of Pediatrics, Children's Mercy Hospital and the University of Missouri-Kansas City, Kansas City, Missouri, USA
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Affiliation(s)
- Jessica L Markham
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Jennifer L Goldman
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
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McMahon AW, Cooper WO, Brown JS, Carleton B, Doshi-Velez F, Kohane I, Goldman JL, Hoffman MA, Kamaleswaran R, Sakiyama M, Sekine S, Sturkenboom MCJM, Turner MA, Califf RM. Big Data in the Assessment of Pediatric Medication Safety. Pediatrics 2020; 145:peds.2019-0562. [PMID: 31937606 DOI: 10.1542/peds.2019-0562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 11/24/2022] Open
Abstract
Big data (BD) in pediatric medication safety research provides many opportunities to improve the safety and health of children. The number of pediatric medication and device trials has increased in part because of the past 20 years of US legislation requiring and incentivizing study of the effects of medical products in children (Food and Drug Administration Modernization Act of 1997, Pediatric Rule in 1998, Best Pharmaceuticals for Children Act of 2002, and Pediatric Research Equity Act of 2003). There are some limitations of traditional approaches to studying medication safety in children. Randomized clinical trials within the regulatory context may not enroll patients who are representative of the general pediatric population, provide the power to detect rare safety signals, or provide long-term safety data. BD sources may have these capabilities. In recent years, medical records have become digitized, and cell phones and personal devices have proliferated. In this process, the field of biomedical science has progressively used BD from those records coupled with other data sources, both digital and traditional. Additionally, large distributed databases that include pediatric-specific outcome variables are available. A workshop entitled "Advancing the Development of Pediatric Therapeutics: Application of 'Big Data' to Pediatric Safety Studies" held September 18 to 19, 2017, in Silver Spring, Maryland, formed the basis of many of the ideas outlined in this article, which are intended to identify key examples, critical issues, and future directions in this early phase of an anticipated dramatic change in the availability and use of BD.
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Affiliation(s)
- Ann W McMahon
- Office of Pediatric Therapeutics, US Food and Drug Administration, Rockville, Maryland;
| | - William O Cooper
- Departments of Pediatrics and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey S Brown
- Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Insititute, Boston, Massachusetts
| | - Bruce Carleton
- Division of Translational Therapeutics, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Finale Doshi-Velez
- Paulson School of Engineering and Applied Sciences, Harvard University, Boston, Massachusetts
| | - Isaac Kohane
- Departments of Biomedical Informatics, Pediatrics, and
| | - Jennifer L Goldman
- Divisions of Pediatric Infectious Diseases and Clinical Parmacology, Department of Pediatrics, and
| | - Mark A Hoffman
- Departments of Biomedical Informatics, Pediatrics, and Emergency Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | | | - Michiyo Sakiyama
- Office of New Drug IV, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan.,Department of Epidemiology, Julius Center Research Program Cardiovascular Edpidemiology, Utrecht University Medical Center, Utrecht, Netherlands
| | - Shohko Sekine
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; and
| | - Miriam C J M Sturkenboom
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Center for Health Science, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Mark A Turner
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; and
| | - Robert M Califf
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Center for Health Science, Duke Clinical Research Institute, Duke University, Durham, North Carolina
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Antoon JW, Goldman JL, Lee BR. Severe cutaneous adverse reactions: comparing outcomes in children with and without complex chronic conditions. J Allergy Clin Immunol Pract 2019; 8:790-792.e3. [PMID: 31421280 DOI: 10.1016/j.jaip.2019.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/22/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Affiliation(s)
- James W Antoon
- Department of Pediatric and Adolescent Medicine, Children's Hospital, University of Illinois Hospital & Health Sciences System, Chicago, Ill; Division of Hospital Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tenn.
| | - Jennifer L Goldman
- Division of Clinical Pharmacology, Children's Mercy Hospitals and Clinics, Kansas City, Mo; Division of Infectious Diseases, Children's Mercy Hospitals and Clinics, Kansas City, Mo
| | - Brian R Lee
- Division of Infectious Diseases, Children's Mercy Hospitals and Clinics, Kansas City, Mo
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Miller JO, Taylor J, Goldman JL. Severe Acute Respiratory Failure in Healthy Adolescents Exposed to Trimethoprim-Sulfamethoxazole. Pediatrics 2019; 143:peds.2018-3242. [PMID: 31142578 DOI: 10.1542/peds.2018-3242] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2019] [Indexed: 11/24/2022] Open
Abstract
Pulmonary toxicity induced by trimethoprim-sulfamethoxazole (TMP-SMX) has been described, although the disease process is poorly understood. We report 5 previously healthy adolescent patients who developed acute respiratory failure while taking TMP-SMX. Four of the 5 adolescents required extracorporeal membrane oxygenation support, and 2 of the teenagers died. All children required a tracheostomy, and all cases were complicated by pneumothoraces and pneumomediastinum. The majority of children were prescribed TMP-SMX for the treatment of acne vulgaris.
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Affiliation(s)
| | | | - Jennifer L Goldman
- Pediatric Infectious Diseases, and.,Clinical Pharmacology and Medical Toxicology, University of Missouri-Kansas City and Children's Mercy Hospital and Clinics, Kansas City, Missouri
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Richardson KM, Chen KS, Goubeaux DL, Atkinson CS, Poulose A, Woods G, Goldman JL. A 16-Year-Old Girl With Eye Pain. J Pediatric Infect Dis Soc 2019; 8:77-79. [PMID: 29688511 DOI: 10.1093/jpids/piy037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/25/2018] [Accepted: 04/06/2018] [Indexed: 11/13/2022]
Affiliation(s)
- Katherine M Richardson
- Division of Infectious Diseases, Children's Mercy Kansas City, Missouri.,Department of Pediatrics, Children's Mercy Kansas City, Missouri
| | - Kevin S Chen
- Department of Ophthalmology, Children's Mercy Kansas City, Missouri.,School of Medicine, University of Missouri-Kansas City
| | - Derrick L Goubeaux
- Department of Pediatrics, Children's Mercy Kansas City, Missouri.,Department of Hematology/Oncology, Children's Mercy Kansas City, Missouri
| | - C Scott Atkinson
- Department of Ophthalmology, Children's Mercy Kansas City, Missouri.,School of Medicine, University of Missouri-Kansas City
| | - Abraham Poulose
- Department of Ophthalmology, Children's Mercy Kansas City, Missouri.,School of Medicine, University of Missouri-Kansas City
| | - Gerald Woods
- Department of Pediatrics, Children's Mercy Kansas City, Missouri.,Department of Hematology/Oncology, Children's Mercy Kansas City, Missouri
| | - Jennifer L Goldman
- Division of Infectious Diseases, Children's Mercy Kansas City, Missouri.,Department of Pediatrics, Children's Mercy Kansas City, Missouri.,School of Medicine, University of Missouri-Kansas City
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Goldman JL, van Haandel L. Trimethoprim: The overlooked component of trimethoprim-sulfamethoxazole idiosyncratic adverse drug reactions. Pharmacoepidemiol Drug Saf 2018; 27:949-951. [PMID: 29869446 DOI: 10.1002/pds.4574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/13/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Jennifer L Goldman
- Divisions of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Leon van Haandel
- Divisions of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Department of Pediatrics, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
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Antoon JW, Goldman JL, Lee B, Schwartz A. Incidence, outcomes, and resource use in children with Stevens-Johnson syndrome and toxic epidermal necrolysis. Pediatr Dermatol 2018; 35:182-187. [PMID: 29315761 DOI: 10.1111/pde.13383] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening cutaneous reactions, typically to drugs or infection. The incidence and outcomes of these conditions in children are unknown. The objective of this study was to report the overall burden of Stevens-Johnson syndrome and toxic epidermal necrolysis in children in the United States. METHODS We performed a retrospective cohort analysis of children and adolescents younger than 18 years of age using the 2009 and 2012 Kids' Inpatient Database. RESULTS We identified 1486 children and adolescents hospitalized with a diagnosis of Stevens-Johnson syndrome or toxic epidermal necrolysis. The national incidence per 100 000 was 6.3 for Stevens-Johnson syndrome, 0.7 for Stevens-Johnson syndrome/toxic epidermal necrolysis overlap syndrome, and 0.5 for toxic epidermal necrolysis. The highest incidence in children was in those aged 11-15 years (38.4 per 100 000). Toxic epidermal necrolysis and Stevens-Johnson syndrome/toxic epidermal necrolysis overlap syndrome were associated with longer stay, greater mortality, and higher hospital charges than those with Stevens-Johnson syndrome. Hospital mortality was highest in children with toxic epidermal necrolysis and in children aged 0-5 years. CONCLUSIONS The incidence of Stevens-Johnson syndrome and toxic epidermal necrolysis in children is higher than reported in adults, and there are significant age-based variations in incidence and outcomes across the pediatric population. Further study is needed to determine the most effective treatment strategies to reduce costs and improve outcomes in children hospitalized with severe cutaneous reactions.
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Affiliation(s)
- James W Antoon
- Department of Pediatric and Adolescent Medicine, Children's Hospital, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA
| | - Jennifer L Goldman
- Division of Clinical Pharmacology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,Division of Infectious Diseases, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Brian Lee
- Division of Clinical Pharmacology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA.,Division of Infectious Diseases, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Alan Schwartz
- Department of Pediatric and Adolescent Medicine, Children's Hospital, University of Illinois Hospital & Health Sciences System, Chicago, IL, USA.,Department of Medical Education, University of Illinois at Chicago, Chicago, IL, USA
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van Haandel L, Funk R, Leeder JS, Goldman JL. Evidence of circulating trimethoprim protein adducts in human plasma. Drug Metab Pharmacokinet 2018. [DOI: 10.1016/j.dmpk.2017.11.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Goldman JL, Leeder JS, van Haandel L. The benzylic alcohol metabolite of trimethoprim covalently binds to proteins in vitro. Drug Metab Pharmacokinet 2018. [DOI: 10.1016/j.dmpk.2017.11.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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White KD, Abe R, Ardern-Jones M, Beachkofsky T, Bouchard C, Carleton B, Chodosh J, Cibotti R, Davis R, Denny JC, Dodiuk-Gad RP, Ergen EN, Goldman JL, Holmes JH, Hung SI, Lacouture ME, Lehloenya RJ, Mallal S, Manolio TA, Micheletti RG, Mitchell CM, Mockenhaupt M, Ostrov DA, Pavlos R, Pirmohamed M, Pope E, Redwood A, Rosenbach M, Rosenblum MD, Roujeau JC, Saavedra AP, Saeed HN, Struewing JP, Sueki H, Sukasem C, Sung C, Trubiano JA, Weintraub J, Wheatley LM, Williams KB, Worley B, Chung WH, Shear NH, Phillips EJ. SJS/TEN 2017: Building Multidisciplinary Networks to Drive Science and Translation. J Allergy Clin Immunol Pract 2018; 6:38-69. [PMID: 29310768 PMCID: PMC5857362 DOI: 10.1016/j.jaip.2017.11.023] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 12/17/2022]
Abstract
Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a life-threatening, immunologically mediated, and usually drug-induced disease with a high burden to individuals, their families, and society with an annual incidence of 1 to 5 per 1,000,000. To effect significant reduction in short- and long-term morbidity and mortality, and advance clinical care and research, coordination of multiple medical, surgical, behavioral, and basic scientific disciplines is required. On March 2, 2017, an investigator-driven meeting was held immediately before the American Academy of Dermatology Annual meeting for the central purpose of assembling, for the first time in the United States, clinicians and scientists from multiple disciplines involved in SJS/TEN clinical care and basic science research. As a product of this meeting, this article summarizes the current state of knowledge and expert opinion related to SJS/TEN covering a broad spectrum of topics including epidemiology and pharmacogenomic networks; clinical management and complications; special populations such as pediatrics, the elderly, and pregnant women; regulatory issues and the electronic health record; new agents that cause SJS/TEN; pharmacogenomics and immunopathogenesis; and the patient perspective. Goals include the maintenance of a durable and productive multidisciplinary network that will significantly further scientific progress and translation into prevention, early diagnosis, and management of SJS/TEN.
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Affiliation(s)
- Katie D White
- Vanderbilt University Medical Center, Nashville, Tenn
| | - Riichiro Abe
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | - Thomas Beachkofsky
- Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, San Antonio, Texas
| | | | - Bruce Carleton
- University of British Columbia, Vancouver, British Columbia, Canada; B.C. Children's Hospital, British Columbia, Vancouver, British Columbia, Canada
| | - James Chodosh
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass
| | - Ricardo Cibotti
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Md
| | - Robert Davis
- University of Tennessee Health Sciences, Memphis, Tenn
| | | | - Roni P Dodiuk-Gad
- Emek Medical Center, Technion-Institute of Technology, Afula, Israel; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | - James H Holmes
- Wake Forest Baptist Medical Center, Winston-Salem, NC; Wake Forest University School of Medicine, Winston-Salem, NC
| | | | | | | | - Simon Mallal
- Vanderbilt University Medical Center, Nashville, Tenn; Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Teri A Manolio
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Md; F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md
| | | | | | - Maja Mockenhaupt
- Medical Center and Medical Faculty-University of Freiburg, Freiburg, Germany
| | | | - Rebecca Pavlos
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | | | - Elena Pope
- University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alec Redwood
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | | | | | | | | | - Hajirah N Saeed
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass
| | - Jeffery P Struewing
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Md
| | | | | | - Cynthia Sung
- Duke-NUS Medical School, Singapore, Singapore; Health Sciences Authority, Singapore, Singapore
| | - Jason A Trubiano
- Austin Health, Heidelberg, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | | | - Lisa M Wheatley
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | | | | | | | - Neil H Shear
- Vanderbilt University Medical Center, Nashville, Tenn
| | - Elizabeth J Phillips
- Vanderbilt University Medical Center, Nashville, Tenn; Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia.
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Beck JN, Suppes SL, Smith CR, Lee BR, Leeder JS, VanDoren M, Newland JG, Goldman JL. Cost and Potential Avoidability of Antibiotic-Associated Adverse Drug Reactions in Children. J Pediatric Infect Dis Soc 2017; 8:66-68. [PMID: 29165624 PMCID: PMC6437835 DOI: 10.1093/jpids/pix096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 08/08/2017] [Accepted: 10/04/2017] [Indexed: 11/13/2022]
Abstract
We identified 375 children who visited the emergency department or urgent care clinic at Children's Mercy Hospitals & Clinics for antibiotic adverse drug reactions over a 1-year period, and the total cost for these visits was $170 893.20. Of these ADRs, 17% were likely avoidable. The potential negative consequences of antibiotics should be considered at the point of prescribing.
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Affiliation(s)
| | | | - Claire R Smith
- Medicine, University of Missouri–Kansas City; Divisions of
| | | | | | | | - Jason G Newland
- Department of Pediatric Infectious Diseases, Washington University in St. Louis, Missouri
| | - Jennifer L Goldman
- Clinical Pharmacology,Department of Pediatric Infectious Diseases, Children’s Mercy Hospitals & Clinics, Kansas City, Missouri,Correspondence: J. L. Goldman, MD, MS, Department of Pediatrics, Children’s Mercy Hospitals & Clinics, 2401 Gillham Rd, Kansas City, MO 64108 ()
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Affiliation(s)
- Russell J McCulloh
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Laura E Norton
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Jennifer L Goldman
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
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