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  • 1
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    Online Resource
    Performance of Saliva, Oropharyngeal Swabs, and Nasal Swabs for SARS-CoV-2 Molecular Detection: a Systematic Review and Meta-analysis
    American Society for Microbiology ; 2021
    In:  Journal of Clinical Microbiology Vol. 59, No. 5 ( 2021-04-20)
    Details
    In: Journal of Clinical Microbiology, American Society for Microbiology, Vol. 59, No. 5 ( 2021-04-20)
    Abstract: Nasopharyngeal (NP) swabs are considered the highest-yield sample for diagnostic testing for respiratory viruses, including SARS-CoV-2. The need to increase capacity for SARS-CoV-2 testing in a variety of settings, combined with shortages of sample collection supplies, have motivated a search for alternative sample types with high sensitivity. We systematically reviewed the literature to understand the performance of alternative sample types compared to NP swabs. We systematically searched PubMed, Google Scholar, medRxiv, and bioRxiv (last retrieval 1 October 2020) for comparative studies of alternative specimen types (saliva, oropharyngeal [OP], and nasal [NS] swabs) versus NP swabs for SARS-CoV-2 diagnosis using nucleic acid amplification testing (NAAT). A logistic-normal random-effects meta-analysis was performed to calculate % positive alternative-specimen, % positive NP, and % dual positives overall and in subgroups. The QUADAS 2 tool was used to assess bias. From 1,253 unique citations, we identified 25 saliva, 11 NS, 6 OP, and 4 OP/NS studies meeting inclusion criteria. Three specimen types captured lower % positives (NS [82%, 95% CI: 73 to 90%], OP [84%, 95% CI: 57 to 100%] , and saliva [88%, 95% CI: 81 to 93%]) than NP swabs, while combined OP/NS matched NP performance (97%, 95% CI: 90 to 100%). Absence of RNA extraction (saliva) and utilization of a more sensitive NAAT (NS) substantially decreased alternative-specimen yield of positive samples. NP swabs remain the gold standard for diagnosis of SARS-CoV-2, although alternative specimens are promising. Much remains unknown about the impact of variations in specimen collection, processing protocols, and population (pediatric versus adult, late versus early in disease course), such that head-to head studies of sampling strategies are urgently needed.
    Type of Medium: Online Resource
    ISSN: 0095-1137 , 1098-660X
    URL: Article
    DOI: 10.1128/JCM.02881-20
    RVK:
    XA 10000
    Language: English
    Publisher: American Society for Microbiology
    Publication Date: 2021
    detail.hit.zdb_id: 1498353-9
    SSG: 12
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  • 2
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    The Antibiotic Likelihood Index: A New Measure of Antimicrobial Stewardship for Pediatric Primary Care Based on Reason for Visit
    Oxford University Press (OUP) ; 2022
    In:  Journal of the Pediatric Infectious Diseases Society Vol. 11, No. 4 ( 2022-04-30), p. 142-148
    Details
    In: Journal of the Pediatric Infectious Diseases Society, Oxford University Press (OUP), Vol. 11, No. 4 ( 2022-04-30), p. 142-148
    Abstract: Quality metrics for antibiotic prescribing by pediatricians are limited. We sought to define a novel measure that assesses clinicians’ overall antibiotic prescribing. Methods Using electronic health record (EHR) data from 2018 to 2019 for children 3 months to 17 years of age from 53 practices within a large pediatric network, we grouped encounters into Reason for Visit categories using the classification system of the National Ambulatory Medical Care Survey and analyzed the proportion of encounters with an antibiotic prescription. Categories were sorted according to the attributable proportion of encounters with an antibiotic prescribed. The proposed metric—the Antibiotic Likelihood Index (ALI)—was defined as the proportion of encounters with an antibiotic prescribed among categories that accounted for & gt;80% of all encounters with an antibiotic prescribed. The ALI was calculated for the entire network and for individual prescribers, and the distribution among prescribers was described. Results Six Reason for Visit categories—cough, ear complaints, fever, sore throat, rash, and congestion/upper respiratory infection—accounted for 82.4% of all antibiotics prescribed. Among the 222 682 encounters for the top 6 categories combined, 67 368 (30.3%) had an antibiotic prescribed, defined as the ALI for the entire sample. The index among individual prescribers ranged from 7.5% to 57.2% (interquartile range 24.3% to 34.9%). The correlation for individual prescribers between 2018 and 2019 was high (R2 = 0.80). Conclusions The ALI, a proposed new metric of pediatric antibiotic prescribing, can be readily calculated from EHR data and captures the range of antibiotic prescribing among pediatricians for common clinical scenarios.
    Type of Medium: Online Resource
    ISSN: 2048-7207
    URL: Article
    DOI: 10.1093/jpids/piab110
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2668791-4
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  • 3
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    Impact of a Guideline on Management of Children Hospitalized With Community-Acquired Pneumonia
    American Academy of Pediatrics (AAP) ; 2012
    In:  Pediatrics Vol. 129, No. 3 ( 2012-03-01), p. e597-e604
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 129, No. 3 ( 2012-03-01), p. e597-e604
    Abstract: We sought to describe the impact a clinical practice guideline (CPG) had on antibiotic management of children hospitalized with community-acquired pneumonia (CAP). PATIENTS AND METHODS: We conducted a retrospective study of discharged patients from a children’s hospital with an ICD-9-CM code for pneumonia (480–486). Eligible patients were admitted from July 8, 2007, through July 9, 2009, 12 months before and after the CAP CPG was introduced. Three-stage least squares regression analyses were performed to examine hypothesized simultaneous relationships, including the impact of our institution\x{2019}s antimicrobial stewardship program (ASP). RESULTS: The final analysis included 1033 patients: 530 (51%) before the CPG (pre-CPG) and 503 (49%) after the CPG (post-CPG). Pre-CPG, ceftriaxone (72%) was the most commonly prescribed antibiotic, followed by ampicillin (13%). Post-CPG, the most common antibiotic was ampicillin (63%). The effect of the CPG was associated with a 34% increase in ampicillin use (P & lt; .001). Discharge antibiotics also changed post-CPG, showing a significant increase in amoxicillin use (P & lt; .001) and a significant decrease in cefdinir and amoxicillin/clavulanate (P & lt; .001), with the combined effect of the CPG and ASP leading to 12% (P & lt; 0.001) and 16% (P & lt; .001) reduction, respectively. Overall, treatment failure was infrequent (1.5% vs 1%). CONCLUSIONS: A CPG and ASP led to the increase in use of ampicillin for children hospitalized with CAP. In addition, less broad-spectrum discharge antibiotics were used. Patient adverse outcomes were low, indicating that ampicillin is appropriate first-line therapy for otherwise healthy children admitted with uncomplicated CAP.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2011-1533
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2012
    detail.hit.zdb_id: 1477004-0
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  • 4
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    Antibiotic Management of Staphylococcus aureus Infections in US Children's Hospitals, 1999–2008
    American Academy of Pediatrics (AAP) ; 2010
    In:  Pediatrics Vol. 125, No. 6 ( 2010-06-01), p. e1294-e1300
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 125, No. 6 ( 2010-06-01), p. e1294-e1300
    Abstract: The objective of this study was to describe trends in antibiotic management for Staphylococcus aureus infections among hospitalized children from 1999 to 2008. METHODS: A retrospective study was conducted by using the Pediatric Health Information Systems database to describe antibiotic treatment of inpatients with S aureus infection at 25 children's hospitals in the United States. Patients who were admitted from 1999 to 2008 with International Classification of Diseases, Ninth Revision, Clinical Modification codes for S aureus infection were included. Trends in the use of vancomycin, clindamycin, linezolid, trimethoprim-sulfamethoxazole, cefazolin, and oxacillin/nafcillin were examined for percentage use and days of therapy per 1000 patient-days. RESULTS: A total of 64813 patients had a discharge diagnosis for S aureus infection. The incidence of methicillin-resistant S aureus (MRSA) infections during this period increased 10-fold, from 2 to 21 cases per 1000 admissions, whereas the methicillin-susceptible S aureus infection rate remained stable. Among patients with S aureus infections, antibiotics that treat MRSA increased from 52% to 79% of cases, whereas those that treat only methicillin-susceptible S aureus declined from 66% to & lt;30% of cases. Clindamycin showed the greatest increase, from 21% in 1999 to 63% in 2008. Similar trends were observed by using days of therapy per 1000 patient-days. CONCLUSIONS: Antibiotic prescribing patterns for the treatment of S aureus infections have changed significantly during the past decade, reflecting the emergence of community-associated MRSA. Clindamycin is now the most commonly prescribed antibiotic for S aureus infections among hospitalized children. The substantial use of clindamycin emphasizes the importance of continuous monitoring of local S aureus susceptibility patterns.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2009-2867
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2010
    detail.hit.zdb_id: 1477004-0
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  • 5
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    Characteristics and Outcomes of Culture-Positive and Culture-Negative Pediatric Sepsis
    Elsevier BV ; 2023
    In:  The Journal of Pediatrics Vol. 263 ( 2023-12), p. 113718-
    Details
    In: The Journal of Pediatrics, Elsevier BV, Vol. 263 ( 2023-12), p. 113718-
    Type of Medium: Online Resource
    ISSN: 0022-3476
    URL: Article
    DOI: 10.1016/j.jpeds.2023.113718
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2005245-5
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  • 6
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    One size does not fit all: advanced practice provider considerations for the antimicrobial steward
    Cambridge University Press (CUP) ; 2023
    In:  Antimicrobial Stewardship & Healthcare Epidemiology Vol. 3, No. 1 ( 2023)
    Details
    In: Antimicrobial Stewardship & Healthcare Epidemiology, Cambridge University Press (CUP), Vol. 3, No. 1 ( 2023)
    Abstract: Advanced practice providers are a diverse and established group of antimicrobial prescribers in both ambulatory and inpatient settings. We outline important considerations for antimicrobial stewardship programs and stewards to consider when engaging this important group of providers.
    Type of Medium: Online Resource
    ISSN: 2732-494X
    URL: Article
    DOI: 10.1017/ash.2023.199
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2023
    detail.hit.zdb_id: 3074908-6
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  • 7
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    Trends in Adverse Reactions to Trimethoprim-Sulfamethoxazole
    American Academy of Pediatrics (AAP) ; 2013
    In:  Pediatrics Vol. 131, No. 1 ( 2013-01-01), p. e103-e108
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 131, No. 1 ( 2013-01-01), p. e103-e108
    Abstract: To examine temporal trends of adverse drug reactions (ADRs) associated with trimethoprim-sulfamethoxazole (TMP-SMX) use in children. METHODS: We performed a retrospective observational study to characterize TMP-SMX ADRs in children between 2000 and 2009. We completed a chart review at our institution by identifying children diagnosed with TMP-SMX ADRs. To compare local trends to comparable institutions, we estimated the frequency of hospitalizations for TMP-SMX ADRs at 25 tertiary pediatric hospitals utilizing the Pediatric Health Information System database. To determine whether changes in outpatient prescribing rates occurred, we used the National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey. RESULTS: At our institution, 109 children were diagnosed with a TMP-SMX ADR (5 cases from 2000 to 2004 as compared with 104 cases from 2005 to 2009). Fifty-eight percent had been treated for a skin and soft tissue infection (SSTI). A similar trend was observed nationally, where the incidence of TMP-SMX ADRs more than doubled from 2004 to 2009 at comparable pediatric hospitals (P & lt; .001). Although national outpatient data revealed no change in overall TMP-SMX prescribing, the percentage of children prescribed TMP-SMX for SSTI sharply increased during the study period (0%–2% [2000-2004]; 9%–17% [2005–2009] ). CONCLUSIONS: The majority of TMP-SMX ADRs at our institution occurred in conjunction with SSTI treatment. TMP-SMX ADRs have occurred more frequently coincident with increased prescribing for SSTI. Increased usage alone may explain the increasing trend of TMP-SMX ADRs in children; however drug–disease interaction may play a role and requires further investigation.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2012-1619
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2013
    detail.hit.zdb_id: 1477004-0
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  • 8
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    Online Resource
    A Pilot Program to Improve Vaccination Status for Hospitalized Children
    American Academy of Pediatrics (AAP) ; 2015
    In:  Hospital Pediatrics Vol. 5, No. 1 ( 2015-01-01), p. 35-41
    Details
    In: Hospital Pediatrics, American Academy of Pediatrics (AAP), Vol. 5, No. 1 ( 2015-01-01), p. 35-41
    Abstract: Screening of immunization status at each health care encounter is recommended to improve immunization coverage rates but is often limited to primary care practices. A pilot intervention study was performed to ascertain the immunization status of hospitalized children and determine if development of an immunization plan before discharge would improve the vaccination status for such children. Methods: On the basis of power calculations estimated to detect an increase in immunization status from 60% to 70% with 80% power, 356 randomly selected children were enrolled between March 6, 2012 and June 14, 2012. Immunization records were obtained, immunization status determined, and parent/guardian informed if catch-up dose(s) were needed. If parent requested vaccine dose(s), they were administered before discharge. Results: Vaccination status was current per Advisory Committee on Immunization Practices guidelines in 73% of hospitalized children, and 27% children required catch-up dose(s) (200 doses for 95 children). Human papilloma virus vaccine (dose 1), varicella zoster vaccine (dose 2), and meningococcal conjugate vaccine were the most commonly identified dose(s) needed. Of those requiring catch-up dose(s), 25% were caught up, increasing vaccination status to 80% at 1-month post hospital discharge. Conclusions: This is the first study to determine the immunization status of hospitalized pediatric patients of all ages, including adolescents, providing new data on the immunization status of the inpatient pediatric population. A pilot intervention consisting of obtaining immunization records, determining immunization status, and discussing catch-up dose(s) before discharge resulted in improvement of immunization status, suggesting that the inpatient setting may be used along with many other national strategies to help address missed vaccination opportunities.
    Type of Medium: Online Resource
    ISSN: 2154-1663 , 2154-1671
    URL: Article
    DOI: 10.1542/hpeds.2014-0027
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2015
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  • 9
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    Benchmarking of Outpatient Pediatric Antibiotic Prescribing: Results of a Multicenter Collaborative
    Oxford University Press (OUP) ; 2023
    In:  Journal of the Pediatric Infectious Diseases Society Vol. 12, No. 6 ( 2023-06-30), p. 364-371
    Details
    In: Journal of the Pediatric Infectious Diseases Society, Oxford University Press (OUP), Vol. 12, No. 6 ( 2023-06-30), p. 364-371
    Abstract: Most antibiotic use occurs in ambulatory settings. No benchmarks exist for pediatric institutions to assess their outpatient antibiotic use and compare prescribing rates to peers. We aimed to share pediatric outpatient antibiotic use reports and benchmarking metrics nationally. Methods We invited institutions from the Sharing Antimicrobial Reports for Pediatric Stewardship OutPatient (SHARPS-OP) Collaborative to contribute quarterly aggregate reports on antibiotic use from January 2019 to June 2022. Outpatient settings included emergency departments (ED), urgent care centers (UCC), primary care clinics (PCC) and telehealth encounters. Benchmarking metrics included the percentage of: (1) all acute encounters resulting in antibiotic prescriptions; (2) acute respiratory infection (ARI) encounters resulting in antibiotic prescriptions; and among ARI encounters receiving antibiotics, (3) the percentage receiving amoxicillin (“Amoxicillin index”); and (4) the percentage receiving azithromycin (“Azithromycin index”). We collected rates of antibiotic prescriptions with durations ≤7 days and & gt;10 days from institutions able to provide validated duration data. Results Twenty-one institutions submitted aggregate reports. Percent ARI encounters receiving antibiotics were highest in the UCC (40.2%), and lowest in telehealth (19.1%). Amoxicillin index was highest for the ED (76.2%), and lowest for telehealth (55.8%), while the azithromycin index was similar for ED, UCC, and PCC (3.8%, 3.7%, and 5.0% respectively). Antibiotic duration of ≤7 days varied substantially (46.4% for ED, 27.8% UCC, 23.7% telehealth, and 16.4% PCC). Conclusions We developed a benchmarking platform for key pediatric outpatient antibiotic use metrics drawing data from multiple pediatric institutions nationally. These data may serve as a baseline measurement for future improvement work.
    Type of Medium: Online Resource
    ISSN: 2048-7207
    URL: Article
    DOI: 10.1093/jpids/piad039
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2668791-4
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  • 10
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    Variability in Ceftriaxone Dosing Across 32 US Acute Care Children’s Hospitals
    Oxford University Press (OUP) ; 2021
    In:  Journal of the Pediatric Infectious Diseases Society Vol. 10, No. 5 ( 2021-05-28), p. 677-681
    Details
    In: Journal of the Pediatric Infectious Diseases Society, Oxford University Press (OUP), Vol. 10, No. 5 ( 2021-05-28), p. 677-681
    Abstract: Ceftriaxone is one of the most common antibiotics prescribed for hospitalized children in the United States. However, ceftriaxone is not dosed consistently. Sepsis/serious bacterial infection had high dosing variability. Dosing for central nervous system infection was frequently suboptimal. Future efforts should focus on optimizing and standardizing ceftriaxone dosing.
    Type of Medium: Online Resource
    ISSN: 2048-7207
    URL: Article
    DOI: 10.1093/jpids/piab004
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2668791-4
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