Re: European guideline on indications, performance, and clinical impact of hydrogen and methane breath tests in adult and pediatric patients

Abstract Background There is a worldwide concern with respect to the antimicrobial resistance and the inappropriate use of antifungal agents, which had led to an ever-increasing antifungal resistance. This study aimed to identify the antifungal susceptibility of Candida species isolated from the pediatric patients with cancer and also to evaluate the clinical impact of antifungal stewardship (AFS) ‎interventions on antifungal susceptibility of Candida species. Methods In this study, Candida species colonization were evaluated among hospitalized children with cancer in a tertiary teaching hospital, Shiraz 2017-18. The broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) for polyenes (amphotericin B), echinocandins (caspofungin), and azoles (voriconazole, fluconazole, posaconazole, and itraconazole). Antifungal susceptibility of Candida species was compared with our previous study results to determine the clinical impact of AFS interventions on the antifungal susceptibility. Results The prevalence of Candida albicans in the present study was significantly higher than other Candida species. Candida albicans species were completely susceptible to the azoles. The sensitivity rate of C. albicans to amphotericin B and caspofungin was 93.1% and 97.1%, respectively. The results confirm the positive effect of optimized antifungal usage and bedside intervention on the susceptibility of Candida species after the implementation of the AFS program. C. albicans and C. glabrata exhibited significant increase in sensitivity after the execution of AFS program. Conclusions Improving the antifungal agent usage can improve antifungal ‎susceptibility and reduce resistance. The AFS is recommended to be addressed, applied, and regularly assessed in centers.

Download Full-text

Appropriate Use and Clinical Impact of Echocardiographic “Evaluation of Murmur” in Pediatric Patients

Congenital Heart Disease ◽

10.1111/chd.12379 ◽

2016 ◽

Vol 11 (6) ◽

pp. 721-726 ◽

Cited By ~ 12

Author(s):

Kirsten Rose-Felker ◽

Michael S. Kelleman ◽

Robert M. Campbell ◽

Matthew E. Oster ◽

Ritu Sachdeva

Keyword(s):

Pediatric Patients ◽

Clinical Impact ◽

Appropriate Use ◽

Echocardiographic Evaluation

Download Full-text

Differences in the Frequency of 23S rRNA Gene Mutations in Mycoplasma pneumoniae between Children and Adults with Community-Acquired Pneumonia: Clinical Impact of Mutations Conferring Macrolide Resistance

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01421-12 ◽

2012 ◽

Vol 56 (12) ◽

pp. 6393-6396 ◽

Cited By ~ 24

Author(s):

Soo Jin Yoo ◽

Hyo-Bin Kim ◽

Sang-Ho Choi ◽

Sang-Oh Lee ◽

Sung-Han Kim ◽

...

Keyword(s):

Mycoplasma Pneumoniae ◽

Pediatric Patients ◽

Gene Mutations ◽

Community Acquired Pneumonia ◽

Clinical Impact ◽

Macrolide Resistance ◽

23S Rrna ◽

Rrna Gene ◽

Content Type ◽

23S Rrna Gene

ABSTRACTWe investigated the frequency and clinical significance of macrolide resistance in adult and pediatric patients with community-acquired pneumonia from aMycoplasma pneumoniaeinfection. The frequency of the A2063G mutation in the 23S rRNA gene was significantly higher in children than in adults (61.3% [19/31] and 13.3% [8/60], respectively;P< 0.001). Patients with macrolide-resistantM. pneumoniaeinfections showed a longer duration of fever (P= 0.021) and required a longer duration of antibiotic treatment (P= 0.007).

Download Full-text

Clinical utility of metagenomic next-generation sequencing in suspected central nervous system infectious pediatric patients with empirical treatment: a cohort study

10.21203/rs.3.rs-275456/v1 ◽

2021 ◽

Author(s):

Bin-Fang Guo ◽

Meng-Xiao Ding ◽

Jing-Ru Xue ◽

Dan-Ni Yan ◽

Su-Zhen Sun

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Next Generation Sequencing ◽

Pediatric Patients ◽

Clinical Impact ◽

Empirical Treatment ◽

Cns Infection ◽

Next Generation ◽

Pathogen Diagnosis ◽

Generation Sequencing

Abstract Background: Metagenomic next generation sequencing (mNGS) is becoming an increasingly available diagnostic method used to identify a broad range of pathogens. However, the optimal role of mNGS in clinical diagnostic schema remains uncertain, especially in pediatric patients suspected central nervous system (CNS) infection and treated with empirical antibiotic. The purpose of this study was to investigate the usefulness of cerebrospinal fluid (CSF) mNGS in the pediatric patients.Methods: We performed a retrospective review of suspected CNS infection patients who had CSF mNGS test from April 2019 to December 2020. Results and clinical impact of mNGS test were collected. We investigated the usefulness of CSF mNGS in clinical impact and diagnosis. Results: We enrolled 57 pediatric patients with empirical treatment. A total of 39 CNS infection patients were diagnosed, and 27 patients were identified by mNGS that only 2 of 27 were co-identified by CSF culture. In all of the patients, 75.4% (45 cases) had changed (addition or de-escalation) in antimicrobial therapy according to the results of the mNGS test. By each CSF mNGS test as a whole, the positive and negative percent agreement were 69.2% (95% CI: 54.1-84.4%) and 61.1% (95% CI: 36.2-86.1%), respectively, and true negatives of negative mNGS tests were 50% (95% CI: 27.3 – 72.7%).Conclusion: In this study, CSF mNGS test improved the diagnosis of neurologic infections and adjusted antibiotic therapy in the vast majority of cases. Consequently, for patients with empirical treatment, CSF mNGS should be used more in pathogen diagnosis and clinical therapy.

Download Full-text