scholarly journals 1957. Impact of β-Lactam Antibiotic Allergy on Antimicrobial Use, Clinical Outcomes, and Costs for Hospitalized Children

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S61-S62
Author(s):  
Trahern Wallace Jones ◽  
Nora Fino ◽  
Jared Olson ◽  
Lauri Hicks ◽  
Katherine E Fleming-Dutra ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Pediatric Patients ◽  
Antimicrobial Use ◽  
Hospitalized Children ◽  
Antibiotic Selection ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Lactam Antibiotic ◽  
The Impact ◽  
To Receive

Abstract Background Most β-lactam antibiotic allergies (BLA) are incorrectly diagnosed and could be de-labeled. Adult patients with BLA are more likely to receive broader-spectrum antimicrobials and experience worse health outcomes than nonallergic patients. Similar studies on the impact of BLA on antimicrobial use and clinical outcomes are limited in pediatrics. Our objective was to compare antimicrobial use, and clinical and economic outcomes between hospitalized children with and without BLA. Methods This was a retrospective cohort of pediatric patients hospitalized at an Intermountain Healthcare (IH) hospital from 2007 to 2017. IH has 22 hospitals including one children’s hospital. Patients aged 30 days-17 years who received ≥1 dose of an antimicrobial during hospitalization were included. The exposure variable was the presence of BLA (penicillins or cephalosporins) in the allergy field of the medical record. Patients with BLA were matched to nonallergic controls on age, sex, race, clinical service line, admission date, children’s hospital or other hospital, and co-morbid conditions. We used multivariable log-transformed-linear and logistic regression models to compare patients with BLA to controls in terms of antibiotic selection and total antimicrobial days, antimicrobial cost, length-of-stay (LOS) and 30-day readmission. For antibiotic selection we examined the odds of receiving the following broader-spectrum agents individually and in composite: vancomycin, fluoroquinolones, clindamycin, carbapenems, and macrolides. Results 39,785 patients were identified including 2897 (7%) with BLA. The prevalence of BLA increased with age (Figure 1). 2459 (85%) patients with BLA were matched to a control. Patients with BLA had higher odds of receiving broader-spectrum antibiotics (OR 2.35, 95% CI: 2.07–2.67) and had greater antimicrobial costs (1.21-fold increase, 95% CI: 1.08–1.35) than nonallergic patients (Figure 2). There were no differences in LOS, total antimicrobial days, or 30-day readmission (Figure 2). Conclusion Pediatric patients with BLA are more likely to receive broader-spectrum antibiotics and incur higher antimicrobial costs than matched controls. De-labeling interventions could reduce unnecessary exposure to these agents and lower costs. Disclosures All Authors: No reported Disclosures.

scholarly journals 43 COVID Crisis: A Burn Approach

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S32-S32
Author(s):  
Jamie Heffernan ◽  
James Gallagher
Keyword(s):  
Patient Care ◽  
Pediatric Patients ◽  
Care Hospital ◽  
Burn Patients ◽  
Strict Adherence ◽  
Children's Hospital ◽  
Burn Care ◽  
Large Patient ◽  
Children’S Hospital ◽  
To Receive

Abstract Introduction The net effect of the COVID-19 pandemic on this northeastern, urban healthcare system during March, April and May 2020 was the redirection of virtually all resources to the care of the affected population. Conversion of the majority of the hospital’s assets, including staff and infrastructure, to COVID care created a large reduction in resources for other clinical problems. The burn service was among those few essential disciplines that continued to receive acutely affected individuals during the crisis. The preservation of the burn center’s ability to continue its mission within the walls of a COVID hospital is the subject of this review. Methods All of the hospital’s ICU rooms, including all those on the burn unit, post anesthesia care units, some step-down units, and over 90% of the operating rooms (ORs) converted to COVID care ICUs. These vital actions by hospital administration enabled an increase in ICU beds from 114 to 270. Staff were redeployed to cover the massive influx of critical COVID patients. Burn inpatients during the transition were categorized by severity and age for disposition consideration. Of the 17 inpatients, 4 pediatric patients discharged home and 1 transferred to our associated children’s hospital; 7 adults discharged home, 2 transferred to our associated inpatient psychiatric hospital, 1 to inpatient rehab, and 2 transferred to a neighboring orthopedic hospital converted into an adult acute care hospital. The commitment to keep the burn center operational for both children and adults was facilitated by protecting the burn ICU hydrotherapy room, a large patient care space in the center of the burn ICU. Children, initially admitted and cared for in the hydrotherapy room until stable, transferred to our network Children’s hospital for continued care. Critical adult burns were admitted to the inpatient ICU with the COVID patients, acute burns were housed on the few remaining medical surgical units. Burn care was performed in the patients’ rooms to keep the hydrotherapy room “clean”. Results During the 3-month period described the burn service admitted and cared for 92 adult and 25 pediatric patients while maintaining a full ICU census. Although 3 admitted burn patients were COVID +, no burn patients housed in the ICU became COVID + during their stay. Conclusions The commitment to protect the burn hydrotherapy space for burn triage and care from the top level of administration was critical and notable given the widespread conversion of the subspecialty ICUs and most other patient care areas to COVID care units. Strict adherence to infection prevention guidelines and protection of the hydrotherapy room allowed burn patients to receive timely and appropriate care during a pandemic.

scholarly journals Pediatric Surgical Reentry Strategy Following the COVID-19 Pandemic: A Tiered and Balanced Approach

2021 ◽  
pp. 000313482110111
Author(s):  
Ryan C. Pickens ◽  
Angela M. Kao ◽  
Mark A. Williams ◽  
Andrew C. Herman ◽  
Jeffrey S. Kneisl
Keyword(s):  
Pediatric Surgery ◽  
Elective Surgery ◽  
Surgical Care ◽  
Children's Hospital ◽  
Protocol Development ◽  
Balanced Approach ◽  
Projective Curves ◽  
Children’S Hospital ◽  
The Impact ◽  
Emergent Surgery

Background In response to the COVID-19 pandemic, children’s hospitals across the country postponed elective surgery beginning in March 2020. As projective curves flattened, administrators and surgeons sought to develop strategies to safely resume non-emergent surgery. This article reviews challenges and solutions specific to a children’s hospital related to the resumption of elective pediatric surgeries. We present our tiered reentry approach for pediatric surgery as well as report early data for surgical volume and tracking COVID-19 cases during reentry. Methods The experience of shutdown, protocol development, and early reentry of elective pediatric surgery are reported from Levine’s Children’s Hospital (LCH), a free-leaning children’s hospital in Charlotte, North Carolina. Data reported were obtained from de-identified hospital databases. Results Pediatric surgery experienced a dramatic decrease in case volumes at LCH during the shutdown, variable by specialty. A tiered and balanced reentry strategy was implemented with steady resumption of elective surgery following strict pre-procedural screening and testing. Early outcomes showed a steady thorough fluctuating increase in elective case volumes without evidence of a surgery-associated positive spread through periprocedural tracking. Conclusion Reentry of non-emergent pediatric surgical care requires unique considerations including the impact of COVID-19 on children, each children hospital structure and resources, and preventing undue delay in intervention for age- and disease-specific pediatric conditions. A carefully balanced strategy has been critical for safe reentry following the anticipated surge. Ongoing tracking of resource utilization, operative volumes, and testing results will remain vital as community spread continues to fluctuate across the country.

scholarly journals 528. Coronavirus Disease 2019 in Children Cared for at Texas Children’s Hospital: Implications of Repeat Testing on Infection Control Strategies

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S331-S332
Author(s):  
Catherine Foster ◽  
Lucila Marquez ◽  
Tjin Koy ◽  
Ila Singh ◽  
Judith Campbell
Keyword(s):  
Infection Control ◽  
Median Time ◽  
Disease Transmission ◽  
Retrospective Chart Review ◽  
Source Control ◽  
Hospitalized Children ◽  
Rt Pcr ◽  
Repeat Testing ◽  
Children's Hospital ◽  
Children’S Hospital

Abstract Background Accurate diagnosis of coronavirus disease 2019 (COVID-19) is key for source control and interrupting disease transmission. To better understand the length of viral shedding in children and potential infection control implications, we describe 51 children with COVID-19 who underwent repeat testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at Texas Children’s Hospital (TCH). Methods We performed a retrospective chart review of all pediatric patients (< 21 years of age) with ≥ 2 nasopharyngeal specimens tested for SARS-CoV-2 by reverse transcription-polymerase chain reaction (rt-PCR) and at least one positive result between 3/13/2020 and 6/7/2020 through the TCH Molecular Microbiology Laboratory. Results Fifty-one patients met inclusion criteria. The median age was 8.6 years (0.02–19.2 years). Sixteen (31%) children were hospitalized. Fourteen (27%) patients underwent testing for surveillance purposes (including 3 admitted patients). Two SARS-CoV-2 tests were performed in 25 (49%) children; while 12 (24%) children had 3 tests, 4 (8%) children had 4 tests, and 10 (20%) children had ≥ 5 tests (including 1 patient with underlying malignancy who had 9 SARS-CoV-2 PCRs performed). SARS-CoV-2 testing timeline for 9 hospitalized children is shown (Fig 1). The median time between collection of tests 1 and 2 was 14 days (n=51, range 1, 53 days). For children with conversion (first detected to first not-detected sample), the median time was 15 days (n=31, range 1, 45 days). For patients with consecutive positive SARS-CoV-2 PCRs, the median time of positivity was 10 days (n=19, range 2, 31). One patient with malignancy had 5 tests over 6 weeks in the outpatient setting and each time alternated between detected and not-detected. Following diagnosis with COVID-19, one patient with sickle cell disease likely had re-infection and had a positive test after having 2 consecutive negative tests; his last SARS-CoV-2 rt-PCR was positive 68 days after initial positive. Fig 1. Timing of Repeat SARS-CoV-2 PCRs in Select Hospitalized Children with COVID-19 Conclusion We observed variation in the duration of SARS-CoV-2 rt-PCR positivity in children with COVID-19. For children with COVID-19, a single negative molecular assay for SARS-CoV-2 may not be predictive of sustained negativity. Disclosures All Authors: No reported disclosures

Handshake antimicrobial stewardship as a model to recognize and prevent diagnostic errors

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Justin B. Searns ◽  
Manon C. Williams ◽  
Christine E. MacBrayne ◽  
Ann L. Wirtz ◽  
Jan E. Leonard ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Interrater Reliability ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Primary Treatment ◽  
Treatment Team ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
The Impact ◽  
Made In

AbstractObjectivesFew studies describe the impact of antimicrobial stewardship programs (ASPs) on recognizing and preventing diagnostic errors. Handshake stewardship (HS-ASP) is a novel ASP model that prospectively reviews hospital-wide antimicrobial usage with recommendations made in person to treatment teams. The purpose of this study was to determine if HS-ASP could identify and intervene on potential diagnostic errors for children hospitalized at a quaternary care children’s hospital.MethodsPreviously self-identified “Great Catch” (GC) interventions by the Children’s Hospital Colorado HS-ASP team from 10/2014 through 5/2018 were retrospectively reviewed. Each GC was categorized based on the types of recommendations from HS-ASP, including if any diagnostic recommendations were made to the treatment team. Each GC was independently scored using the “Safer Dx Instrument” to determine presence of diagnostic error based on a previously determined cut-off score of ≤1.50. Interrater reliability for the instrument was measured using a randomized subset of one third of GCs.ResultsDuring the study period, there were 162 GC interventions. Of these, 65 (40%) included diagnostic recommendations by HS-ASP and 19 (12%) had a Safer Dx Score of ≤1.50, (Κ=0.44; moderate agreement). Of those GCs associated with diagnostic errors, the HS-ASP team made a diagnostic recommendation to the primary treatment team 95% of the time.ConclusionsHandshake stewardship has the potential to identify and intervene on diagnostic errors for hospitalized children.

scholarly journals 1339. Antibiotic Prescribing Varies among Patients with a Documented Penicillin or Cephalosporin Adverse Drug Reaction

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S681-S681
Author(s):  
Brian R Lee ◽  
Jason Newland ◽  
Jennifer Goldman
Keyword(s):  
Pediatric Patients ◽  
Antibiotic Prescribing ◽  
Hospitalized Children ◽  
Beta Lactam ◽  
Research Support ◽  
Point Prevalence Study ◽  
History Of ◽  
Gi Infections ◽  
To Receive ◽  
Indication For Treatment

Abstract Background Studies have shown that over half of hospitalized children receive an antibiotic during their encounter, of which between 30-50% is considered inappropriate. Antibiotic prescribing is further complicated as approximately 10% of children are labeled beta-lactam allergic, resulting in the use of either broad-spectrum or suboptimal therapy. The purpose of this study was to compare antibiotic prescribing between patients with a documented ADR vs. those without using a nationwide sample of hospitalized children. Methods We performed a point prevalence study among 32 hospitals between July 2016-December 2017 where data were collected via chart review on pediatric patient and antimicrobial characteristics, including the indication for all antimicrobials. In additional, ADR history data were collected on which antimicrobial(s) were documented (e.g., penicillin, cephalosporins). Patients were mutually assigned into either: 1) no documented ADR; 2) penicillin ADR-only; 3) cephalosporin ADR-only; and 4) ADR for both penicillin and cephalosporin. The distribution of antibiotics were compared between the ADR groups, stratified by the indication for treatment. Results A total of 12,250 pediatric patients (17,929 antibiotic orders) who were actively receiving antibiotics were identified. A history of penicillin and cephalosporin ADR was documented in 5.5% and 2.8% of these patients, respectively. When compared to patients with no documented ADR, penicillin ADR patients were more likely to receive a fluoroquinolone for a SSTI infection (odds ratio [OR]: 5.6), surgical prophylaxis (OR: 18.8) or for surgical treatment (OR: 5.2) (see Figure). Conversely, penicillin ADR patients were less likely to receive first-line agents, such as narrow-spectrum penicillin for bacterial LRTI (OR: 0.08) and piperacillin/tazobactam for GI infections (OR: 0.22). Cephalosporin ADR patients exhibited similar patterns with increased use of carbapenems and fluoroquinolones when compared to patients with no ADR. Figure 1: Odds of Receiving Select Antimicrobials Among PCN ADR Patients When Compared to Non-ADR patients, by Indication Conclusion A large, nationwide sample of pediatric patients who were actively prescribed antibiotics helped identify several diagnoses where comprehensive guidelines for appropriate ADR prescribing and increased ADR de-labeling initiatives are needed to ensure optimal treatment. Disclosures Brian R. Lee, MPH, PhD, Merck (Grant/Research Support) Jason Newland, MD, MEd, FPIDS, Merck (Grant/Research Support)Pfizer (Other Financial or Material Support, Industry funded clinical trial)

The impact of a complex care clinic in a children's hospital

2010 ◽  
Vol 36 (4) ◽  
pp. 574-582 ◽  
Author(s):  
E. Cohen ◽  
J. N. Friedman ◽  
S. Mahant ◽  
S. Adams ◽  
V. Jovcevska ◽  
...  
Keyword(s):  
Complex Care ◽  
Care Clinic ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
The Impact

scholarly journals A Retrospective Review of Hospital-Acquired Venous Thromboembolism at a Large Pediatric Tertiary Care Center

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3471-3471
Author(s):  
Marissa A. Just ◽  
Joanna Robles ◽  
Karan R. Kumar ◽  
Andrew Yazman ◽  
Jennifer A. Rothman ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Research Funding ◽  
Pediatric Patients ◽  
Central Venous ◽  
Vte Prophylaxis ◽  
Children's Hospital ◽  
Congenital Cardiac Disease ◽  
Children’S Hospital ◽  
Icd 10 ◽  
Hospital Acquired

Introduction: The incidence of venous thromboembolism (VTE) in hospitalized pediatric patients is increasing secondary to the growing medical complexity of pediatric patients and the increasing use of central venous catheters. Pediatric patients diagnosed with VTE have up to 2% mortality associated directly with their thromboses. While incidence, risk factor identification and preventive strategies are well established in hospitalized adults, this information is limited in the pediatric population. There are currently no standardized VTE risk screening tools or thromboprophylaxis guidelines for children at Duke Children's Hospital. The incidence of hospital acquired VTE (HA-VTE), as well as their associated risk factors were investigated in a retrospective review. Methods: Medical records of pediatric patients hospitalized at Duke Children's Hospital during June 2018 through November 2018 were reviewed. The EPIC SlicerDicer tool was used to identify patients with ICD-10 diagnoses codes related to thrombosis or treated with anticoagulants. Included patients were diagnosed with HA-VTE during their hospitalization or within 14 days of discharge. Data collected included demographics, thrombosis characteristics, family history, mobility, and acute or chronic co-morbid conditions. The characteristics of the study population were described by median (with 25th and 75th percentiles) for continuous variables and frequencies (with percentages) for binary or categorical variables. Results: Out of 4,176 total pediatric admissions to all units of Duke Children's Hospital (ages 0-18.99 years) during the inclusion timeframe, 33 VTE events were identified. The incidence of VTE events per 1000 patient days was 0.98. The complete patient and VTE event characteristics are listed in Tables 1 and 2. The median age of patients with VTE events was 0.4 years. Of the identified cohort, 73% had an associated central venous line (CVL). Neonates with congenital cardiac disease comprised the majority of the cohort. Other common patient characteristics observed in this cohort included impaired mobility, recent major surgery, and recent mechanical ventilation. Of the 33 VTE diagnoses, 70% received therapeutic anticoagulation with enoxaparin or unfractionated heparin. Only 2 patients (8%) received prophylactic anticoagulation prior to their diagnosis of VTE. Conclusions: The retrospective review of HA-VTE events at Duke Children's Hospital identified that the majority of the events occurred in neonates with congenital cardiac disease and the presence of CVLs. It was also noted that there was no standardization among the use of anticoagulation agents that were initiated for treatment of VTE. Furthermore, few patients received VTE prophylaxis during the hospitalization. A limitation of this review was that it was retrospective and the documentation of family history of thrombosis was inconsistent. It is also possible that several VTE events were missed due to inadequate ICD-10 coding. Based on the results of this review, there is a need to implement a risk stratification tool and develop standardized recommendations of VTE prophylaxis and treatments for pediatric patients admitted to Duke Children's Hospital. There is an additional quality improvement phase of this project and the goal is to implement a risk calculator that is based on information learned from the retrospective review. Ultimately, this risk calculator will help to decrease the incidence of VTE events at Duke Children's Hospital. Disclosures Rothman: Agios: Honoraria, Research Funding; Pfizer: Consultancy, Honoraria, Research Funding; Novartis: Honoraria, Research Funding.

scholarly journals Improving Pediatric Adverse Drug Event Reporting through Clinical Pharmacy Services

2011 ◽  
Vol 16 (4) ◽  
pp. 285-290
Author(s):  
David M. Crowther ◽  
Marcia L. Buck ◽  
Michelle W. McCarthy ◽  
Virginia W. Barton
Keyword(s):  
Causative Agent ◽  
Adverse Drug Event ◽  
Pediatric Patients ◽  
Drug Event ◽  
University Of Virginia ◽  
Children's Hospital ◽  
Therapeutic Class ◽  
Children’S Hospital ◽  
The University

OBJECTIVES The purpose of this study was to summarize adverse drug event (ADE) reporting and to characterize the type of healthcare practitioners involved in reporting over a 10-year period at a 120-bed university-affiliated children's hospital. METHODS The University of Virginia Children's Hospital ADE database was analyzed for records involving pediatric patients. Data from patients <18 years of age who were admitted to the University of Virginia Children's Hospital between January 1, 2000, and December 31, 2009, were analyzed. Data collected included drug name and therapeutic class of the suspected causative agent, description of the event, severity, causality, outcome, and the type of healthcare practitioner reporting the event. RESULTS A total of 863 ADEs were reported over the 10-year period. The 5 most common types reported were extravasation injury (10%), rash (8%), hypotension (5%), pruritus (5%), and renal failure (3%). A total of 196 (21%) cases were categorized as mild, 436 (47%) cases as moderate, and 296 (32%) cases as severe. Further characterization of extravasations was performed to identify trends relating to potential causes. In 45 (57%) reports, parenteral nutrition was identified as the causative agent. Full recovery was documented in 21 (47%) extravasations. Of the total events reported, 83% were reported by pharmacists, 16% by nurses, and <1% by other healthcare practitioners. CONCLUSIONS Results of this study are consistent with those of previous studies involving ADE reporting in children's hospitals. This consistency is due in part to system design and use of unit-based pharmacists as the primary reporters.

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