1130. Vancomycin Use in Pediatric Severe Sepsis at a Freestanding Children’s Hospital

Abstract Background Surviving Sepsis Campaign guidelines recommend antibiotics be administered within 1 hour of severe sepsis (SS) onset, but do not suggest which agents to give. Vancomycin (VAN) is often chosen as empiric therapy for severe sepsis (SS) in children without evidence of the prevalence or risk factors for infections requiring VAN. As VAN is associated with significant nephrotoxicity, this study was performed to measure the risk-benefit ratio of empiric VAN use in pediatric sepsis. Methods This was a retrospective study of children with SS between 1/1/2015 to 6/30/2018 at the Women and Children’s Hospital of Buffalo, as captured by billing data and sent to state Department of Health for mandated reporting. SS cases were assessed for risk factors for Gram-positive infections, including presence of a central venous line (CVL) or other invasive device; history of MRSA infection or nasal colonization within the last 2 years; skilled nursing facility (SNF) residence; and prolonged hospitalization of >1 month. Invasive infections for which vancomycin is an optimal agent, specifically culture-proven methicillin-resistant Staphylococcus aureus (MRSA), coagulase-negative Staphylococcus (CoNS), and ampicillin-resistant Enterococcus infections, were defined as vancomycin requiring (VAN-req). Acute kidney injury (AKI) was defined as having a serum Creatinine of twice normal per age-related reference values. Results Of 304 identified SS cases, 8.9% had VAN-req infections. VAN was empirically given to 58.2% of cases (177); 86.4% ultimately did not have VAN-req infections. 9.2% of all SS cases had AKI at SS onset; this included 15.8% of patients (28) receiving VAN, of which only 1 (3.6%) had a VAN-req infection. History of a past MRSA infection, prolonged hospitalization, SNF residence, and CVL presence were found to be independent risk factors for a VAN-req infection (Table 1). VAN-req infections in patients lacking these four risk factors was 3.1% (4/130). Conclusion VAN was given empirically in the majority of pediatric SS cases, but culture-proven infections requiring the drug were infrequent, especially in patients without specific risk factors. The use of empiric VAN for SS should be guided by well-defined criteria, as the drug’s potential risks are likely to outweigh any benefit in most patients. Disclosures All authors: No reported disclosures.

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Determining the Incidence and Risk Factors for Central Venous Catheter Related Thrombosis in Children

Blood ◽

10.1182/blood.v128.22.419.419 ◽

2016 ◽

Vol 128 (22) ◽

pp. 419-419 ◽

Cited By ~ 6

Author(s):

Julie Jaffray ◽

Char Witmer ◽

Brian Vasquez ◽

Rosa Diaz ◽

Jemily Malvar ◽

...

Keyword(s):

Risk Factors ◽

Interim Analysis ◽

Male Gender ◽

Multivariable Model ◽

Insertion Technique ◽

Central Venous ◽

Children's Hospital ◽

Pediatric Study ◽

Children’S Hospital ◽

History Of

Abstract Introduction: Venous thromboembolism (VTE) rates in children are increasing, largely due to the improved care of critically ill children and the placement of central venous catheters (CVCs). There is limited evidence regarding risk factors for CVC-associated thrombosis, and there are no guidelines for pediatric patients on choosing catheter type, insertion technique or consideration for prophylaxis. This study aims to be the first prospective, observational, multi-center, pediatric study to compare the VTE incidence between peripherally inserted central catheters (PICCs) and centrally inserted tunneled lines (TLs), as well as identify additional risk factors for CVC-associated thrombosis. Methods: This prospective, observational cohort study enrolled patients aged 6 months to <18 years from 3 large pediatric hospitals, Children's Hospital Los Angeles, Children's Hospital of Philadelphia and Texas Children's Hospital between September 2013 to April 2016 who either had a PICC or TL placed. Data regarding subject demographics and medical history (cancer, congenital heart disease, history of VTE, current infection, etc.) were collected via electronic medical record (EMR) review. Details specific to the CVC (reason for insertion, CVC size, number of lumens, brand and CVC material) and insertion technique (length of CVC, vein accessed, number of attempts) were also collected. Subjects were then prospectively monitored for the occurrence of a VTE and other CVC-related complications (infection, malfunction, use of tissue plasminogen activator) via EMR review for up to 6 months after their CVC was placed or after diagnosis of a VTE. Univariable and multivariable logistic regression was utilized to examine the association of patient and CVC characteristics on VTE incidence. All significant predictors (p < 0.10) in the univariable analyses were entered into a multivariable model where each predictor's contribution was assessed. Results: Interim analysis includes 789 subjects [53% male, median age 6 years (0.5, 18)] who had 883 CVCs placed (Table 1). PICCs were placed in 570 (65%) subjects and 313 (35%) had TLs placed. There were a total of 43 CVC-related VTEs (4.9%) and the majority, 37 (86%), were in subjects with PICCs. The median time to develop a PICC-associated VTE after placement was 37 days (1, 215). Twenty-four predictors were analyzed in separate logistic regression models. Univariable analysis of twenty-four possible predictors revealed a statistically significant increased risk of VTE incidence in subjects with a history of VTE with an odds ratio (OR) of 2.9 [95% confidence interval (CI), 1.3-6.6] or congenital heart disease OR=2.8 (CI 1.3-6.0), subjects with PICCs (vs. TLs) OR=3.8 (CI 1.6-9.1), multiple lumen CVCs (TL or PICC) OR=3.2 (CI 1.7-6.0) or in CVCs with a malfunction OR=2.1 (1.1-3.9). Male gender, on the other hand, was associated with a reduced risk of VTE OR=0.46 (0.2-0.9). Type of CVC (PICC vs. TL) OR=3.4 (CI 1.4-8.2), number of lumens OR=2.7 (CI 1.5-5.3), and history of VTE OR=2.8 (CI 1.2-6.5) remained significant positive predictors of VTE incidence in the setting of a multivariable model. Male gender remained to be inversely associated with VTE incidence (Table 2). Conclusions: This is the first prospective pediatric study comparing VTE incidence in PICCs versus TLs. This interim analysis of nearly 800 subjects revealed a significantly higher risk of VTE in subjects who have had a PICC placed versus a TL. Due to their ease of insertion, PICCs are being placed at increasing rates in some pediatric centers, thus this finding may be the leading factor for the increasing pediatric VTE incidence. Other significant risk factors for VTE were patients with multiple lumen CVCs and a history of VTE. For children who require a new CVC, practitioners should consider avoiding PICCs and multiple lumen CVCs if possible. Consideration should also be made to give prophylactic anticoagulation for children with a CVC and a history of VTE. Further analysis will be performed concerning the decreased VTE rate in male patients. The identification of these risk factors is the first step to creating CVC selection and insertion guidelines for all children to prevent VTE. Continued subject recruitment, with the recent addition of Nationwide Children's Hospital, is occurring to complete this evaluation. Disclosures Young: Biogen: Consultancy, Speakers Bureau; Novo Nordisk: Consultancy, Speakers Bureau; Kedrion: Consultancy; Baxter: Consultancy.

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A clinical, radiological and etiological study of neonatal pneumonia

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20194614 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2309

Author(s):

Mallikarjun R. Kobal ◽

Prashant S. Gadgi ◽

Sharanabasappa S. Dhanwadkar ◽

Ashwini Kumari N. B.

Keyword(s):

Early Recognition ◽

Tertiary Care ◽

Coagulase Negative Staphylococcus ◽

Klebsiella Pneumonia ◽

Positive Finding ◽

Tertiary Care Centre ◽

Children's Hospital ◽

Children’S Hospital ◽

History Of ◽

Home Deliveries

Background: Pneumonia contributes to between 7, 50,000 and 1.2 million neonatal deaths and an unknown number of stillbirths each year worldwide1. It is estimated that 3.9 million of the 10.8 million deaths in children annually worldwide occur in the first 28 days of life.2 Neonatal pneumonia can be preventable if it is diagnosed as early as possible. Early recognition and prompt management are essential for the better outcome.Aim and objective: To determine bacterial etiology of neonatal pneumonia and to study the risk factors associated with neonatal pneumonia.Methods: A prospective, descriptive study was conducted for the duration of one year from July 2014 to June 2015 in Pragna children’s Hospital, a tertiary care centre, Hyderabad, Telangana, India. A total of 100 neonates were admitted in Pragna children’s Hospital with the signs and symptoms of neonatal pneumonia. A detailed history was taken including age, obstetric history of the mother, detailed birth history including resuscitation details and gestational age assessment were evaluated.Results: Out of 100 cases, 39(39%) neonates were preterm babies and 61(61%) were term. Also found history of Prolonged Rupture of Membrane (PROM) in 22% cases, maternal fever in 18%, home deliveries in 14% and foul smelling liquor in 18%. Out of 100 cases, 51 (51%) cases had positive finding in Chest X-Ray for neonatal pneumonia and 57(57%) had pneumonia with septicemia. Out of 100 cases, 9% of cases are positive for Coagulase negative staphylococcus (CONS), 5% for Klebsiella pneumonia, 2% for Pseudomonas aeroginosa and the remaining 84% of the cases had no growth for any organism.Conclusions: Major predisposing factors included PROM, foul smelling liquor, maternal fever, and home deliveries. CONS was the commonest organism isolated in blood culture.

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Risk factors associated with severe asthma exacerbations in children attending Alexandria University Children’s Hospital, Egypt

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20184670 ◽

2018 ◽

Vol 5 (12) ◽

pp. 5019

Author(s):

Ihab H. El Sawy ◽

Reham M. Wagdy ◽

Afaf G. Ibrahim ◽

Suzy W. Ibrahim

Keyword(s):

Risk Factors ◽

Severe Asthma ◽

Asthma Exacerbation ◽

Mild Asthma ◽

Factors Associated ◽

Children's Hospital ◽

Asthma Exacerbations ◽

Severe Asthma Exacerbation ◽

Children’S Hospital ◽

History Of

Background: Severe asthma exacerbation is one of the common pediatric medical emergencies that necessitates hospital visits. The study aimed to identify risk factors associated with pediatric severe asthma exacerbations that might have the potential to guide the parents for early medical consultations and physicians at primary health care centers for proper management.Methods: A case-control study was conducted on over 100 asthmatic children below 12 years attending the Emergency Department of Alexandria University Children’s Hospital in acute exacerbation. Based on a modified pulmonary index score, the patients were allocated into 2 groups; study group (50 patients with severe asthma exacerbation) and control group (50 patients with mild asthma exacerbations). Demographic data, history of illness, alarming clinical signs, medications, and outcome of all participants were recorded.Results: Severe asthma exacerbations were more encountered among males, older age, and with a longer duration of asthma (X±SD=28.4±15.9 months) with significant differences when compared to controls. Comparing the studied groups revealed higher risk for severe asthma exacerbations mainly with; history of sudden onset of severe respiratory distress (Odds ratio “OR”=30.13, 95% CI, 13.78-66.69) and chronic steroid-dependent asthma (OR=14.46, 95% CI, 3.97-52.65). Cyanosis, lethargy, and inability to talk were alarming signs in patients with severe asthma exacerbation when compared to those with mild asthma exacerbation (p<0.05).Conclusions: Severe asthma exacerbation in children is still associated with many risk factors that may alert the patients’ caregivers and physicians prospectively for early proper management.

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RISK FACTORS FOR MULTIDRUG-RESISTANT BACTERIA (MRB) IN A PAEDIATRIC MEDICAL WARD FROM A PORTUGUESE CHILDREN’S HOSPITAL

10.26226/morressier.58fa1766d462b80290b51222 ◽

2017 ◽

Author(s):

Ana Sofia Geraldes Vaz

Keyword(s):

Risk Factors ◽

Multidrug Resistant ◽

Medical Ward ◽

Resistant Bacteria ◽

Multidrug Resistant Bacteria ◽

Children's Hospital ◽

Children’S Hospital

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Determination of risk factors associated with malnutrition among children under the age of five: a case control study at Arthur Davison children’s hospital in Ndola, Zambia

Asian Pacific Journal of Health Sciences ◽

10.21276/apjhs.2017.4.2.18 ◽

2017 ◽

Vol 4 (2) ◽

pp. 105-109 ◽

Cited By ~ 1

Author(s):

Maurice Mhango ◽

◽

Seter Siziya ◽

Victor Mwanakasale ◽

◽

...

Keyword(s):

Risk Factors ◽

Case Control Study ◽

Case Control ◽

Factors Associated ◽

Children's Hospital ◽

Children’S Hospital ◽

Control Study

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THE HISTORY OF ROYAL CHILDREN'S HOSPITAL, BRISBANE

The Medical Journal of Australia ◽

10.5694/j.1326-5377.1969.tb105462.x ◽

1969 ◽

Vol 1 (13) ◽

pp. 705-706

Keyword(s):

Children's Hospital ◽

Children’S Hospital ◽

History Of

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1367. Reduced Ceftaroline Susceptibility Among Invasive MRSA Isolates at a Tertiary Children’s HospitalReduced Ceftaroline Susceptibility Among Invasive MRSA Isolates at a Tertiary Children’s Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1549 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S693-S694

Author(s):

Lauren Sommer ◽

Jesus G Vallejo ◽

Kristina G Hulten ◽

Sheldon L Kaplan ◽

Jonathon C McNeil

Keyword(s):

Pediatric Population ◽

Staphylococcal Infection ◽

Healthcare Associated Infections ◽

Accessory Gene ◽

Children's Hospital ◽

Children’S Hospital ◽

Mrsa Infection ◽

Group Ii ◽

Healthcare Associated ◽

Research Grant

Abstract Background The emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) in the late 1990s-early 2000s complicated the empiric management of suspected staphylococcal infection in children. Rising clindamycin resistance rates in many communities adds further to management challenges. Ceftaroline, an anti-MRSA cephalosporin, represents an attractive therapy option. Little data are available, however, regarding the frequency of reduced susceptibility (RS) to ceftaroline among MRSA isolates from a general pediatric population. Methods Isolates were selected from an ongoing S. aureus surveillance study at Texas Children’s Hospital. Invasive MRSA isolates from 2015-2018 were included. Isolates were initially screened for ceftaroline RS with E-test; all isolates with a ceftaroline E-test MIC ≥ 1.5µg/ml underwent ceftaroline broth dilution. Ceftaroline RS was regarded as an MIC ≥ 2 µg/ml; full ceftaroline resistance was defined as an MIC ≥ 8 μg/ml. Accessory gene regulator (agr) groups were characterized by PCR. Results 201 viable isolates were included. The ceftaroline MIC50 and MIC90 were 0.5 and 1 µg/ml, respectively (Figure 1). Six isolates had MIC ≥ 2 µg/ml (2.9%) with two having MIC ≥ 8 µg/ml (0.9%). All ceftaroline RS isolates were from healthcare associated infections. Ceftaroline RS isolates were more often associated with clindamycin-resistance and agr group II (Figure 2). Infections with ceftaroline RS were associated with central venous lines, recent ICU admission, preceding antibiotic exposure (specifically cephalosporins) and prior MRSA infection. One subject with MRSA CLABSI had a ceftaroline susceptible MRSA infection followed < 1 month later by a ceftaroline resistant infection (MIC =32 μg/ml); the isolates were identical by PFGE. Only 3 subjects had previously received ceftaroline, none of which subsequently developed a ceftaroline RS isolate. Figure 1. Ceftaroline MIC Distribution Figure 2. Clinical And Microbiologic Associations with Reduced Ceftaroline Susceptibility Conclusion Ceftaroline RS occurs in 2.9% of invasive MRSA isolates in children and is most prominent among healthcare-associated infections. These isolates were associated with clindamycin resistance and agr group II. While ceftaroline RS is rare among invasive MRSA infections, the lack of preceding ceftaroline exposure is concerning and warrants careful surveillance. Disclosures Sheldon L. Kaplan, MD, Allergan (Research Grant or Support)Pfizer (Grant/Research Support) Jonathon C. McNeil, MD, Allergan (Research Grant or Support, Allergan provided ceftaroline powder for use in studies described in this abstract)

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Incidence of elevated intraocular pressure after intravitreal injection in Japanese patients with age-related macular degeneration

Scientific Reports ◽

10.1038/s41598-021-91832-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Maiko Maruyama-Inoue ◽

Tatsuya Inoue ◽

Shaheeda Mohamed ◽

Yoko Kitajima ◽

Shoko Ikeda ◽

...

Keyword(s):

Risk Factors ◽

Intraocular Pressure ◽

Macular Degeneration ◽

Intravitreal Injection ◽

Odds Ratio ◽

Japanese Patients ◽

Age Related Macular Degeneration ◽

Age Related ◽

Elevated Intraocular Pressure ◽

History Of

AbstractThe purpose of this study was to report the incidence of elevated intraocular pressure (IOP) after intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF) in Japanese patients with age-related macular degeneration (AMD). A retrospective study of chart review of patients who underwent ≥ 10 intravitreal anti-VEGF injections between April 2009 and December 2019 was conducted. Elevated IOP was defined as IOP ≥ 25 mmHg at one visit. Cases with elevated IOP resulting from IVI were identified. Furthermore, the association between elevated IOP and some parameters, as the risk factors that influence elevated IOP, was investigated. A total of 402 eyes of 370 patients were included in this study. Twenty-eight eyes of 26 patients (7.0%) were identified as cases with elevated IOP after IVI. The mean time of elevation after baseline was 50.6 ± 26.5 months. History of glaucoma (p = 0.021; odds ratio, 5.85), treatment modality (p = 0.019; odds ratio, 6.32), and total number of injections (p = 0.003; odds ratio, 1.03) were significantly associated with elevated IOP. A late complication of elevated IOP is associated with IVI in patients with AMD. Particularly, history of glaucoma and treat and extend regimen with frequent injections were found to be risk factors of elevated IOP.

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