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Detection of potential enteric pathogens in children with severe acute gastroenteritis using the filmarray: Results from a three - years hospital-based survey in Northern Italy. Diagn Microbiol Infect Dis 2021; 102:115611. [PMID: 34953368 DOI: 10.1016/j.diagmicrobio.2021.115611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
Acute gastroenteritis (AGE) are leading causes of morbidity and mortality in children. Therefore, rapid pathogens identification is needed. The AGE aetiology was investigated from 2018 to 2020 in 2,066 children in Parma (Italy) by FilmArray Gastrointestinal Panel and Enterovirus-targeting RT-PCR. Pathogens were detected in 1,162 (56.2%) stool samples from as many children; 798 (68.7%) were single and 364 (31.3%) mixed infections (68.7% vs 31.3%, P < 0.0001). Children aged 0-5 years showed the highest infection incidence (66.1%). The most frequent pathogens were Enteropathogenic Escherichia coli (EPEC; 19.14%), Clostridioides difficile (10.42%), Norovirus (10.36%), Enterovirus (9.44%), and Campylobacter (9.21%). EPEC, Campylobacter, enteroaggregative E. coli, Norovirus, and Rotavirus showed seasonality. The incidence of pathogens detected decreased between 2018 and 2020 (42.7% vs 20.8%, P < 0.0001), seemingly for the preventive measures imposed by the severe acute respiratory syndrome coronavirus-2 pandemic. A putative aetiology in half the children examined and an estimate of enteric pathogens epidemiology were assessed.
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Bonanni P, Conforti G, Franco E, Gabutti G, Marchetti F, Mattei A, Prato R, Vitali Rosati G, Vitale F. Fourteen years' clinical experience and the first million babies protected with human live-attenuated vaccine against rotavirus disease in Italy. Hum Vaccin Immunother 2021; 17:4636-4645. [PMID: 34370615 PMCID: PMC8828124 DOI: 10.1080/21645515.2021.1955611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Rotavirus (RV) causes up to half of hospital and community acute gastroenteritis (AGE) cases in young children in Italy. Two RV vaccines, available since 2006, are human RV (HRV) and human bovine RV (HBRV). This report looks back at the implementation of RV vaccination with HRV in Italy, and at HRV current and future perspectives. Initial regional policies led to national implementation by 2018, after scientific societies' disease awareness efforts. Following vaccination, RV hospitalizations declined significantly, and cost savings were observed. The two-dose HRV vaccine is easily administered during compulsory vaccine visits, helping increase coverage. Intussusception, a serious event in children <1 year, was reported in Italy with a rate of 33-40 per 100,000 infants. RV vaccination presents a low increased risk of intussusception after the first dose, estimated at 0.6 cases per 100,000 doses in Italy in 2019. Parents should be aware of the intussusception risk and symptoms to ensure prompt treatment. It is widely recognized that the vaccination benefits (large numbers of RV hospitalizations prevented) outweigh the risk. HRV introduction in Italy was supported by epidemiologic burden studies, healthcare provider opinions, and congress debates, which significantly contributed to implementation of RV universal routine infant vaccination in Italy.
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Affiliation(s)
- Paolo Bonanni
- Department of Health Sciences, University of Florence, Italy
| | - Giorgio Conforti
- Italian Federation of Primary Care Pediatricians (FIMP), Genoa, Italy
| | - Elisabetta Franco
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Gabutti
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Antonella Mattei
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rosa Prato
- Department of Medical and Surgical Sciences, University of Foggia; Department of Hygiene, Policlinico Riuniti University Hospital of Foggia, Foggia, Italy
| | - Giovanni Vitali Rosati
- Family Pediatrician (FIMP Federazione Italiana Medici Pediatri), Greve in Chianti, FI, Italy
| | - Francesco Vitale
- Department of Health Promotion, Maternal-Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
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Camilloni B, Alunno A, Nunzi E, Sarnari L, Ianiro G, Monini M. Hospital-acquired rotavirus acute gastroenteritis in 10 consecutive seasons in Umbria (Italy). J Med Virol 2020; 92:3202-3208. [PMID: 32285951 DOI: 10.1002/jmv.25878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 04/02/2020] [Accepted: 04/11/2020] [Indexed: 11/11/2022]
Abstract
Group A rotaviruses (RVA) are the leading cause of acute gastroenteritis (AGE) in young (aged <5 years) children. Several studies showed that RVA is one of the main cause of nosocomial gastroenteritis in hospitalized pediatric population worldwide, with an incidence ranging from 8 to 33 cases per 100 hospitalized children. Nosocomial infections, in which AGE symptoms develop at least 2 days after admission, may severely affect children already admitted to hospital for other causes. This study aimed to define the trends of the RVA genotypes through statistical analysis of the data obtained by the rotavirus surveillance in Umbria in 10 consecutive seasons, from 2007-2008 to 2016-2017, with update information on hospital-acquired RVA AGE. During RVA gastroenteritis surveillance in Umbria (Italy) in 2007 to 2017, a total of 741 RVA positive faecal samples were collected from children hospitalized with AGE, and RVA strains were genotyped following standard EuroRotaNet protocols. Of the 741 analyzed samples, 75 (10%) were reported to be hospital-acquired. Comparing the distributions of the RVA genotypes circulating in the community or associated with nosocomial infections, we observed a different distribution of genotypes circulating inside the hospital wards, with respect to those observed in the community except in 2010 to 2011, 2011 to 2012, and 2012 to 2013 when G1P[8], G4P[8] and the novel strain G12P[8] caused a large community- and hospital-acquired outbreak. Of the 741 analyzed samples, 75 (10%) were reported to be hospital-acquired. Comparing the distributions of the RVA genotypes circulating in the community or associated with nosocomial infections, we observed a different distribution of genotypes circulating inside the hospital wards, with respect to those observed in the community except in 2010 to 2011, 2011 to 2012, and 2012 to 2013 when G1P[8], G4P[8], and the novel strain G12P[8] caused a large community- and hospital-acquired outbreak. The information from this study will be useful to implement guidelines for preventing nosocomial RVA AGE, which should include an improved management of the hospitalized patients and an increase in vaccination coverage.
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Affiliation(s)
| | - Anna Alunno
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Emilia Nunzi
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Laura Sarnari
- School of Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy
| | - Giovanni Ianiro
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marina Monini
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Rome, Italy
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Yi J, Sederdahl BK, Wahl K, Jerris RR, Kraft CS, McCracken C, Gillespie S, Kirby AE, Shane AL, Moe CL, Anderson EJ. Rotavirus and Norovirus in Pediatric Healthcare-Associated Gastroenteritis. Open Forum Infect Dis 2016; 3:ofw181. [PMID: 27807589 PMCID: PMC5088695 DOI: 10.1093/ofid/ofw181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/23/2016] [Indexed: 12/30/2022] Open
Abstract
Rotavirus and norovirus are important etiologies of gastroenteritis among hospitalized children. During 2012–2013, we tested 207 residual stool specimens from children with healthcare-associated vomiting and/or diarrhea for rotavirus and norovirus. Twenty (10%) were rotavirus positive, and 3 (3%) were norovirus positive, stressing the importance of these pathogens in hospitalized children.
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Affiliation(s)
- Jumi Yi
- Department of Pediatrics , Emory University School of Medicine
| | - Bethany K Sederdahl
- Department of Pediatrics, Emory University School of Medicine; Rollins School of Public Health, Emory University
| | - Kelly Wahl
- Rollins School of Public Health , Emory University
| | - Robert R Jerris
- Children's Healthcare of Atlanta; Department of Pathology and Laboratory Medicine
| | - Colleen S Kraft
- Department of Pathology and Laboratory Medicine; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | - Scott Gillespie
- Department of Pediatrics , Emory University School of Medicine
| | - Amy E Kirby
- Rollins School of Public Health , Emory University
| | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine; Rollins School of Public Health, Emory University; Children's Healthcare of Atlanta
| | | | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Gervasi G, Capanna A, Mita V, Zaratti L, Franco E. Nosocomial rotavirus infection: An up to date evaluation of European studies. Hum Vaccin Immunother 2016; 12:2413-8. [PMID: 27185183 PMCID: PMC5027725 DOI: 10.1080/21645515.2016.1183858] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Rotavirus (RV) is worldwide considered as the most important viral agent of acute gastroenteritis in children less than 5 y. Since 2006, the availability of anti-RV vaccines has deeply modified the incidence and economic burden of RV infection. In Europe, some countries have introduced an anti-RV vaccination program in the last 10 y. Although community acquired RV (CARV) disease is the most studied condition of RV infection, recently some authors have highlighted the importance of nosocomial RV (nRV) disease as an emerging public health issue. The aim of this review is to summarize the epidemiology of both CARV and nRV, in order to discuss the difficulty of a clear evaluation of the burden of the disease in absence of comparable data. In particular, we focused our attention to European studies regarding nRV in terms of divergences related to definition, report of incidence rate and methodological issues.
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Affiliation(s)
- G Gervasi
- a Specialization School for Hygiene and Preventive Medicine , University of Rome Tor Vergata , Rome , Italy
| | - A Capanna
- a Specialization School for Hygiene and Preventive Medicine , University of Rome Tor Vergata , Rome , Italy
| | - V Mita
- b Department of Biomedicine and Prevention , University of Rome Tor Vergata , Rome , Italy
| | - L Zaratti
- b Department of Biomedicine and Prevention , University of Rome Tor Vergata , Rome , Italy
| | - E Franco
- b Department of Biomedicine and Prevention , University of Rome Tor Vergata , Rome , Italy
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Mattei A, Sbarbati M, Fiasca F, Angelone AM, Mazzei MC, di Orio F. Temporal trends in hospitalization for rotavirus gastroenteritis: A nationwide study in Italy, 2005-2012. Hum Vaccin Immunother 2016; 12:534-9. [PMID: 26337458 PMCID: PMC5049727 DOI: 10.1080/21645515.2015.1081726] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/14/2015] [Accepted: 08/06/2015] [Indexed: 11/07/2022] Open
Abstract
AGE severity is linked to etiology, and Rotavirus (RV) accounts for most of severe cases. In 2009 the World Health Organization recommended RV vaccination for all children. Worldwide a number of Countries implemented RV vaccination in their pediatric immunisation programmes, but only a limited number in Europe. This study was designed to estimate the proportion of RVGE among children aged <6 y who were diagnosed with AGE and admitted to hospitals in Italy during the years 2005-2012. A total of 334,982 hospital discharge forms were collected, being 79,344 hospitalizations associated with RV. The average hospitalization rate (HR) was 146/100,000 children for RVGE in primary diagnosis (PD) and 150/100,000 children for RVGE in secondary diagnosis (SD). Since 2008 the RVGE hospitalization figures and rates (HRs) in SD exceed those in PD. The majority of RVGE hospitalizations (33.67%) were reported among children aged ≤ 2 years. Despite some limitations due to the hospital discharge database (HDD) synthetic contents and low potential for clinical interpretation, the analysis of national HDD, including PD and SD, documents that RV still represents a consistent cause of pediatric hospitalizations in Italy.
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Affiliation(s)
- Antonella Mattei
- Medical Statistics; Section of Public Health; Department of Life, Health and Environmental Sciences; University of L'Aquila; L'Aquila, Italy
| | - Margherita Sbarbati
- Department of Maternal and Child Health; Local Health Unit of Rieti; Rieti, Italy
| | - Fabiana Fiasca
- Clinical Medicine and Public Health; Department of Life, Health and Environmental Sciences; University of L'Aquila; L'Aquila, Italy
| | - Anna Maria Angelone
- Department of Life, Health and Environmental Sciences; University of L'Aquila; L'Aquila, Italy
| | - Maria Chiara Mazzei
- Epidemiology, Prevention, and Rehabilitation of Chronic-Degenerative Diseases; Department of Life, Health and Environmental Sciences; University of L'Aquila; L'Aquila, Italy
| | - Ferdinando di Orio
- General and Applied Hygiene; Section of Public Health; Department of Life, Health and Environmental Sciences; University of L'Aquila; L'Aquila, Italy
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Pasteur S. The Economic Value of Vaccination: Why Prevention is Wealth. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2015; 3:29414. [PMID: 27123186 PMCID: PMC4802700 DOI: 10.3402/jmahp.v3.29414] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Largeron N, Lévy P, Wasem J, Bresse X. Role of vaccination in the sustainability of healthcare systems. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2015; 3:27043. [PMID: 27123188 PMCID: PMC4802702 DOI: 10.3402/jmahp.v3.27043] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 05/11/2023]
Abstract
The use of vaccines to prevent diseases in children, adults, and the elderly results in fewer medical visits, diagnostic tests, treatments, and hospitalisations, which leads to substantial savings in healthcare costs each year in Europe and elsewhere. Vaccines also contribute to reducing resource utilisation by preventing nosocomial infections, such as rotavirus gastroenteritis, which can increase hospital stays by 4-12 days. Vaccination also has an important role in the prevention of cancers with, for example, human papillomavirus or hepatitis B vaccines. Since the financial impact of cancer is high for patients, healthcare systems, and society as a whole, any cases prevented will reduce this impact. Newer vaccines, such as the herpes zoster vaccine, can provide an answer to unmet medical needs by preventing and reducing the severity of shingles and associated post-herpetic neuralgia, which are difficult conditions to treat. Thus, in the context of increasing pressure on healthcare budgets, vaccination can contribute to the sustainability of healthcare systems through reduced and more efficient use of healthcare resources.
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Affiliation(s)
- Nathalie Largeron
- Sanofi Pasteur MSD, Lyon, France
- Correspondence to: Nathalie Largeron, Sanofi Pasteur MSD, 162 avenue Jean Jaurès, Lyon, France,
| | - Pierre Lévy
- LEDa-LEGOS, Université Paris-Dauphine, Paris, France
| | - Jürgen Wasem
- Institute of Health Care Management and Research, Universität Duisburg, Essen, Germany
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Álvarez Aldeán J, Aristegui J, López-Belmonte JL, Pedrós M, Sicilia JG. Economic and psychosocial impact of rotavirus infection in Spain: a literature review. Vaccine 2014; 32:3740-51. [PMID: 24837768 DOI: 10.1016/j.vaccine.2014.04.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/15/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
Abstract
Severe rotavirus gastroenteritis is common in children under 5 years of age. A literature review was performed to investigate the economic and psychosocial impact of rotavirus infection in children in this age group. We retrieved 56 articles on the economic burden of the disease in Europe, 18 of them reported data from Spain; 8 articles were retrieved analysing its psychosocial impact. In Spain, rotavirus is responsible for 14% to 30% of all cases of gastroenteritis, and a quarter of these require hospitalisation. It is also associated with high use of health care resources (emergency and primary care visits). Rotavirus gastroenteritis costs the Spanish national health system EUR 28 million a year and causes productivity loss in two-thirds of parents (mean of 4 days). Taking into account these costs, it was estimated that implementing universal vaccination could prevent 76% to 95% of hospital admissions due to rotavirus gastroenteritis, as well as reduce emergency and paediatric visits, nosocomial infections, and days missed from work (77% reduction). Rotavirus gastroenteritis also has a considerable psychosocial impact on the family, although it is difficult to compare results due to the diversity of study designs and the low specificity of the measurement tools used. It also causes high stress among parents, adding to their workload and adversely affecting their quality of life.
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Adenoviruses associated with acute diarrhea in children in Beijing, China. PLoS One 2014; 9:e88791. [PMID: 24533149 PMCID: PMC3923065 DOI: 10.1371/journal.pone.0088791] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 01/10/2014] [Indexed: 11/19/2022] Open
Abstract
Adenoviruses have been recognized as important causal pathogens of community-acquired diarrhea (CAD) among children, but their role in hospital-acquired diarrhea (HAD) is not well-understood. Hospitalized children with acute diarrhea and children who visited the outpatient department due to diarrhea were investigated from 2011 to 2012. Adenovirus was detected in stool specimens by PCR and further characterized by sequencing and phylogenetic analysis. SPSS software (version 19.0) was used for statistical analyses. A total of 2233 diarrheal children were enrolled in this study; this sample was comprised of 1371 hospitalized children, including 885 with CAD (IP-CAD) and 486 with HAD, and 862 outpatients with CAD (OP-CAD). Among these 2,233 patients, adenovirus was detected in 219 cases (9.8%). The positive rates for adenovirus were significantly different between the IP-CAD (9.3%), HAD (13.8%) and OP-CAD (8.1%) cases (X² = 11.76, p = 0.003). The positive rate of adenovirus was lower in infants under six months of age compared to the positive rates in the other age groups. Of the 219 of adenovirus positive patients, 91 (41.6%) were identified as having serotype 41. Although enteric adenovirus (group F) was the most frequently detected adenovirus among children with either CAD or HAD, the role of non-enteric adenoviruses, especially the adenovirus 31 type (19.7%), cannot be ignored in diarrheal children.
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Brüggenjürgen B, Lorrot M, Sheppard FR, Rémy V. Do current cost-effectiveness analyses reflect the full value of childhood vaccination in Europe? A rotavirus case study. Hum Vaccin Immunother 2014; 10:2290-4. [PMID: 25424934 PMCID: PMC4896769 DOI: 10.4161/hv.29090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 05/01/2014] [Indexed: 01/18/2023] Open
Abstract
Economic evaluation of vaccination programs can be challenging and does not always fully capture the benefits provided. Reasons for this include the difficulties incurred in accurately capturing the health and economic impact of infectious diseases and how different diseases may interact with each other. Rotavirus infection, for example, peaks at a similar time than other infectious diseases, such as RSV and influenza, which can cause hospital overcrowding and disruption, and may pose a risk to more vulnerable children due to limited availability of isolation facilities. Another challenge, specific to evaluating childhood vaccination, is that QoL cannot be accurately measured in children due to a lack of validated instruments. Childhood diseases also incur a care giver burden, due to the need for parents to take time off work, and this is important to consider. Finally, for diseases such as RVGE, cost-effectiveness analyses in which longer time horizons are considered may not reflect the short-term benefits of vaccination. Further quantification of the economic impact of childhood diseases is thus required to fully highlight the true benefits of childhood vaccination that may be realized. Herein we explore the limitations of existing economic evaluations for childhood vaccination, and how economic analyses could be better adapted in future.
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Pockett RD, Campbell D, Carroll S, Rajoriya F, Adlard N. Rotavirus, respiratory syncytial virus and non-rotaviral gastroenteritis analysis of hospital readmissions in England and Wales. Acta Paediatr 2013; 102:e158-63. [PMID: 23289533 DOI: 10.1111/apa.12124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 12/03/2012] [Accepted: 12/05/2012] [Indexed: 11/29/2022]
Abstract
AIM To quantify readmissions with infectious diseases and differences in readmission patterns. METHODS Using the CHKS database, children <5 years admitted to hospital in England and Wales, between 2000 and 2008, with rotavirus (RV), respiratory syncytial virus (RSV) or non-rotaviral gastroenteritis (NRV) were identified. All admissions within a 30-day prior period were similarly identified, and the proportion of readmissions was calculated. RESULTS There were 365,693 admissions for RV, RSV and NRV; 17.2% were readmissions. In 36% of cases, the cause of the prior admission was also RV, RSV or NRV, with 64% having a different prior diagnosis. The majority of readmissions were within 5 days of their prior admission, the majority of those with RV (n = 2,566/58.7%) within 3 days, NRV (n = 11 326/53.5%) within 4 days and RSV (n = 18 811/50.2%) within 9 days of prior discharge. Readmission for RV was associated with greater LOS than RSV (p < 0.001) and NRV (p < 0.001), while cost per admission was greater for RV compared to RSV (p < 0.001) and NRV (p < 0.001). CONCLUSIONS Thirty-six percent of readmissions indicated discharge without resolution from the first admission; nosocomial infection needs to be considered as a cause in the other. Although RSV represented the largest readmission group, higher costs and longer LOS were associated with RV.
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Affiliation(s)
- Rhys D. Pockett
- Swansea Centre for Health Economics; Swansea University; Swansea UK
| | - David Campbell
- General Paediatrics; Sheffield Children's Hospital NHS Foundation Trust; Sheffield UK
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Park KK, Kim MU, Chung MS, Lee DH, Hong CH. Easily removable ureteral catheters for internal drainage in children: a preliminary report. Yonsei Med J 2013; 54:464-8. [PMID: 23364982 PMCID: PMC3575964 DOI: 10.3349/ymj.2013.54.2.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We review our experience using a new and easily removable ureteral catheter in patients who underwent complicated ureteral reimplantation. Our goal was to shorten hospital stay and lower anxiety during catheter removal without fear of postoperative ureteral obstruction. MATERIALS AND METHODS Between April 2009 and September 2010, nine patients who underwent our new method of catheter removal after ureteral reimplantation were enrolled. Patients who underwent simple ureteral reimplantation were excluded from the study. Following ureteral reimplantation, a combined drainage system consisting of a suprapubic cystostomy catheter and a ureteral catheter was installed. Proximal external tubing was clamped with a Hem-o-lok clamp and the rest of the external tubing was eliminated. Data concerning the age and sex of each patient, reason for operation, method of ureteral reimplantation, and postoperative parameters such as length of hospital stay and complications were recorded. RESULTS Of the nine patients, four had refluxing megaureter, four had a solitary or non-functional contralateral kidney and one had ureteral stricture due to a previous anti-reflux operation. The catheter was removed at postoperative week one. The mean postoperative hospital stay was 2.4 days (range 1-4 days), and the mean follow-up was 9.8 months. None of the patients had postoperative ureteral obstructions, and there were no cases of migration or dislodgement of the catheter. CONCLUSION Our new method for removing the ureteral catheter would shorten hospital stays and lower levels of anxiety when removing ureteral catheters in patients with a high risk of postoperative ureteral obstruction.
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Affiliation(s)
- Kyung Kgi Park
- Department of Urology, Jeju National University College of Medicine, Jeju, Korea
| | - Myung Up Kim
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mun Su Chung
- Department of Urology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Dong Hoon Lee
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Hee Hong
- Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Abstract
OBJECTIVE Rotavirus (RV) gastroenteritis is a notifiable disease in Germany. The reports to the authorities contain few data concerning the severity of disease. The aims of this study were to determine incidence and outcome of very severe cases of RV disease. METHODS Cases of very severe RV disease were collected by the German Paediatric Surveillance Unit for rare diseases (Erhebungseinheit für seltene pädiatrische Erkrankungen in Deutschland) using anonymous questionnaires based on hospitalized patients between April 2009 and March 2011. Inclusion criteria were detection of RV antigen in feces, patient aged 0-16 years and 1 or more of the following criteria: intensive care treatment, hypernatremia or hyponatremia (>155 mmol/L or <125 mmol/L), clinical signs of encephalopathy (somnolence, seizures, apnea) and RV-associated death. RESULTS During 2 years, 130 cases of very severe RV disease were reported, 101 of 130 were verified. Seventeen patients had nosocomial infection, of whom 14 were neonates in intensive care. Among those, 12 infants had verified or suspected necrotizing enterocolitis. Eighty-four community-acquired cases were reported, median age was 10.5 months (0-108 months). The median hospital stay was 6 days, and 48 patients needed intensive care treatment. Among children less than 5 years of age, the yearly incidence of community-acquired very severe RV disease was 1.2 of 100,000 (95% confidence interval: 0.9-1.4/100,000). A total of 26 of 84 and 10 of 84 patients had severe hypernatremia or hyponatremia, respectively, and 58 of 84 patients had signs of encephalopathy. Three deaths were reported (1 nosocomial and 2 community acquired). CONCLUSIONS RV infection in Germany can have a life-threatening course. A substantial number are nosocomial infections.
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Rotavirus-related hospitalizations are responsible for high seasonal peaks in all-cause pediatric hospitalizations. Pediatr Infect Dis J 2012; 31:e244-9. [PMID: 22828647 DOI: 10.1097/inf.0b013e31826a5ba1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Seasonal rotavirus (RV) epidemics partly overlap with those of other common childhood infections, thereby generating enormous, but poorly quantified, pressure on hospital resources during winter and spring. We assessed RV contribution to seasonal excess in all-cause pediatric hospitalizations and RV hospitalization incidence rate in an observational study. METHODS The study was conducted among pediatric wards in 3 general hospitals and 1 pediatric tertiary care center. Numbers of RV hospitalizations were determined from 5-year data on confirmed RV hospitalizations and adjusted for RV underreporting, assessed through active surveillance for acute gastroenteritis during the 2011 RV season. Incidence rate and RV contribution to all-cause hospitalizations were determined on hospital administrative data and population statistics. RESULTS RV accounted for 6.2% (95% confidence interval: 5.3-7.1) of all-cause pediatric hospitalizations among general hospitals and 3.1% (95% confidence interval: 2.9-3.3) at the tertiary care center, adjusted for the proportion RV underreporting among gastroenteritis patients (33%) as observed during active surveillance. Among general hospitals, there was a 30% increase in all-cause hospitalizations during the active season of common childhood infections compared with summer months. RV contributed 31% to seasonal excess in all-cause pediatric hospitalizations, representing 12.9% of hospitalizations between January and May. RV hospitalizations incidence rate in the population was 510/100,000 child-years <5 years (95% confidence interval: 420-600). CONCLUSION RV is one of the main causes of seasonal peaks in pediatric hospitalizations, and as such contributes significantly to periodic high bed capacity pressures and associated adverse effects. RV vaccination benefits in this respect should be considered in decision-making processes.
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Mittmann N, Koo M, Daneman N, McDonald A, Baker M, Matlow A, Krahn M, Shojania KG, Etchells E. The economic burden of patient safety targets in acute care: a systematic review. Drug Healthc Patient Saf 2012; 4:141-65. [PMID: 23097615 PMCID: PMC3476359 DOI: 10.2147/dhps.s33288] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Our objective was to determine the quality of literature in costing of the economic burden of patient safety. METHODS We selected 15 types of patient safety targets for our systematic review. We searched the literature published between 2000 and 2010 using the following terms: "costs and cost analysis," "cost-effectiveness," "cost," and "financial management, hospital." We appraised the methodologic quality of potentially relevant studies using standard economic methods. We recorded results in the original currency, adjusted for inflation, and then converted to 2010 US dollars for comparative purposes (2010 US$1.00 = 2010 €0.76). The quality of each costing study per patient safety target was also evaluated. RESULTS We screened 1948 abstracts, and identified 158 potentially eligible studies, of which only 61 (39%) reported any costing methodology. In these 61 studies, we found wide estimates of the attributable costs of patient safety events ranging from $2830 to $10,074. In general hospital populations, the cost per case of hospital-acquired infection ranged from $2132 to $15,018. Nosocomial bloodstream infection was associated with costs ranging from $2604 to $22,414. CONCLUSION There are wide variations in the estimates of economic burden due to differences in study methods and methodologic quality. Greater attention to methodologic standards for economic evaluations in patient safety is needed.
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Affiliation(s)
- Nicole Mittmann
- Health Outcomes and Pharmaco Economics (HOPE) Research Centre, Division of Clinical Pharmacology, Toronto, ON, Canada
| | - Marika Koo
- Health Outcomes and Pharmaco Economics (HOPE) Research Centre, Division of Clinical Pharmacology, Toronto, ON, Canada
| | - Nick Daneman
- Division of Infectious Diseases, Toronto, ON, Canada
| | - Andrew McDonald
- Quality and Patient Safety, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michael Baker
- Patient Safety in Ontario, University Health Network, Toronto, ON, Canada
| | - Anne Matlow
- Infection Prevention and Control and Patient Safety, Hospital for Sick Children, Toronto, ON, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada
| | - Kaveh G Shojania
- University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Edward Etchells
- University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Polage CR, Solnick JV, Cohen SH. Nosocomial diarrhea: evaluation and treatment of causes other than Clostridium difficile. Clin Infect Dis 2012; 55:982-9. [PMID: 22700831 DOI: 10.1093/cid/cis551] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Diarrhea is common among hospitalized patients but the causes are distinct from those of diarrhea in the community. We review existing data about the epidemiology of nosocomial diarrhea and summarize recent progress in understanding the mechanisms of diarrhea. Clinicians should recognize that most cases of nosocomial diarrhea have a noninfectious etiology, including medications, underlying illness, and enteral feeding. Apart from Clostridium difficile, the frequency of infectious causes such as norovirus and toxigenic strains of Clostridium perfringens, Klebsiella oxytoca, Staphylococcus aureus, and Bacteroides fragilis remains largely undefined and test availability is limited. Here we provide a practical approach to the evaluation and management of nosocomial diarrhea when tests for C. difficile are negative.
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Affiliation(s)
- Christopher R Polage
- Department of Pathology and Laboratory Medicine, Division of Infectious Diseases, University of California, Davis Medical Center, Sacramento, USA.
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The unpredictable diversity of co-circulating rotavirus types in Europe and the possible impact of universal mass vaccination programmes on rotavirus genotype incidence. Vaccine 2012; 30:4596-605. [PMID: 22579864 DOI: 10.1016/j.vaccine.2012.04.097] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 04/17/2012] [Accepted: 04/26/2012] [Indexed: 11/21/2022]
Abstract
This article reviews the incidence of group A rotavirus (RV) types isolated from children with acute gastroenteritis (AGE) in European countries during the last 5-10 years, with the aim of establishing an overview of RV diversity before the introduction of universal mass vaccination (UMV) programmes against RV disease in most European countries. Consistent with findings from previous surveys, a high degree of diversity of co-circulating RV types exists in different locations of Europe, and over different RV seasons. Whilst RV UMV can potentially change the diversity of co-circulating genotypes, there are at present insufficient data for Europe to come to firm conclusions. Even in countries outside Europe, with several years of RV surveillance following the introduction of RV UMV (Brazil, Australia, USA), it is not clear whether changes observed in the diversity of particular RV types are due to natural fluctuations or immunological pressure exerted by RV UMVs. Consequently, it will be very difficult for European countries that have RV UMVs to conclude whether incidence changes of RV types in children with AGE are driven by immune pressures from vaccination or simply reflect natural temporal and spatial fluctuations. Whilst the monitoring of co-circulating RV strains should be continued, it should be acknowledged that the licensed monovalent and pentavalent RV vaccines are similarly effective in developed countries and that levels of RV type-specific neutralising antibodies after RV vaccination are only partially correlated with the degree of protection achieved; therefore, the significance of RV diversity for RV vaccination may be less important than is often assumed.
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Abstract
BACKGROUND AND OBJECTIVES Nosocomial rotavirus (nRV) infections represent an important part of rotavirus (RV)-associated morbidity. The incidence of nRV influences the estimated total RV disease burden, an important determinant of cost-effectiveness of RV vaccination programs. Our aim is to summarize the existing evidence and produce reliable estimates of nRV incidence, in pediatric settings in Europe and North America. METHODS We searched electronic databases for studies on nRV incidence among pediatric inpatients. To ascertain complete case reporting, only studies describing active nRV surveillance in their methodology were included. Random effects meta-analysis was performed. Meta-regression was used to obtain results adjusted for important study characteristics. RESULTS Twenty surveillance studies met the quality criteria for inclusion. The pooled unadjusted nRV incidence was 2.9 per 100 hospitalizations (95% confidence interval [CI]: 1.6-4.4). Incidence was significantly influenced by studies' seasonality-months (RV epidemic season only or year-round) and the age range of included patients. Highest nRV incidence was found for children <2 years of age, hospitalized during the epidemic months (8.1/100 hospitalizations; 95% CI: 6.4-9.9). The adjusted year-round nRV incidence estimate without age restriction was 0.4/100 hospitalizations (95% CI: 0.1-2.1) and 0.7 (95% CI: 0.0-1.8) for children <5 years of age. CONCLUSIONS This is the first meta-analysis to summarize results of surveillance studies on nRV incidence. nRV is an important problem among hospitalized infants during the winter months. The lower season and age-adjusted nRV incidence estimate seems more appropriate for application in population-based burden of disease analysis.
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Complications in hospitalized children with acute gastroenteritis caused by rotavirus: a retrospective analysis. Eur J Pediatr 2012; 171:337-45. [PMID: 21833497 DOI: 10.1007/s00431-011-1536-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 07/18/2011] [Indexed: 10/17/2022]
Abstract
UNLABELLED Acute gastroenteritis (AGE) caused by rotavirus (RV) is a common disease among infants and toddlers, often leading to hospitalization and, in resource-poor countries, to death. However, little is known on specific complications of severe RV-positive (RV+) AGE and on the clinical course in chronically ill children. This was a retrospective analysis of data for children <5 years of age hospitalized due to AGE during six rotavirus seasons in three large German pediatric hospitals. The primary study end point was the incidence and type of complications in RV+ versus RV-negative (RV-) cases. A total of 6,884 episodes of AGE in hospitalized children aged <5 years were included in this analysis. Of the 4,880 stools tested for RV, 2,118 (43.4%) were RV+. Hypernatremia was significantly more common in RV+ AGE (P < 0.001) and was associated with severe disease, need for intensive care treatment, and longer duration of hospitalization. Metabolic disorders, particularly hypoglycemia, were more common in RV+ AGE. In contrast, symptoms such as respiratory infections, neurological, and abdominal symptoms were more common in children with RV- AGE. CONCLUSIONS Hypernatremia is a specific complication of RV+ AGE. RV would therefore appear to be the cause of infant toxicosis, the traditional descriptive term for severe dehydration and clinical deterioration following AGE.
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Abstract
Probiotics have been extensively studied over the past several years in the prevention and, to a larger extent, in the treatment of diarrheal diseases, especially in pediatric populations. Diarrhea is a symptom, and not a disease. This review will not address chronic disorders associated with diarrhea, or Clostridium difficile-induced diarrhea. Rather it will focus on published clinical trials performed on acute-onset, likely infectious diarrhea occurring in the settings of day-care centers, in the community, acquired in the hospital, antibiotic-associated diarrhea, and treatment of acute infectious diarrhea. For prevention of diarrhea acquired in day-care centers, 9 randomized and placebo-controlled trials have been published, conducted in different parts of the world. Probiotics tested were Lactobacillus GG, Bifidobacterium lactis (alone or in combination with Streptococcus thermophilus, and Lactobacillus reuteri, Lactobacillus rhamnosus (not GG), and Lactobacillus acidophilus, in various trials either alone or in comparison with each other. The evidence of their efficacy in these settings is only modest for the prevention of diarrhea, although somewhat better for prevention of upper respiratory infections. In the community, new trails conducted in underprivileged areas of India, again with modest efficacy. Previous trials that examined the potential role of probiotics in preventing the spreading of diarrhea in hospitalized children had yielded conflicting results. More recently, a large trial in Poland showed, however, rather good evidence of efficacy for Lactobacillus GG. The prevention of antibiotic-associated diarrhea has been the subject of many investigations, both in children and in adults. Most commonly used probiotics were Lactobacillus GG, Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium ssp, Streptococcus ssp, and the yeast Saccharomyces boulardii. In general, most of these trials do show clear evidence of efficacy, with the 2 most effective strains being Lactobacillus GG and S. boulardii. Evidence is also emerging on the importance of the dose in reducing the incidence of this type of diarrhea, and the incidence of Clostridium difficile-associated postantibiotic diarrhea. As for treatment, a large body of data is available, especially in children, on the effect of several strains of probiotics in treating sporadic infectious diarrhea. The vast majority of the published trials show a statistically significant benefit and moderate clinical benefit of a few, well-identified probiotic strains-mostly Lactobacillus GG and S. boulardii-in the treatment of acute watery diarrhea, and particularly those due to rotavirus. Such a beneficial effect results, on average, in a reduction of diarrhea duration of approximately 1 day. The effect is strain-dependent and dose-dependent.
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Roca-Chiapas JMDL, Cordova-Fraga T. Biomagnetic techniques for evaluating gastric emptying, peristaltic contraction and transit time. World J Gastrointest Pathophysiol 2011; 2:65-71. [PMID: 22025978 PMCID: PMC3196621 DOI: 10.4291/wjgp.v2.i5.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 08/31/2011] [Accepted: 09/07/2011] [Indexed: 02/06/2023] Open
Abstract
Biomagnetic techniques were used to measure motility in various parts of the gastrointestinal (GI) tract, particularly a new technique for detecting magnetic markers and tracers. A coil was used to enhance the signal from a magnetic tracer in the GI tract and the signal was detected using a fluxgate magnetometer or a magnetoresistor in an unshielded room. Estimates of esophageal transit time were affected by the position of the subject. The reproducibility of estimates derived using the new biomagnetic technique was greater than 85% and it yielded estimates similar to those obtained using scintigraphy. This technique is suitable for studying the effect of emotional state on GI physiology and for measuring GI transit time. The biomagnetic technique can be used to evaluate digesta transit time in the esophagus, stomach and colon, peristaltic frequency and gastric emptying and is easy to use in the hospital setting.
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Verhagen P, Moore D, Manges A, Quach C. Nosocomial rotavirus gastroenteritis in a Canadian paediatric hospital: incidence, disease burden and patients affected. J Hosp Infect 2011; 79:59-63. [DOI: 10.1016/j.jhin.2011.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 04/15/2011] [Indexed: 10/18/2022]
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