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McMullan B, Govender N, Carlesse F, Singhal T, Sati H, Warris A. Children and fungal priority pathogens. Lancet Child Adolesc Health 2024:S2352-4642(24)00056-7. [PMID: 38648807 DOI: 10.1016/s2352-4642(24)00056-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Brendan McMullan
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Nelesh Govender
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Fabianne Carlesse
- Oncology Pediatric Institute, IOP-GRACC, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Tanu Singhal
- Kokilaben Dhirubhai Ambani Hospital, Medical Research Institute, Mumbai, India
| | - Hatim Sati
- Antimicrobial Resistance Division, WHO, Geneva, Switzerland
| | - Adilia Warris
- MRC Centre for Medical Mycology, University of Exeter, Exeter EX4 5QD, UK; Department of Paediatric Infectious Diseases, Great Ormond Street Hospital London, London, UK.
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Gifford A, Jayawardena N, Carlesse F, Lizarazo J, McMullan B, Groll AH, Warris A. Pediatric Cryptococcosis. Pediatr Infect Dis J 2024; 43:307-312. [PMID: 38241632 DOI: 10.1097/inf.0000000000004216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Seroprevalence studies have shown that 70% of children are exposed to Cryptococcus , the most common cause of meningitis in people living with human immunodeficiency virus (HIV), but reported pediatric disease prevalence is much lower than in adults. METHODS PubMed and Ovid Global Health databases were searched with the terms "cryptococcosis," "cryptococcal meningitis," " Cryptococcus neoformans " or " Cryptococcus gattii ." All studies reporting pediatric specific data in the English language from 1980 up until December 2022 were included. RESULTS One hundred sixty-eight publications were reviewed totaling 1469 children, with the majority reported from Africa (54.2%). Sixty-five percent (961) were HIV positive, 10% (147) were non-HIV immunocompromised and 19% (281) were immunocompetent. Clinical signs and symptoms were only reported for 458 children, with fever (64%), headache (55%) and vomiting (39%) being the most common. Most children (80%) suffered from meningoencephalitis. Lung involvement was rarely described in HIV-positive children (1%), but significantly more common in the non-HIV immunocompromised (36%) and immunocompetent (40%) groups ( P < 0.0001). Only 22% received the recommended antifungal combination therapy, which was significantly higher in immunocompetent children than those with HIV (39% vs. 6.8%; P < 0.0001). Overall mortality was 23%. A significant higher mortality was observed in children with HIV compared with immunocompetent children (32% vs. 16%; P < 0.001), but not compared with children with non-HIV immunosuppression (25). CONCLUSIONS This is the largest review of pediatric cryptococcosis with new observations on differences in clinical presentation and outcome depending on the underlying condition. The lack of granular clinical data urges prospective clinical epidemiological studies for improved insight in the epidemiology, management and outcome of cryptococcosis in children.
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Affiliation(s)
- Alison Gifford
- MRC Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Naamal Jayawardena
- MRC Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Fabianne Carlesse
- Pediatric Department, Federal University of Sao Paulo, Sao Paolo, Brazil
- Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), Oncology Pediatric Institute, Federal University of São Paulo, Sao Paolo, Brazil
| | - Jairo Lizarazo
- Faculty of Health, Hospital Universitario Erasmo Meoz de Cúcuta, Universidad de Pamplona, Cucuta, Colombia
| | - Brendan McMullan
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital Randwick, Sydney, Australia
| | - Andreas H Groll
- Department of Pediatric Hematology/Oncology, Infectious Disease Research Program, Center for Bone Marrow Transplantation, Children's University Hospital Münster, Munster, Germany
| | - Adilia Warris
- MRC Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
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Lim SA, Chan M, Hu N, McMullan B, Britton PN, Bartlett A, Kandasamy R, Saravanos GL, Prentice B, Jaffe A, Owens L, Homaira N. Risk Factors and Clinical Prognosis Associated With RSV-ALRI Intensive Care Unit Admission in Children <2 Years of Age: A Multicenter Study. Pediatr Infect Dis J 2024:00006454-990000000-00760. [PMID: 38377461 DOI: 10.1097/inf.0000000000004288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections (ALRIs) in children aged <2 years. Currently, there are limited data on risk factors for very severe RSV-ALRI requiring intensive care unit (ICU) admission. METHODS We conducted a case-control study of children aged <2 years admitted with RSV-ALRI to the Sydney Children's Hospital Network, comprising 2 large tertiary pediatric hospitals. Cases were children with laboratory-confirmed RSV-ALRI admitted to ICU, and controls were (1:2, matched on date of admission) children hospitalized with RSV-ALRI but not requiring ICU transfer. Data on risk factors were retrieved from the electronic medical record system. Adjusted odds ratios (aORs) with 95% confidence intervals (95% CI) associated with risk factors for ICU admission and the association with clinical and treatment factors were determined from logistic regression models. RESULTS A total of 44 (44%) of 100 cases and 90 (48.1%) of 187 controls were male. Age <6 months and preterm births were associated with a 2.10-fold (95% CI: 1.14-3.79) and 2.35-fold (95% CI: 1.26-4.41) increased risk in ICU admissions, respectively. The presence of any chronic health condition was a significant risk factor for ICU admission. The clinical presentations on admission more commonly seen in cases were apnea (aOR: 5.01, 95% CI: 1.50-17.13) and respiratory distress (aOR: 15.91, 95% CI: 4.52-55.97). Cases were more likely to be hospitalized for longer duration and require respiratory support. CONCLUSIONS Our results can be translated into a clinical risk algorithm to identify children at risk of very severe RSV disease.
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Affiliation(s)
- Su Ann Lim
- From the Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Australia
| | - Mei Chan
- From the Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Australia
| | - Nan Hu
- From the Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Australia
| | - Brendan McMullan
- From the Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Australia
- Sydney Children's Hospital, Randwick, Sydney, Australia
| | - Philip N Britton
- Sydney Medical School, University of Sydney, Sydney, Australia
- The Children's Hospital at Westmead, Sydney, Australia
| | - Adam Bartlett
- From the Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Australia
- Sydney Children's Hospital, Randwick, Sydney, Australia
| | - Rama Kandasamy
- The Children's Hospital at Westmead, Sydney, Australia
- School of Clinical Medicine, University of Sydney, Sydney, Australia
| | - Gemma L Saravanos
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Bernadette Prentice
- From the Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Australia
- Sydney Children's Hospital, Randwick, Sydney, Australia
| | - Adam Jaffe
- From the Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Australia
- Sydney Children's Hospital, Randwick, Sydney, Australia
| | - Louisa Owens
- From the Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Australia
- Sydney Children's Hospital, Randwick, Sydney, Australia
| | - Nusrat Homaira
- From the Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Australia
- Sydney Children's Hospital, Randwick, Sydney, Australia
- James P. Grant School of Public Health, Dhaka, Bangladesh
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Hurley S, Eden JS, Bingham J, Rodriguez M, Neave MJ, Johnson A, Howard-Jones AR, Kok J, Anazodo A, McMullan B, Williams DT, Watson J, Solinas A, Kim KW, Rawlinson W. Fatal Human Neurologic Infection Caused by Pigeon Avian Paramyxovirus-1, Australia. Emerg Infect Dis 2023; 29:2482-2487. [PMID: 37987582 PMCID: PMC10683822 DOI: 10.3201/eid2912.230250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
Avian paramyxovirus type 1 (APMV-1) is a virus of birds that results in a range of outcomes, from asymptomatic infections to outbreaks of systemic respiratory and neurologic disease, depending on the virus strain and the avian species affected. Humans are rarely affected; those who are predominantly experience mild conjunctivitis. We report a fatal case of neurologic disease in a 2-year-old immunocompromised child in Australia. Metagenomic sequencing and histopathology identified the causative agent as the pigeon variant of APMV-1. This diagnosis should be considered in neurologic conditions of undefined etiologies. Agnostic metagenomic sequencing methods are useful in such settings to direct diagnostic and therapeutic efforts.
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Affiliation(s)
| | | | - John Bingham
- Prince of Wales Hospital, Randwick, New South Wales, Australia (S. Hurley, K.W. Kim)
- Westmead Institute for Medical Research Centre for Virus Research, Westmead, New South Wales, Australia (J.S. Eden)
- Sydney Institute for Infectious Diseases, University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia (J.S. Eden, A.R. Howard-Jones)
- CSIRO Australian Centre for Disease Preparedness, Geelong, Victoria, Australia (J. Bingham, M.J. Neave, D.T. Williams, J. Watson)
- Prince of Wales and Sydney Children’s Hospital, Randwick (M. Rodriguez, A. Solinas)
- Sydney Children’s Hospital, Randwick (A. Johnson, B. McMullan)
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology–Institute of Clinical Pathology and Medical Research, Westmead (A.R. Howard-Jones, J. Kok)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick (A. Anazodo)
- University of New South Wales Faculty of Medicine and Health, School of Clinical Medicine, Sydney (B. McMullan, K. Kim)
- Prince of Wales Hospital and Community Health Services, Sydney (W. Rawlinson)
- University of New South Wales Schools of Clinical Medicine, Biotechnology and Biomolecular Sciences, Sydney (W. Rawlinson)
| | - Michael Rodriguez
- Prince of Wales Hospital, Randwick, New South Wales, Australia (S. Hurley, K.W. Kim)
- Westmead Institute for Medical Research Centre for Virus Research, Westmead, New South Wales, Australia (J.S. Eden)
- Sydney Institute for Infectious Diseases, University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia (J.S. Eden, A.R. Howard-Jones)
- CSIRO Australian Centre for Disease Preparedness, Geelong, Victoria, Australia (J. Bingham, M.J. Neave, D.T. Williams, J. Watson)
- Prince of Wales and Sydney Children’s Hospital, Randwick (M. Rodriguez, A. Solinas)
- Sydney Children’s Hospital, Randwick (A. Johnson, B. McMullan)
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology–Institute of Clinical Pathology and Medical Research, Westmead (A.R. Howard-Jones, J. Kok)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick (A. Anazodo)
- University of New South Wales Faculty of Medicine and Health, School of Clinical Medicine, Sydney (B. McMullan, K. Kim)
- Prince of Wales Hospital and Community Health Services, Sydney (W. Rawlinson)
- University of New South Wales Schools of Clinical Medicine, Biotechnology and Biomolecular Sciences, Sydney (W. Rawlinson)
| | - Matthew J. Neave
- Prince of Wales Hospital, Randwick, New South Wales, Australia (S. Hurley, K.W. Kim)
- Westmead Institute for Medical Research Centre for Virus Research, Westmead, New South Wales, Australia (J.S. Eden)
- Sydney Institute for Infectious Diseases, University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia (J.S. Eden, A.R. Howard-Jones)
- CSIRO Australian Centre for Disease Preparedness, Geelong, Victoria, Australia (J. Bingham, M.J. Neave, D.T. Williams, J. Watson)
- Prince of Wales and Sydney Children’s Hospital, Randwick (M. Rodriguez, A. Solinas)
- Sydney Children’s Hospital, Randwick (A. Johnson, B. McMullan)
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology–Institute of Clinical Pathology and Medical Research, Westmead (A.R. Howard-Jones, J. Kok)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick (A. Anazodo)
- University of New South Wales Faculty of Medicine and Health, School of Clinical Medicine, Sydney (B. McMullan, K. Kim)
- Prince of Wales Hospital and Community Health Services, Sydney (W. Rawlinson)
- University of New South Wales Schools of Clinical Medicine, Biotechnology and Biomolecular Sciences, Sydney (W. Rawlinson)
| | - Alexandra Johnson
- Prince of Wales Hospital, Randwick, New South Wales, Australia (S. Hurley, K.W. Kim)
- Westmead Institute for Medical Research Centre for Virus Research, Westmead, New South Wales, Australia (J.S. Eden)
- Sydney Institute for Infectious Diseases, University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia (J.S. Eden, A.R. Howard-Jones)
- CSIRO Australian Centre for Disease Preparedness, Geelong, Victoria, Australia (J. Bingham, M.J. Neave, D.T. Williams, J. Watson)
- Prince of Wales and Sydney Children’s Hospital, Randwick (M. Rodriguez, A. Solinas)
- Sydney Children’s Hospital, Randwick (A. Johnson, B. McMullan)
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology–Institute of Clinical Pathology and Medical Research, Westmead (A.R. Howard-Jones, J. Kok)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick (A. Anazodo)
- University of New South Wales Faculty of Medicine and Health, School of Clinical Medicine, Sydney (B. McMullan, K. Kim)
- Prince of Wales Hospital and Community Health Services, Sydney (W. Rawlinson)
- University of New South Wales Schools of Clinical Medicine, Biotechnology and Biomolecular Sciences, Sydney (W. Rawlinson)
| | - Annaleise R. Howard-Jones
- Prince of Wales Hospital, Randwick, New South Wales, Australia (S. Hurley, K.W. Kim)
- Westmead Institute for Medical Research Centre for Virus Research, Westmead, New South Wales, Australia (J.S. Eden)
- Sydney Institute for Infectious Diseases, University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia (J.S. Eden, A.R. Howard-Jones)
- CSIRO Australian Centre for Disease Preparedness, Geelong, Victoria, Australia (J. Bingham, M.J. Neave, D.T. Williams, J. Watson)
- Prince of Wales and Sydney Children’s Hospital, Randwick (M. Rodriguez, A. Solinas)
- Sydney Children’s Hospital, Randwick (A. Johnson, B. McMullan)
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology–Institute of Clinical Pathology and Medical Research, Westmead (A.R. Howard-Jones, J. Kok)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick (A. Anazodo)
- University of New South Wales Faculty of Medicine and Health, School of Clinical Medicine, Sydney (B. McMullan, K. Kim)
- Prince of Wales Hospital and Community Health Services, Sydney (W. Rawlinson)
- University of New South Wales Schools of Clinical Medicine, Biotechnology and Biomolecular Sciences, Sydney (W. Rawlinson)
| | - Jen Kok
- Prince of Wales Hospital, Randwick, New South Wales, Australia (S. Hurley, K.W. Kim)
- Westmead Institute for Medical Research Centre for Virus Research, Westmead, New South Wales, Australia (J.S. Eden)
- Sydney Institute for Infectious Diseases, University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia (J.S. Eden, A.R. Howard-Jones)
- CSIRO Australian Centre for Disease Preparedness, Geelong, Victoria, Australia (J. Bingham, M.J. Neave, D.T. Williams, J. Watson)
- Prince of Wales and Sydney Children’s Hospital, Randwick (M. Rodriguez, A. Solinas)
- Sydney Children’s Hospital, Randwick (A. Johnson, B. McMullan)
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology–Institute of Clinical Pathology and Medical Research, Westmead (A.R. Howard-Jones, J. Kok)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick (A. Anazodo)
- University of New South Wales Faculty of Medicine and Health, School of Clinical Medicine, Sydney (B. McMullan, K. Kim)
- Prince of Wales Hospital and Community Health Services, Sydney (W. Rawlinson)
- University of New South Wales Schools of Clinical Medicine, Biotechnology and Biomolecular Sciences, Sydney (W. Rawlinson)
| | - Antoinette Anazodo
- Prince of Wales Hospital, Randwick, New South Wales, Australia (S. Hurley, K.W. Kim)
- Westmead Institute for Medical Research Centre for Virus Research, Westmead, New South Wales, Australia (J.S. Eden)
- Sydney Institute for Infectious Diseases, University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia (J.S. Eden, A.R. Howard-Jones)
- CSIRO Australian Centre for Disease Preparedness, Geelong, Victoria, Australia (J. Bingham, M.J. Neave, D.T. Williams, J. Watson)
- Prince of Wales and Sydney Children’s Hospital, Randwick (M. Rodriguez, A. Solinas)
- Sydney Children’s Hospital, Randwick (A. Johnson, B. McMullan)
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology–Institute of Clinical Pathology and Medical Research, Westmead (A.R. Howard-Jones, J. Kok)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick (A. Anazodo)
- University of New South Wales Faculty of Medicine and Health, School of Clinical Medicine, Sydney (B. McMullan, K. Kim)
- Prince of Wales Hospital and Community Health Services, Sydney (W. Rawlinson)
- University of New South Wales Schools of Clinical Medicine, Biotechnology and Biomolecular Sciences, Sydney (W. Rawlinson)
| | - Brendan McMullan
- Prince of Wales Hospital, Randwick, New South Wales, Australia (S. Hurley, K.W. Kim)
- Westmead Institute for Medical Research Centre for Virus Research, Westmead, New South Wales, Australia (J.S. Eden)
- Sydney Institute for Infectious Diseases, University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia (J.S. Eden, A.R. Howard-Jones)
- CSIRO Australian Centre for Disease Preparedness, Geelong, Victoria, Australia (J. Bingham, M.J. Neave, D.T. Williams, J. Watson)
- Prince of Wales and Sydney Children’s Hospital, Randwick (M. Rodriguez, A. Solinas)
- Sydney Children’s Hospital, Randwick (A. Johnson, B. McMullan)
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology–Institute of Clinical Pathology and Medical Research, Westmead (A.R. Howard-Jones, J. Kok)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick (A. Anazodo)
- University of New South Wales Faculty of Medicine and Health, School of Clinical Medicine, Sydney (B. McMullan, K. Kim)
- Prince of Wales Hospital and Community Health Services, Sydney (W. Rawlinson)
- University of New South Wales Schools of Clinical Medicine, Biotechnology and Biomolecular Sciences, Sydney (W. Rawlinson)
| | - David T. Williams
- Prince of Wales Hospital, Randwick, New South Wales, Australia (S. Hurley, K.W. Kim)
- Westmead Institute for Medical Research Centre for Virus Research, Westmead, New South Wales, Australia (J.S. Eden)
- Sydney Institute for Infectious Diseases, University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia (J.S. Eden, A.R. Howard-Jones)
- CSIRO Australian Centre for Disease Preparedness, Geelong, Victoria, Australia (J. Bingham, M.J. Neave, D.T. Williams, J. Watson)
- Prince of Wales and Sydney Children’s Hospital, Randwick (M. Rodriguez, A. Solinas)
- Sydney Children’s Hospital, Randwick (A. Johnson, B. McMullan)
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology–Institute of Clinical Pathology and Medical Research, Westmead (A.R. Howard-Jones, J. Kok)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick (A. Anazodo)
- University of New South Wales Faculty of Medicine and Health, School of Clinical Medicine, Sydney (B. McMullan, K. Kim)
- Prince of Wales Hospital and Community Health Services, Sydney (W. Rawlinson)
- University of New South Wales Schools of Clinical Medicine, Biotechnology and Biomolecular Sciences, Sydney (W. Rawlinson)
| | - James Watson
- Prince of Wales Hospital, Randwick, New South Wales, Australia (S. Hurley, K.W. Kim)
- Westmead Institute for Medical Research Centre for Virus Research, Westmead, New South Wales, Australia (J.S. Eden)
- Sydney Institute for Infectious Diseases, University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia (J.S. Eden, A.R. Howard-Jones)
- CSIRO Australian Centre for Disease Preparedness, Geelong, Victoria, Australia (J. Bingham, M.J. Neave, D.T. Williams, J. Watson)
- Prince of Wales and Sydney Children’s Hospital, Randwick (M. Rodriguez, A. Solinas)
- Sydney Children’s Hospital, Randwick (A. Johnson, B. McMullan)
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology–Institute of Clinical Pathology and Medical Research, Westmead (A.R. Howard-Jones, J. Kok)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick (A. Anazodo)
- University of New South Wales Faculty of Medicine and Health, School of Clinical Medicine, Sydney (B. McMullan, K. Kim)
- Prince of Wales Hospital and Community Health Services, Sydney (W. Rawlinson)
- University of New South Wales Schools of Clinical Medicine, Biotechnology and Biomolecular Sciences, Sydney (W. Rawlinson)
| | - Annalisa Solinas
- Prince of Wales Hospital, Randwick, New South Wales, Australia (S. Hurley, K.W. Kim)
- Westmead Institute for Medical Research Centre for Virus Research, Westmead, New South Wales, Australia (J.S. Eden)
- Sydney Institute for Infectious Diseases, University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia (J.S. Eden, A.R. Howard-Jones)
- CSIRO Australian Centre for Disease Preparedness, Geelong, Victoria, Australia (J. Bingham, M.J. Neave, D.T. Williams, J. Watson)
- Prince of Wales and Sydney Children’s Hospital, Randwick (M. Rodriguez, A. Solinas)
- Sydney Children’s Hospital, Randwick (A. Johnson, B. McMullan)
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology–Institute of Clinical Pathology and Medical Research, Westmead (A.R. Howard-Jones, J. Kok)
- Kids Cancer Centre, Sydney Children’s Hospital, Randwick (A. Anazodo)
- University of New South Wales Faculty of Medicine and Health, School of Clinical Medicine, Sydney (B. McMullan, K. Kim)
- Prince of Wales Hospital and Community Health Services, Sydney (W. Rawlinson)
- University of New South Wales Schools of Clinical Medicine, Biotechnology and Biomolecular Sciences, Sydney (W. Rawlinson)
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Tio SY, Chen SCA, Hamilton K, Heath CH, Pradhan A, Morris AJ, Korman TM, Morrissey O, Halliday CL, Kidd S, Spelman T, Brell N, McMullan B, Clark JE, Mitsakos K, Hardiman RP, Williams P, Campbell AJ, Beardsley J, Van Hal S, Yong MK, Worth LJ, Slavin MA. Invasive aspergillosis in adult patients in Australia and New Zealand: 2017-2020. Lancet Reg Health West Pac 2023; 40:100888. [PMID: 37701716 PMCID: PMC10494171 DOI: 10.1016/j.lanwpc.2023.100888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/25/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Abstract
Background New and emerging risks for invasive aspergillosis (IA) bring the need for contemporary analyses of the epidemiology and outcomes of IA, in order to improve clinical practice. Methods The study was a retrospective, multicenter, cohort design of proven and probable IA in adults from 10 Australasian tertiary centres (January 2017-December 2020). Descriptive analyses were used to report patients' demographics, predisposing factors, mycological characteristics, diagnosis and management. Accelerated failure-time model was employed to determine factor(s) associated with 90-day all-cause mortality (ACM). Findings Of 382 IA episodes, 221 (in 221 patients) fulfilled inclusion criteria - 53 proven and 168 probable IA. Median patient age was 61 years (IQR 51-69). Patients with haematologic malignancies (HM) comprised 49.8% of cases. Fifteen patients (6.8%) had no pre-specified immunosuppression and eleven patients (5.0%) had no documented comorbidity. Only 30% of patients had neutropenia. Of 170 isolates identified, 40 (23.5%) were identified as non-Aspergillus fumigatus species complex. Azole-resistance was present in 3/46 (6.5%) of A. fumigatus sensu stricto isolates. Ninety-day ACM was 30.3%. HM (HR 1.90; 95% CI 1.04-3.46, p = 0.036) and ICU admission (HR 4.89; 95% CI 2.93-8.17, p < 0.001) but not neutropenia (HR 1.45; 95% CI 0.88-2.39, p = 0.135) were associated with mortality. Chronic kidney disease was also a significant predictor of death in the HM subgroup (HR 3.94; 95% CI 1.15-13.44, p = 0.028). Interpretation IA is identified in high number of patients with mild/no immunosuppression in our study. The relatively high proportion of non-A. fumigatus species complex isolates and 6.5% azole-resistance rate amongst A. fumigatus sensu stricto necessitates accurate species identification and susceptibility testing for optimal patient outcomes. Funding This work is unfunded. All authors' financial disclosures are listed in detail at the end of the manuscript.
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Affiliation(s)
- Shio Yen Tio
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- National Centre for Infections in Cancer, Melbourne, Australia
- Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - Sharon C.-A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
- School of Medicine, University of Sydney, Australia
| | - Kate Hamilton
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
| | - Christopher H. Heath
- Department of Microbiology, PathWest Laboratory Medicine, Murdoch, Western Australia, Australia
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Department of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Alyssa Pradhan
- Prince of Wales Hospital, Southeast Sydney LHD, NSW Health Pathology, Australia
- School of Medicine, University of Sydney, Australia
| | - Arthur J. Morris
- Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Tony M. Korman
- Monash University and Monash Health, Clayton, Victoria, Australia
| | - Orla Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Catriona L. Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital, Sydney, Australia
- School of Medicine, University of Sydney, Australia
| | - Sarah Kidd
- National Mycology Reference Centre, Microbiology & Infectious Diseases, SA Pathology, Adelaide, South Australia, Australia
| | - Timothy Spelman
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Nadiya Brell
- Prince of Wales Hospital, Southeast Sydney LHD, NSW Health Pathology, Australia
- University of New South Wales, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW, Australia
| | - Julia E. Clark
- Infection Management Service, Queensland Children’s Hospital, Children’s Health Queensland, Brisbane 4101, Australia
- School of Clinical Medicine, CHQCU, University of Queensland, Australia
| | - Katerina Mitsakos
- Department of Infectious Disease and Microbiology, Royal North Shore Hospital, Sydney, Australia
| | - Robyn P. Hardiman
- Department of Infectious Disease and Microbiology, Royal North Shore Hospital, Sydney, Australia
| | - Phoebe Williams
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Australia
- School of Public Health, Faculty of Medicine, The University of Sydney, Australia
| | - Anita J. Campbell
- Department of Infectious Diseases, Perth Children’s Hospital, Western Australia, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Western Australia, Australia
| | - Justin Beardsley
- University of Sydney Infectious Disease Institute, Australia
- Westmead Hospital, Western Sydney LHD, NSW Health, Australia
- Westmead Institute for Medical Research, Australia
| | - Sebastiaan Van Hal
- School of Medicine, University of Sydney, Australia
- Department of Infectious Diseases and Microbiology Royal Prince Alfred Hospital, Australia
| | - Michelle K. Yong
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- National Centre for Infections in Cancer, Melbourne, Australia
- Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - Leon J. Worth
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- National Centre for Infections in Cancer, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - Monica A. Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- National Centre for Infections in Cancer, Melbourne, Australia
- Department of Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
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6
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Phuong LK, Cheung A, Agrawal R, Butters C, Buttery J, Clark J, Connell T, Curtis N, Daley AJ, Dobinson HC, Frith C, Hameed NS, Hernstadt H, Krieser DM, Loke P, Ojaimi S, McMullan B, Pinzon-Charry A, Sharp EG, Sinnappurajar P, Templeton T, Wen S, Cole T, Gwee A. Inborn Errors of Immunity in Children With Invasive Pneumococcal Disease: A Multicenter Prospective Study. Pediatr Infect Dis J 2023; 42:908-913. [PMID: 37463351 DOI: 10.1097/inf.0000000000004004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND In settings with universal conjugate pneumococcal vaccination, invasive pneumococcal disease (IPD) can be a marker of an underlying inborn error of immunity. The aim of this study was to determine the prevalence and characterize the types of immunodeficiencies in children presenting with IPD. METHODS Multicenter prospective audit following the introduction of routinely recommended immunological screening in children presenting with IPD. The minimum immunological evaluation comprised a full blood examination and film, serum immunoglobulins (IgG, IgA and IgM), complement levels and function. Included participants were children in whom Streptococcus pneumoniae was isolated from a normally sterile site (cerebrospinal fluid, pleura, peritoneum and synovium). If isolated from blood, features of sepsis needed to be present. Children with predisposing factors for IPD (nephrotic syndrome, anatomical defect or malignancy) were excluded. RESULTS Overall, there were 379 episodes of IPD of which 313 (83%) were eligible for inclusion and 143/313 (46%) had an immunologic evaluation. Of these, 17/143 (12%) were diagnosed with a clinically significant abnormality: hypogammaglobulinemia (n = 4), IgA deficiency (n = 3), common variable immunodeficiency (n = 2), asplenia (n = 2), specific antibody deficiency (n = 2), incontinentia pigmenti with immunologic dysfunction (n = 1), alternative complement deficiency (n = 1), complement factor H deficiency (n = 1) and congenital disorder of glycosylation (n = 1). The number needed to investigate to identify 1 child presenting with IPD with an immunologic abnormality was 7 for children under 2 years and 9 for those 2 years old and over. CONCLUSIONS This study supports the routine immune evaluation of children presenting with IPD of any age, with consideration of referral to a pediatric immunologist.
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Affiliation(s)
- Linny Kimly Phuong
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Microbiology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Abigail Cheung
- Department of Allergy and Clinical Immunology, Women's and Children's Hospital, South Australia
- General Paediatric and Adolescent Medicine, John Hunter Children's Hospital, New Lambton, Australia
| | - Rishi Agrawal
- Department of General Medicine, Women's and Children's Hospital, South Australia
| | - Coen Butters
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- General Paediatric and Adolescent Medicine, John Hunter Children's Hospital, New Lambton, Australia
| | - Jim Buttery
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Julia Clark
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Tom Connell
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Nigel Curtis
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Andrew J Daley
- Department of Microbiology, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Hazel C Dobinson
- Department of Paediatrics and Child Health, Te Whatu Ora Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Catherine Frith
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick
| | | | - Hayley Hernstadt
- Department of Paediatrics, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia
| | - David M Krieser
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatric Emergency Medicine, Sunshine Hospital, St Albans, Victoria, Australia
| | - Paxton Loke
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Allergy & Immunology, Murdoch Children's Research Institute, Melbourne, Australia
- Monash Pathology, Monash Health; Clayton, Victoria, Australia
| | - Samar Ojaimi
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Allergy & Immunology, Murdoch Children's Research Institute, Melbourne, Australia
- Monash Pathology, Monash Health; Clayton, Victoria, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick
| | - Alberto Pinzon-Charry
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- Queensland Paediatric Immunology & Allergy Service, Queensland Children's Hospital, Queensland, Australia
- Griffith University, Brisbane, Queensland, Australia
| | - Ella Grace Sharp
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick
| | | | - Tiarni Templeton
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Sophie Wen
- Infection Management Prevention Service, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Theresa Cole
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Amanda Gwee
- From the Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Infection and Immunity Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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7
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Lopez L, Burgner D, Glover C, Carr J, Clark J, Boast A, Vasilunas N, McMullan B, Francis JR, Bowen AC, Blyth CC, Macartney K, Crawford NW, Carey E, Wood N, Britton PN. Corrigendum to "Lower risk of multi-system Inflammatory Syndrome in Children (MIS-C) with the Omicron variant" [The Lancet Regional Health - Western Pacific 27 (2022) 100604]. Lancet Reg Health West Pac 2023; 35:100808. [PMID: 37274779 PMCID: PMC10228331 DOI: 10.1016/j.lanwpc.2023.100808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
[This corrects the article DOI: 10.1016/j.lanwpc.2022.100604.].
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Affiliation(s)
- Laura Lopez
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - David Burgner
- Royal Children's Hospital, Melbourne and Murdoch Children's Research Institute, Victoria, Australia
| | - Catherine Glover
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Jeremy Carr
- Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Julia Clark
- Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Alison Boast
- Royal Children's Hospital, Melbourne and Murdoch Children's Research Institute, Victoria, Australia
| | - Nan Vasilunas
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Brendan McMullan
- Sydney Children's Hospital, Randwick, New South Wales, Australia
| | | | - Asha C Bowen
- Perth Children's Hospital, Perth, Western Australia, Australia
| | | | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- The Children's Hospital at Westmead and University of Sydney, New South Wales, Australia
| | - Nigel W Crawford
- Royal Children's Hospital, Melbourne and Murdoch Children's Research Institute, Victoria, Australia
| | - Emma Carey
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- The Children's Hospital at Westmead and University of Sydney, New South Wales, Australia
| | - Philip N Britton
- The Children's Hospital at Westmead and University of Sydney, New South Wales, Australia
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8
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Nguyen TA, Kirubakaran R, Schultz HB, Wong S, Reuter SE, McMullan B, Bolisetty S, Campbell C, Horvath AR, Stocker SL. Analytical and Non-Analytical Variation May Lead to Inappropriate Antimicrobial Dosing in Neonates: An In Silico Study. Clin Chem 2023:7146664. [PMID: 37116191 DOI: 10.1093/clinchem/hvad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/01/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Therapeutic drug monitoring (TDM) of aminoglycosides and vancomycin is used to prevent oto- and nephrotoxicity in neonates. Analytical and nonanalytical factors potentially influence dosing recommendations. This study aimed to determine the impact of analytical variation (imprecision and bias) and nonanalytical factors (accuracy of drug administration time, use of non-trough concentrations, biological variation, and dosing errors) on neonatal antimicrobial dosing recommendations. METHODS Published population pharmacokinetic models and the Australasian Neonatal Medicines Formulary were used to simulate antimicrobial concentration-time profiles in a virtual neonate population. Laboratory quality assurance data were used to quantify analytical variation in antimicrobial measurement methods used in clinical practice. Guideline-informed dosing recommendations based on drug concentrations were applied to compare the impact of analytical variation and nonanalytical factors on antimicrobial dosing. RESULTS Analytical variation caused differences in subsequent guideline-informed dosing recommendations in 9.3-12.1% (amikacin), 16.2-19.0% (tobramycin), 12.2-45.8% (gentamicin), and 9.6-19.5% (vancomycin) of neonates. For vancomycin, inaccuracies in drug administration time (45.6%), use of non-trough concentrations (44.7%), within-subject biological variation (38.2%), and dosing errors (27.5%) were predicted to result in more dosing discrepancies than analytical variation (12.5%). Using current analytical performance specifications, tolerated dosing discrepancies would be up to 14.8% (aminoglycosides) and 23.7% (vancomycin). CONCLUSIONS Although analytical variation can influence neonatal antimicrobial dosing recommendations, nonanalytical factors are more influential. These result in substantial variation in subsequent dosing of antimicrobials, risking inadvertent under- or overexposure. Harmonization of measurement methods and improved patient management systems may reduce the impact of analytical and nonanalytical factors on neonatal antimicrobial dosing.
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Affiliation(s)
- Thi A Nguyen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ranita Kirubakaran
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Department of Clinical Pharmacology and Toxicology, St. Vincent's Hospital, Sydney, NSW, Australia
- Seberang Jaya Hospital, Penang, Malaysia
| | - Hayley B Schultz
- UniSA: Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Sherilyn Wong
- UniSA: Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Stephanie E Reuter
- UniSA: Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Srinivas Bolisetty
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Craig Campbell
- NSW Health Pathology, Department of Chemical Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Andrea R Horvath
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- NSW Health Pathology, Department of Chemical Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Sophie L Stocker
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Department of Clinical Pharmacology and Toxicology, St. Vincent's Hospital, Sydney, NSW, Australia
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9
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Eldredge JA, Stormon MO, Clark JE, Nightingale S, McMullan B, Andersen B, Travers C, Hardikar W. Direct-acting antiviral treatments in Australia for children with chronic hepatitis C virus infection. Med J Aust 2023; 218:229-230. [PMID: 36794442 DOI: 10.5694/mja2.51852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 02/17/2023]
Affiliation(s)
| | - Michael O Stormon
- The Children's Hospital at Westmead, Sydney, NSW
- The University of Sydney, Sydney, NSW
| | - Julia E Clark
- Queensland Children's Hospital, Brisbane, QLD
- The University of Queensland, Brisbane, QLD
| | - Scott Nightingale
- John Hunter Children's Hospital, Newcastle, NSW
- The University of Newcastle, Newcastle, NSW
| | - Brendan McMullan
- Sydney Children's Hospital Randwick, Sydney, NSW
- University of New South Wales, Sydney, NSW
| | | | | | - Winita Hardikar
- Royal Children's Hospital, Melbourne, VIC
- The University of Melbourne, Melbourne, VIC
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10
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Wilkins AL, Lai T, Zhu X, Bolisetty S, Chiletti R, Cranswick N, Gardiner K, Hunt R, Malhotra A, McMullan B, Mehta B, Michalowski J, Popat H, Ward M, Duffull S, Curtis N, Gwee A. Individualized vancomycin dosing in infants: prospective evaluation of an online dose calculator. Int J Antimicrob Agents 2023; 61:106728. [PMID: 36657532 DOI: 10.1016/j.ijantimicag.2023.106728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/24/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Empiric vancomycin dosing regimens fail to achieve recommended target trough concentrations of 10-20 mg/L in the majority of infants. This study assessed the performance of a model-based dosing calculator (Vanc App) in achieving target vancomycin concentrations at first steady-state level. METHODS This was a multicenter prospective study in four tertiary pediatric hospitals over an 18-month period. Infants aged 0-90 days with suspected Gram-positive sepsis requiring empiric vancomycin treatment were included if they did not meet any of the exclusion criteria: post-menstrual age (PMA) <25 weeks, weight <500 g, glycopeptide allergy, receiving extracorporeal membrane oxygenation, vancomycin use within the previous 72 h, and renal impairment. The Vanc App used a published population pharmacokinetic model to generate a dose based on the infant's PMA, weight, creatinine, and target vancomycin concentration. RESULTS A total of 40 infants were included; 40% were female, median (range) weight was 2505 (700-4460) g and median (range) PMA was 37.4 (25.7-49.0) weeks. The median (range) vancomycin dose was 45 (24-79) mg/kg/day. All infants had trough vancomycin concentrations measured at steady-state (24-<48 hours) and 30 (75%) infants achieved target concentrations. Five infants had supratherapeutic (median 25, range 21-38 mg/L) and five had subtherapeutic (median 6, range <5-9 mg/L) concentrations. An area under the concentration-time curve (AUC0-24) of 400-650 mg/L.h was achieved in 33 (83%) infants. There were no infusion-related reactions or nephrotoxicity. CONCLUSION Individualized intermittent vancomycin dosing using a model-based online calculator resulted in 75% and 83% of infants achieving target trough and AUC0-24, respectively, at first steady-state level. There were no vancomycin-related nephrotoxicity or infusion-related reactions.
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Affiliation(s)
- Amanda L Wilkins
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Tony Lai
- Pharmacy Department, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; School of Pharmacy, The University of Sydney, New South Wales, Australia
| | - Xiao Zhu
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
| | - Srinivas Bolisetty
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Roberto Chiletti
- Department of Intensive Care, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Paediatric Intensive Care Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Noel Cranswick
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; Clinical Pharmacology Unit, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia; Melbourne Children's Trials Centre, Murdoch Children's Research Institution, Parkville, Victoria, Australia
| | - Kaya Gardiner
- Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Research Operations, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Rodney Hunt
- Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia; Clinical Sciences Theme, Murdoch Children's Research Institution, Parkville, Victoria, Australia
| | - Atul Malhotra
- Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Brendan McMullan
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Immunology and Infectious Disease, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Bhavesh Mehta
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; Discipline of Paediatrics & Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanna Michalowski
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Himanshu Popat
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; NHMRC Clinical Trial Centre, Camperdown, New South Wales, Australia; Sydney Children's Hospital Westmead Clinical School, The University of Sydney, New South Wales Australia
| | - Meredith Ward
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Stephen Duffull
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Infectious Diseases, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Amanda Gwee
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; Infectious Diseases Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Infectious Diseases, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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11
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McMullan B, Bryant PA, Duffy E, Bielicki J, De Cock P, Science M, Zembles T, Timberlake K, Monsees E, Hamdy RF, Tribble AC, Newland J, Patel S. Multinational consensus antimicrobial stewardship recommendations for children managed in hospital settings. Lancet Infect Dis 2022; 23:e199-e207. [PMID: 36566768 DOI: 10.1016/s1473-3099(22)00726-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 12/24/2022]
Abstract
Children are entitled to receive antibiotic therapy that is based on evidence and best practice, but might be overlooked in hospital programmes designed to achieve antimicrobial stewardship [AMS]. This failure to include children could be because children make up small proportion of patients in most hospitals, and are cared for by specialised paediatric staff. We reviewed the evidence and consulted experts in three global regions to develop ten recommendations for good-practice in hospital AMS programmes for children. We performed a review of scientific research, published between Jan 1, 2007, and Oct 17, 2019, concerning AMS, and formed a multinational expert group comprising members from the USA, Canada, the UK, Belgium, Switzerland, Australia, and Aotearoa New Zealand to develop the recommendations. These recommendations aim to help health-care workers who care for children in these regions to deliver best-practice care. We surveyed health-care workers with expertise in antibiotic therapy for children across these regions, and found that the recommendations were considered both very important and generally feasible. These recommendations should be implemented in hospitals to improve antibiotic therapy for children and to stimulate research into future improvements in care.
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Affiliation(s)
- Brendan McMullan
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Immunology, Sydney Children's Hospital Randwick, Sydney, NSW, Australia; Department of Infectious Diseases, Sydney Children's Hospital Randwick, Sydney, NSW, Australia.
| | - Penelope A Bryant
- Departments of Hospital-in-the-Home, The Royal Children's Hospital, Melbourne, VIC, Australia; Department of Infectious Diseases, The Royal Children's Hospital, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Eamon Duffy
- Departments of Infectious Disease, Te Whatu Ora Health New Zealand, Auckland, New Zealand; Department of Pharmacy, Te Whatu Ora Health New Zealand, Auckland, New Zealand; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Julia Bielicki
- Department of Paediatric Infectious Diseases and Infection Prevention and Control, University of Basel Children's Hospital, Basel, Switzerland; Centre for Neonatal and Paediatric Infection, St George's University, London, UK
| | - Pieter De Cock
- Department of Pharmacy, Ghent University Hospital, Ghent, Belgium; Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium; Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Michelle Science
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Tracy Zembles
- Department of Enterprise Safety, Children's Wisconsin, WI, Milwaukee, USA
| | - Kathryn Timberlake
- Department of Pharmacy, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Monsees
- Children's Mercy Hospital, Kansas City, MO, USA; Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Rana F Hamdy
- Division of Infectious Diseases, Children's National Hospital, Washington DC, USA; Department of Pediatrics, George Washington School of Medicine and Health Sciences, Washington DC, USA
| | - Alison C Tribble
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Jason Newland
- Department of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, MO, USA
| | - Sanjay Patel
- Department of Paediatric Infectious Diseases and Immunology, Southampton Children's Hospital, Southampton, UK
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12
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Lopez L, Burgner D, Glover C, Carr J, Clark J, Boast A, Vasilunas N, McMullan B, Francis JR, Bowen AC, Blyth CC, Macartney K, Crawford NW, Carey E, Wood N, Britton PN. Lower risk of Multi-system inflammatory syndrome in children (MIS-C) with the omicron variant. Lancet Reg Health West Pac 2022; 27:100604. [PMID: 36237982 PMCID: PMC9541565 DOI: 10.1016/j.lanwpc.2022.100604] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Affiliation(s)
- Laura Lopez
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - David Burgner
- Royal Children's Hospital, Melbourne and Murdoch Children's Research Institute, Victoria, Australia
| | - Catherine Glover
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Jeremy Carr
- Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Julia Clark
- Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Alison Boast
- Royal Children's Hospital, Melbourne and Murdoch Children's Research Institute, Victoria, Australia
| | - Nan Vasilunas
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Brendan McMullan
- Sydney Children's Hospital, Randwick, New South Wales, Australia
| | | | - Asha C. Bowen
- Perth Children's Hospital, Perth, Western Australia, Australia
| | | | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- The Children's Hospital at Westmead and University of Sydney, New South Wales, Australia
| | - Nigel W. Crawford
- Royal Children's Hospital, Melbourne and Murdoch Children's Research Institute, Victoria, Australia
| | - Emma Carey
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- The Children's Hospital at Westmead and University of Sydney, New South Wales, Australia
| | - Philip N. Britton
- The Children's Hospital at Westmead and University of Sydney, New South Wales, Australia
- Corresponding author at: C/o Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Cnr Hainsworth St and Hawkesbury Rd, Westmead, New South Wales, Australia.
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13
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Williams P, Koirala A, Saravanos GL, Lopez LK, Glover C, Sharma K, Williams T, Carey E, Shaw N, Dickens E, Sitaram N, Ging J, Bray P, Crawford NW, McMullan B, Macartney K, Wood N, Fulton EL, Lau C, Britton PN. COVID
‐19 in New South Wales children during 2021: severity and clinical spectrum. Med J Aust 2022; 217:303-310. [PMID: 35851698 PMCID: PMC9349636 DOI: 10.5694/mja2.51661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/23/2022]
Abstract
Objectives: To describe the severity and clinical spectrum of coronavirus disease 2019 (COVID‐19) in children during the 2021 New South Wales outbreak of the Delta variant of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Design, setting: Prospective cohort study in three metropolitan Sydney local health districts, 1 June – 31 October 2021. Participants: Children under 16 years of age with positive SARS‐CoV‐2 nucleic acid test results admitted to hospital or managed by the Sydney Children’s Hospital Network (SCHN) virtual care team. Main outcome measures: Age‐specific SARS‐CoV‐2 infection frequency, overall and separately for SCHN virtual and hospital patients; rates of medical and social reason admissions, intensive care admissions, and paediatric inflammatory multisystem syndrome temporally associated with SARS‐CoV‐2 per 100 SARS‐CoV‐2 infections; demographic and clinical factors that influenced likelihood of hospital admission. Results: A total of 17 474 SARS‐CoV‐2 infections in children under 16 were recorded in NSW, of whom 11 985 (68.6%) received SCHN‐coordinated care, including 459 admitted to SCHN hospitals: 165 for medical reasons (1.38 [95% CI, 1.17–1.59] per 100 infections), including 15 admitted to intensive care, and 294 (under 18 years of age) for social reasons (2.45 [95% CI, 2.18–2.73] per 100 infections). In an analysis that included all children admitted to hospital and a random sample of those managed by the virtual team, having another medical condition (adjusted odds ratio [aOR], 7.42; 95% CI, 3.08–19.3) was associated with increased likelihood of medical admission; in univariate analyses, non‐asthmatic chronic respiratory disease was associated with greater (OR, 9.21; 95% CI, 1.61–174) and asthma/viral induced wheeze with lower likelihood of admission (OR, 0.38; 95% CI, 0.18–0.78). The likelihood of admission for medical reasons declined from infancy to 5–11 years, but rose again for those aged 12–15 years. Sex and Indigenous status did not influence the likelihood of admission. Conclusion: Most SARS‐CoV‐2 infections (Delta variant) in children were asymptomatic or associated with mild disease. Hospitalisation was relatively infrequent, and most common for infants, adolescents, and children with other medical conditions. More children were hospitalised for social than for medical reasons. The known: Information regarding disease severity and reasons for hospital admissions of children with COVID‐19 in Australia is very limited. The new: In 2021, more NSW children with SARS‐CoV‐2 infections were hospitalised for social or welfare reasons (294, 64%; 2.45 per 100 infections) than for medical treatment (165, 36%; 1.38 per 100 infections). Children under six months of age, aged 12–15 years, or with another medical condition were more likely to be hospitalised than other children. The implications: As acute COVID‐19 is typically mild in children, measures that protect them from SARS‐CoV‐2 but harm their overall wellbeing may be disproportionate. Community support for children with special care needs could reduce the number of hospitalisations.
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Affiliation(s)
- Phoebe Williams
- The Children's Hospital at Westmead Sydney NSW
- Sydney Children's Hospital at Randwick Sydney NSW
| | - Archana Koirala
- The University of Sydney Sydney NSW
- National Centre for Immunisation Research and Surveillance, the Children's Hospital at Westmead Sydney NSW
| | | | - Laura K Lopez
- National Centre for Immunisation Research and Surveillance, the Children's Hospital at Westmead Sydney NSW
| | - Catherine Glover
- National Centre for Immunisation Research and Surveillance, the Children's Hospital at Westmead Sydney NSW
| | - Ketaki Sharma
- The University of Sydney Sydney NSW
- National Centre for Immunisation Research and Surveillance, the Children's Hospital at Westmead Sydney NSW
| | - Tracey Williams
- The Children's Hospital at Westmead Sydney NSW
- Home in the Hospital service, the Sydney Children's Hospitals Network Sydney NSW
| | - Emma Carey
- Kids Research, the Sydney Children's Hospitals Network Sydney NSW
| | - Nadine Shaw
- virtualKIDS, the Sydney Children's Hospitals Network Sydney NSW
| | - Emma Dickens
- virtualKIDS, the Sydney Children's Hospitals Network Sydney NSW
| | - Neela Sitaram
- virtualKIDS, the Sydney Children's Hospitals Network Sydney NSW
| | - Joanne Ging
- virtualKIDS, the Sydney Children's Hospitals Network Sydney NSW
| | - Paula Bray
- Kids Research, the Sydney Children's Hospitals Network Sydney NSW
- Home in the Hospital service, the Sydney Children's Hospitals Network Sydney NSW
| | - Nigel W Crawford
- Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC), Murdoch Children’s Research Institute Melbourne VIC
- Royal Children's Hospital Melbourne Melbourne VIC
| | - Brendan McMullan
- Royal Children's Hospital Melbourne Melbourne VIC
- The University of New South Wales Sydney NSW
| | - Kristine Macartney
- The University of Sydney Sydney NSW
- National Centre for Immunisation Research and Surveillance, the Children's Hospital at Westmead Sydney NSW
| | - Nicholas Wood
- The Children's Hospital at Westmead Sydney NSW
- The University of Sydney Sydney NSW
| | - Elizabeth L Fulton
- The Children's Hospital at Westmead Sydney NSW
- Home in the Hospital service, the Sydney Children's Hospitals Network Sydney NSW
| | - Christine Lau
- virtualKIDS, the Sydney Children's Hospitals Network Sydney NSW
| | - Philip N Britton
- The Children's Hospital at Westmead Sydney NSW
- The University of Sydney Sydney NSW
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14
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Loprete J, Katelaris CH, Evans L, Kane A, McMullan B, Wainstein B, Wong M, Post J, Suan D, Swaminathan S, Richardson R, Rogers J, Torda A, Campbell DE, Kelleher AD, Law M, Carr A, Tong WW. Standardized testing and written communication improve patient understanding of beta-lactam allergy testing outcomes: A multicenter, prospective study. J Allergy Clin Immunol Glob 2022; 1:99-105. [PMID: 37781263 PMCID: PMC10509847 DOI: 10.1016/j.jacig.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 10/03/2023]
Abstract
Background Historical penicillin allergy is commonly reported, but the lack of standardized allergy clinic practices may diminish the ability to delabel beta-lactam allergy appropriately. Objective We sought to improve beta-lactam allergy testing and patient understanding of their antibiotic allergy status by standardizing testing and communication practices between 7 adult and pediatric hospital centers. Methods Phase 1 prospectively described the beta-lactam allergy testing practices at each center. Following this, practice was standardized to achieve a defined panel of skin testing reagents, pro forma result letters for patients and referring doctors, and provision of medical alert jewelry to those with confirmed allergy. Testing outcomes and patient perception regarding allergy status 8 weeks postassessment were compared before (phase 1) and after standardization (phase 2). Primary outcomes were the percentage of participants delabeled after testing, and concordance rates between participant perception of their allergy status and their status as determined by the treating physician at 8-week follow-up. Results Of 195 adult and pediatric participants (median age, 50 years; 21.5% <18 years; 36.9% males), 75% were delabeled of their beta-lactam allergy. No patient experienced anaphylaxis related to any beta-lactam delabeling testing. In phase 1, 75% of participants received written results, 52% were informed verbally, and 48% received results in more than 1 form. All phase 2 participants received written results (P < .01), 61% received verbal results from a physician as well (P > .05). At 8-week follow-up, 54% of phase 1 participants had concordant perceptions of their allergy status as the testing team versus 91.6% in phase2 (P < .001). Of the 17 participants who were delabeled and treated with a beta-lactam antibiotic during the 8-week follow-up period, there were no reported allergic reactions, although 1 participant experienced anaphylaxis following exposure to amoxicillin-clavulanic acid 1 year after delabeling. Conclusions Standardization of testing and written patient information improved short-term patient perception of beta-lactam allergy status.
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Affiliation(s)
- Jacqueline Loprete
- Immunology and HIV Unit, St Vincent’s Hospital, Sydney, Australia
- St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, Australia
| | - Constance H. Katelaris
- Campbelltown Hospital, Western Sydney University, Campbelltown, Australia
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | | | - Alisa Kane
- Immunology and HIV Unit, St Vincent’s Hospital, Sydney, Australia
- Liverpool Hospital, Liverpool, Australia
| | - Brendan McMullan
- Sydney Children’s Hospital, Randwick, Australia
- St Vincent’s Clinical Campus, School of Clinical Medicine, UNSW Medicine & Health, Sydney, Australia
| | - Brynn Wainstein
- Sydney Children’s Hospital, Randwick, Australia
- St Vincent’s Clinical Campus, School of Clinical Medicine, UNSW Medicine & Health, Sydney, Australia
| | - Melanie Wong
- Children’s Hospital Westmead, Westmead, Australia
- School of Medicine, Sydney University, Sydney, Australia
| | - Jeffrey Post
- St Vincent’s Clinical Campus, School of Clinical Medicine, UNSW Medicine & Health, Sydney, Australia
- Prince of Wales Hospital, Randwick, Australia
| | - Daniel Suan
- St Vincent’s Clinical Campus, School of Clinical Medicine, UNSW Medicine & Health, Sydney, Australia
- Westmead Hospital, Westmead, Australia
| | - Sanjay Swaminathan
- School of Medicine, Western Sydney University, Campbelltown, Australia
- School of Medicine, Sydney University, Sydney, Australia
- Westmead Hospital, Westmead, Australia
| | - Robyn Richardson
- St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, Australia
| | - Jamie Rogers
- St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, Australia
| | - Adrienne Torda
- St Vincent’s Clinical Campus, School of Clinical Medicine, UNSW Medicine & Health, Sydney, Australia
- Prince of Wales Hospital, Randwick, Australia
| | - Dianne E. Campbell
- Children’s Hospital Westmead, Westmead, Australia
- School of Medicine, Sydney University, Sydney, Australia
| | - Anthony D. Kelleher
- Immunology and HIV Unit, St Vincent’s Hospital, Sydney, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Matthew Law
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew Carr
- Immunology and HIV Unit, St Vincent’s Hospital, Sydney, Australia
- St Vincent’s Clinical Campus, School of Clinical Medicine, UNSW Medicine & Health, Sydney, Australia
| | - Winnie W.Y. Tong
- Immunology and HIV Unit, St Vincent’s Hospital, Sydney, Australia
- St Vincent’s Centre for Applied Medical Research, St Vincent’s Hospital, Sydney, Australia
- St Vincent’s Clinical Campus, School of Clinical Medicine, UNSW Medicine & Health, Sydney, Australia
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15
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Fraile Navarro D, McMullan B, Bowen AC. Clinical care of children and adolescents with
COVID
‐19: recommendations from the National
COVID
‐19 Clinical Evidence Taskforce. Med J Aust 2022; 216:489. [PMID: 35445433 PMCID: PMC9115057 DOI: 10.5694/mja2.51510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022]
Affiliation(s)
- David Fraile Navarro
- Cochrane Australia Monash University Melbourne VIC
- Centre for Health Informatics Australian Institute of Health Innovation Sydney NSW
| | - Brendan McMullan
- Sydney Children’s Hospital Sydney NSW
- University of New South Wales Sydney NSW
| | - Asha C Bowen
- Perth Children’s Hospital Perth WA
- Wesfarmers Centre of Vaccines and Infectious Diseases Telethon Kids Institute Perth WA
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16
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Furlong E, Kotecha RS, Conyers R, O'Brien TA, Hansford JR, Super L, Downie P, Eisenstat DD, Haeusler G, McMullan B, Phillips MB, Padhye B, Dalla-Pozza L, Alvaro F, Fraser CJ, Nicholls W, Clark JE, O'Connor M, Saxon BR, Tapp H, Heath J, Hunter SE, Tsui K, Winstanley M, Lyver A, Best EJ, Wadia U, Yeoh D, Blyth CC, Gottardo NG. COVID-19 vaccination in children and adolescents aged 5 years and older undergoing treatment for cancer and non-malignant haematological conditions: Australian and New Zealand Children's Haematology/Oncology Group consensus statement. Med J Aust 2022; 216:312-319. [PMID: 35201615 PMCID: PMC9115069 DOI: 10.5694/mja2.51444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/19/2022] [Accepted: 02/01/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The Australian Technical Advisory Group on Immunisation and New Zealand Ministry of Health recommend all children aged ≥ 5 years receive either of the two mRNA COVID-19 vaccines: Comirnaty (Pfizer), available in both Australia and New Zealand, or Spikevax (Moderna), available in Australia only. Both vaccines are efficacious and safe in the general population, including children. Children and adolescents undergoing treatment for cancer and immunosuppressive therapy for non-malignant haematological conditions are particularly vulnerable, with an increased risk of severe or fatal COVID-19. There remains a paucity of data regarding the immune response to COVID-19 vaccines in immunosuppressed paediatric populations, with data suggestive of reduced immunogenicity of the vaccine in immunocompromised adults. RECOMMENDATIONS Considering the safety profile of mRNA COVID-19 vaccines and the increased risk of severe COVID-19 in immunocompromised children and adolescents, COVID-19 vaccination is strongly recommended for this at-risk population. We provide a number of recommendations regarding COVID-19 vaccination in this population where immunosuppressive, chemotherapeutic and/or targeted biological agents are used. These include the timing of vaccination in patients undergoing active treatment, management of specific situations where vaccination is contraindicated or recommended under special precautions, and additional vaccination recommendations for severely immunocompromised patients. Finally, we stress the importance of upcoming clinical trials to identify the safest and most efficacious vaccination regimen for this population. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT This consensus statement provides recommendations for COVID-19 vaccination in children and adolescents aged ≥ 5 years with cancer and immunocompromising non-malignant haematological conditions, based on evidence, national and international guidelines and expert opinion. ENDORSED BY The Australian and New Zealand Children's Haematology/Oncology Group.
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Affiliation(s)
- Eliska Furlong
- Perth Children's Hospital, Perth, WA.,Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA
| | - Rishi S Kotecha
- Perth Children's Hospital, Perth, WA.,Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA.,Curtin University, Perth, WA
| | - Rachel Conyers
- Murdoch Children's Research Institute, Melbourne, VIC.,Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Tracey A O'Brien
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW.,University of New South Wales, Sydney, NSW
| | - Jordan R Hansford
- Murdoch Children's Research Institute, Melbourne, VIC.,Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Leanne Super
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC.,Monash University, Melbourne, VIC
| | - Peter Downie
- Monash University, Melbourne, VIC.,Monash Children's Hospital, Melbourne, VIC.,Hudson Institute of Medical Research, Melbourne, VIC
| | - David D Eisenstat
- Murdoch Children's Research Institute, Melbourne, VIC.,Children's Cancer Centre, Royal Children's Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Gabrielle Haeusler
- Murdoch Children's Research Institute, Melbourne, VIC.,Paediatric Integrated Cancer Service, Melbourne, VIC.,National Centre for Infections in Cancer, Melbourne, VIC
| | - Brendan McMullan
- University of New South Wales, Sydney, NSW.,National Centre for Infections in Cancer, Melbourne, VIC.,Sydney Children's Hospital, Sydney, NSW
| | | | - Bhavna Padhye
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW
| | - Frank Alvaro
- John Hunter Children's Hospital, Newcastle, NSW.,University of Newcastle, Newcastle, NSW
| | | | - Wayne Nicholls
- Queensland Children's Hospital, Brisbane, QLD.,University of Queensland, Brisbane, QLD
| | - Julia E Clark
- Queensland Children's Hospital, Brisbane, QLD.,University of Queensland, Brisbane, QLD
| | - Matthew O'Connor
- Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, Adelaide, SA
| | - Benjamin R Saxon
- Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, Adelaide, SA
| | - Heather Tapp
- Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, Adelaide, SA
| | - John Heath
- Children's and Adolescent/Young Adult Cancer Centre, Royal Hobart Hospital, Hobart, TAS
| | - Sarah E Hunter
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, NZ
| | - Karen Tsui
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, NZ
| | - Mark Winstanley
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, NZ
| | - Amanda Lyver
- Children's Haematology Oncology Centre, Christchurch Hospital, Christchurch, NZ
| | - Emma J Best
- Starship Children's Hospital, Auckland, NZ.,Immunisation Advisory Centre, University of Auckland, Auckland, NZ.,University of Auckland, Auckland, NZ
| | - Ushma Wadia
- Perth Children's Hospital, Perth, WA.,Fiona Stanley Hospital, Perth, WA.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Daniel Yeoh
- Perth Children's Hospital, Perth, WA.,National Centre for Infections in Cancer, Melbourne, VIC
| | - Christopher C Blyth
- Perth Children's Hospital, Perth, WA.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA.,University of Western Australia, Perth, WA
| | - Nicholas G Gottardo
- Perth Children's Hospital, Perth, WA.,Telethon Kids Cancer Centre, Telethon Kids Institute, Perth, WA.,University of Western Australia, Perth, WA
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17
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Campbell AJ, Mowlaboccus S, Coombs GW, Daley DA, Al Yazidi LS, Phuong LK, Leung C, Best EJ, Webb RH, Voss L, Athan E, Britton PN, Bryant PA, Butters CT, Carapetis JR, Ching NS, Francis J, Hung TY, Nourse C, Ojaimi S, Tai A, Vasilunas N, McMullan B, Bowen AC, Blyth CC. Whole genome sequencing and molecular epidemiology of pediatric Staphylococcus aureus bacteremia. J Glob Antimicrob Resist 2022; 29:197-206. [PMID: 35342022 DOI: 10.1016/j.jgar.2022.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/25/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The role Staphylococcus aureus antimicrobial resistance genes and toxins play in disease severity, management and outcome in childhood is an emerging field requiring further exploration. METHODS A prospective multi-site study of Australian and New Zealand children hospitalized with S. aureus bacteremia (SAB), occurred over 24-months (2017-2018). Whole genome sequencing (WGS) data was paired with clinical information from the ISAIAH cohort. RESULTS 353 SAB isolates were sequenced; 85% methicillin-susceptible S. aureus ([MSSA], 301/353); 15% methicillin-resistant S. aureus ([MRSA], 52/353). There were 92 sequence types (STs), most commonly; ST5 (18%) and ST30 (8%), grouped into 23 clonal complexes (CCs), most frequently CC5 (21%) and CC30 (12%). MSSA comprised the majority of healthcare-associated SAB (87%, 109/125), with principal clones CC15 (48%, 11/21) and CC8 (33%, 7/21). Panton Valentine Leukocidin (PVL)-positive SAB occurred in 22% (76/353); predominantly MSSA (59%, 45/76), community-onset (92%, 70/76) infections. For community-onset SAB, the only microbiological independent predictor of poor outcomes was PVL-positivity (aOR 2.6 [CI 1.0-6.2]). CONCLUSION From this WGS pediatric SAB data, we demonstrate the previously under-recognized role MSSA has in harboring genetic virulence and causing healthcare-associated infections. PVL-positivity was the only molecular independent predictor of poor outcomes in children. These findings underscore the need for further research to define the potential implications PVL-producing strains may have on approaches to S. aureus clinical management.
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Affiliation(s)
- Anita J Campbell
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute. Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia.
| | - Shakeel Mowlaboccus
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch; Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Western Australia; School of Biomedical Sciences, University of Western Australia, Nedlands
| | - Geoffrey W Coombs
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch; Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Western Australia
| | - Denise A Daley
- Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Western Australia; The Australian Group on Antimicrobial Resistance (AGAR)
| | - Laila S Al Yazidi
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman; Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia; The Children's Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, NSW, Australia
| | - Linny K Phuong
- Department of General Medicine, Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia; Infection and Immunity Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Clare Leung
- Department of Paediatrics, Wagga Wagga Base Hospital, New South Wales, Australia
| | - Emma J Best
- Department of Paediatrics; Child and Youth Health, The University of Auckland; The National Immunisation Advisory Centre, The University of Auckland; Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Rachel H Webb
- Department of Paediatrics, Child and Youth Health, The University of Auckland; Department of Infectious Diseases Starship Children's Hospital, Auckland, New Zealand; Department of Paediatrics, Kidz First Hospital, Auckland, New Zealand
| | - Lesley Voss
- Department of Paediatrics, Child and Youth Health, The University of Auckland; Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Eugene Athan
- Department of Infectious Disease, Barwon Health, Geelong, Australia; School of Medicine, Deakin University, Geelong, Australia
| | - Philip N Britton
- Sydney Medical School and Marie Bashir Institute, University of Sydney, NSW, Australia; Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, Sydney, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Coen T Butters
- Department of General Medicine, Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia; Infection and Immunity Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jonathan R Carapetis
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia; University of Western Australia. School of Medicine, Perth, Western Australia
| | - Natasha S Ching
- Infection and Immunity, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia; Department of General Paediatrics, Monash Children's Hospital, Monash Health, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Australia
| | - Joshua Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - Te-Yu Hung
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - Clare Nourse
- Queensland Children's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Australia
| | - Samar Ojaimi
- Infection & Immunity, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Australia; Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
| | - Alex Tai
- Department of Infectious Disease, Barwon Health, Geelong, Australia
| | - Nan Vasilunas
- Infectious Diseases Department, Women's and Children's Hospital, Adelaide
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia; National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute; School of Medicine, University of Western Australia, Subiaco; Menzies School of Health Research, Charles Darwin Hospital, Darwin, NT
| | - Christopher C Blyth
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia; Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia
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18
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Villanueva P, Coffin SE, Mekasha A, McMullan B, Cotton MF, Bryant PA. Comparison of Antimicrobial Stewardship and Infection Prevention and Control Activities and Resources Between Low-/Middle- and High-income Countries. Pediatr Infect Dis J 2022; 41:S3-S9. [PMID: 35134034 PMCID: PMC8815833 DOI: 10.1097/inf.0000000000003318] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND The growth of antimicrobial resistance worldwide has led to increased focus on antimicrobial stewardship (AMS) and infection prevention and control (IPC) measures, although primarily in high-income countries (HIC). We aimed to compare pediatric AMS and IPC resources/activities between low- and middle-income countries (LMIC) and HIC and to determine the barriers and priorities for AMS and IPC in LMIC as assessed by clinicians in those settings. METHODS An online questionnaire was distributed to clinicians working in HIC and LMIC healthcare facilities in 2020. RESULTS Participants were from 135 healthcare settings in 39 LMIC and 27 HIC. Formal AMS and IPC programs were less frequent in LMIC than HIC settings (AMS 42% versus 76% and IPC 58% versus 89%). Only 47% of LMIC facilities conducted audits of antibiotic use for pediatric patients, with less reliable availability of World Health Organization Access list antibiotics (29% of LMIC facilities). Hand hygiene promotion was the most common IPC intervention in both LMIC and HIC settings (82% versus 91%), although LMIC hospitals had more limited access to reliable water supply for handwashing and antiseptic hand rub. The greatest perceived barrier to pediatric AMS and IPC in both LMIC and HIC was lack of education: only 17% of LMIC settings had regular/required education on antimicrobial prescribing and only 25% on IPC. CONCLUSIONS Marked differences exist in availability of AMS and IPC resources in LMIC as compared with HIC. A collaborative international approach is urgently needed to combat antimicrobial resistance, using targeted strategies that address the imbalance in global AMS and IPC resource availability and activities.
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Affiliation(s)
- Paola Villanueva
- From the Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Infectious Diseases Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Medicine, Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
| | - Susan E. Coffin
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, PA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Amha Mekasha
- Department of Paediatrics and Child Health, Tikur Anbesa Specialized Hospital, Ethiopia
- College of Health Sciences, Addis Ababa University, Ethiopia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Randwick, Sydney, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia
- National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - Mark F. Cotton
- Tygerberg Children’s Hospital, Tygerberg, South Africa
- Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - Penelope A. Bryant
- Infectious Diseases and Hospital-in-the-Home Departments, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
- Clinical Paediatrics Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
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19
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Williams PCM, Bartlett AW, Palasanthiran P, McMullan B. A not so innocuous playground fall: lymphocutaneous nocardiosis in an immunocompetent boy. Arch Dis Child 2022; 107:257-258. [PMID: 34340985 DOI: 10.1136/archdischild-2021-322392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Phoebe C M Williams
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia .,School of Women and Children's Health, The University of NSW, Sydney, New South Wales, Australia.,Department of Infectious Diseases and Immunology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Adam William Bartlett
- School of Women and Children's Health, The University of NSW, Sydney, New South Wales, Australia.,Department of Infectious Diseases and Immunology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Pamela Palasanthiran
- School of Women and Children's Health, The University of NSW, Sydney, New South Wales, Australia.,Department of Infectious Diseases and Immunology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Brendan McMullan
- School of Women and Children's Health, The University of NSW, Sydney, New South Wales, Australia.,Department of Infectious Diseases and Immunology, Sydney Children's Hospital, Randwick, NSW, Australia
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20
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Campbell AJ, Dotel R, Braddick M, Britton PN, Eisen DP, Francis JR, Lynar S, McMullan B, Meagher N, Nelson J, O’Sullivan MVN, Price DJ, Robinson JO, Whelan A, Tong SYC, Bowen AC, Davis JS. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac014. [PMID: 35237755 PMCID: PMC8884362 DOI: 10.1093/jacamr/dlac014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/21/2022] [Indexed: 12/04/2022] Open
Abstract
Background Combination antibiotic therapy with an antitoxin agent, such as clindamycin, is included in some guidelines for severe, toxin-mediated Staphylococcus aureus infections. The evidence to support this practice is currently limited to in vitro, animal and observational human case-series data, with no previous randomized controlled trials (RCTs). Objectives This pilot RCT aimed to determine the feasibility of conducting a clinical trial to examine if adjunctive clindamycin with standard therapy has greater efficacy than standard therapy alone for S. aureus infections. Methods We performed an investigator-initiated, open-label, multicentre, pilot RCT (ACTRN12617001416381p) in adults and children with severe S. aureus infections, randomized to standard antibiotic therapy with or without clindamycin for 7 days. Results Over 28 months, across nine sites, 127 individuals were screened and 34 randomized, including 11 children (32%). The primary outcome—number of days alive and free of systemic inflammatory response syndrome ≤14 days—was similar between groups: clindamycin (3 days [IQR 1–6]) versus standard therapy (4 days [IQR 0–8]). The 90 day mortality was 0% (0/17) in the clindamycin group versus 24% (4/17) in the standard therapy group. Secondary outcomes—microbiological relapse, treatment failure or diarrhoea—were similar between groups. Conclusions As the first clinical trial assessing adjunctive clindamycin for S. aureus infections, this study indicates feasibility and that adults and children can be incorporated into one trial using harmonized endpoints, and there were no safety concerns. The CASSETTE trial will inform the definitive S. aureus Network Adaptive Platform (SNAP) trial, which includes an adjunctive clindamycin domain and participants with non-severe disease.
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Affiliation(s)
- A. J. Campbell
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- Corresponding author. E-mail:
| | - R. Dotel
- Department of Infectious Diseases, Blacktown Hospital, Sydney, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, University of Sydney, Sydney, Australia
| | - M. Braddick
- Department of Infectious Diseases, Townsville University Hospital, Townsville, Queensland, Australia
| | - P. N. Britton
- Department of Infectious Diseases and Microbiology, Children’s Hospital Westmead, Sydney, Australia
- University of Sydney, Discipline of Child and Adolescent Health, Sydney Medical School, Sydney, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - D. P. Eisen
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - J. R. Francis
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia
| | - S. Lynar
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia
- Infectious Diseases, Royal Darwin Hospital, Northern Territory, Australia
| | - B. McMullan
- Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Randwick, Sydney, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia
- National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - N. Meagher
- Department of Infectious Diseases, Doherty Institute for Infection & Immunity, The University of Melbourne & Royal Melbourne Hospital, Melbourne, Australia
- Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Australia
| | - J. Nelson
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia
| | - M. V. N. O’Sullivan
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, University of Sydney, Sydney, Australia
- New South Wales Health Pathology, Newcastle, Australia
| | - D. J. Price
- Department of Infectious Diseases, Doherty Institute for Infection & Immunity, The University of Melbourne & Royal Melbourne Hospital, Melbourne, Australia
- Centre for Epidemiology & Biostatistics, Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Australia
| | - J. O. Robinson
- Department of Infectious Diseases, Royal Perth Hospital, Perth, Australia
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Australia
- Department of Microbiology, Pathwest Laboratory Medicine, Perth, Australia
- College of Science, Health, Engineering and Education, Discipline of Health, Murdoch University, Perth, Australia
| | - A. Whelan
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - S. Y. C. Tong
- Department of Infectious Diseases, Doherty Institute for Infection & Immunity, The University of Melbourne & Royal Melbourne Hospital, Melbourne, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - A. C. Bowen
- Department of Infectious Diseases, Perth Children’s Hospital, Perth, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- School of Medicine, University of Western Australia, Perth, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia
| | - J. S. Davis
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia
- John Hunter Hospital, University of Newcastle, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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21
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Rischin KJ, Mostaghim M, Rao A, Smith B, O'Brien TA, Trubiano JA, Frith K, McMullan B. ESCAPE-Allergy: Evaluating screening for children and adolescents with penicillin allergy. J Paediatr Child Health 2022; 58:83-89. [PMID: 34323321 DOI: 10.1111/jpc.15657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/31/2022]
Abstract
AIM Penicillin allergy labels are frequently encountered in children and are associated with significant harms. Most children are falsely labelled and can safely tolerate a penicillin but delabelling strategies are underutilised and paediatric-specific resources are lacking. The aim of this study was to evaluate an allergy assessment tool for children in hospital. METHODS We evaluated a paediatric-adapted penicillin allergy assessment tool, using an online survey of clinicians in a tertiary paediatric hospital, with 10 hypothetical potential penicillin allergy or adverse reaction cases (including non-allergy reactions). For each case, respondents were asked to use the tool to assign a reaction phenotype and recommend management. We determined the tool's sensitivity, specificity and acceptability to end users. RESULTS We evaluated 30 complete survey responses from senior and junior medical staff, nurses and pharmacists. The tool's overall sensitivity was 80.7% (95% confidence interval (CI) 74.2-87.1%) for assigning the correct reaction phenotype and 85.3% (95% CI 79.4-91.3%) for appropriate management. The tool had high sensitivity for identifying immediate hypersensitivity reactions at 95.6% (95% CI 90.2-100%). Most respondents agreed or strongly agreed that they would use the tool in their practice (22/30, 73.3%). CONCLUSION This survey evaluated a paediatric-adapted penicillin allergy assessment tool in a tertiary paediatric hospital among multidisciplinary clinician groups. The tool performed well overall and had high safety in identifying immediate hypersensitivity reactions. Further research to support implementation of allergy assessment and delabelling programmes among children is required.
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Affiliation(s)
- Kobi J Rischin
- School of Women's and Children's Heath, University of New South Wales, Sydney, New South Wales, Australia
| | - Mona Mostaghim
- Pharmacy Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Arjun Rao
- School of Women's and Children's Heath, University of New South Wales, Sydney, New South Wales, Australia.,Emergency Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Bridget Smith
- Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Tracey A O'Brien
- School of Women's and Children's Heath, University of New South Wales, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Jason A Trubiano
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Katie Frith
- School of Women's and Children's Heath, University of New South Wales, Sydney, New South Wales, Australia.,Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Brendan McMullan
- School of Women's and Children's Heath, University of New South Wales, Sydney, New South Wales, Australia.,Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia
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22
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Douglas AP, Smibert OC, Bajel A, Halliday CL, Lavee O, McMullan B, Yong MK, Hal SJ, Chen SC. Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021. Intern Med J 2021; 51 Suppl 7:143-176. [DOI: 10.1111/imj.15591] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Abby P. Douglas
- Department of Infectious Diseases Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology University of Melbourne Melbourne Victoria Australia
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Department of Infectious Diseases Austin Health Melbourne Victoria Australia
| | - Olivia. C. Smibert
- Department of Infectious Diseases Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology University of Melbourne Melbourne Victoria Australia
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Department of Infectious Diseases Austin Health Melbourne Victoria Australia
| | - Ashish Bajel
- Sir Peter MacCallum Department of Oncology University of Melbourne Melbourne Victoria Australia
- Department of Clinical Haematology Peter MacCallum Cancer Centre and The Royal Melbourne Hospital Melbourne Victoria Australia
| | - Catriona L. Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital Sydney New South Wales Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity The University of Sydney Sydney New South Wales Australia
| | - Orly Lavee
- Department of Haematology St Vincent's Hospital Sydney New South Wales Australia
| | - Brendan McMullan
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Department of Immunology and Infectious Diseases Sydney Children's Hospital Sydney New South Wales Australia
- School of Women's and Children's Health University of New South Wales Sydney New South Wales Australia
| | - Michelle K. Yong
- Department of Infectious Diseases Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology University of Melbourne Melbourne Victoria Australia
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Victorian Infectious Diseases Service Royal Melbourne Hospital Melbourne Victoria Australia
| | - Sebastiaan J. Hal
- Sydney Medical School University of Sydney Sydney New South Wales Australia
- Department of Microbiology and Infectious Diseases Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Sharon C.‐A. Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital Sydney New South Wales Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity The University of Sydney Sydney New South Wales Australia
- Sydney Medical School University of Sydney Sydney New South Wales Australia
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23
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Ackermann K, Baker J, Festa M, McMullan B, Westbrook J, Li L. Computerized Clinical Decision Support Systems for Early Detection of Sepsis Among Pediatric, Neonatal, and Maternal Inpatients: A Scoping Review (Preprint). JMIR Med Inform 2021; 10:e35061. [PMID: 35522467 PMCID: PMC9123549 DOI: 10.2196/35061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/27/2022] [Accepted: 03/19/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Khalia Ackermann
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Jannah Baker
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Marino Festa
- Kids Critical Care Research, Department of Paediatric Intensive Care, Children's Hospital at Westmead, Sydney, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia
- Faculty of Medicine & Health, University of New South Wales, Sydney, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Australia
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24
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Wurzel D, McMinn A, Hoq M, Blyth CC, Burgner D, Tosif S, Buttery J, Carr J, Clark JE, Cheng AC, Dinsmore N, Francis JR, Kynaston A, Lucas R, Marshall H, McMullan B, Singh-Grewal D, Wood N, Macartney K, Britton PN, Crawford NW. Prospective characterisation of SARS-CoV-2 infections among children presenting to tertiary paediatric hospitals across Australia in 2020: a national cohort study. BMJ Open 2021; 11:e054510. [PMID: 34750151 PMCID: PMC8576200 DOI: 10.1136/bmjopen-2021-054510] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To present Australia-wide data on paediatric COVID-19 and multisystem inflammatory syndromes to inform health service provision and vaccination prioritisation. DESIGN Prospective, multicentre cohort study. SETTING Eight tertiary paediatric hospitals across six Australian states and territories in an established research surveillance network-Paediatric Active Enhanced Disease (PAEDS). PARTICIPANTS All children aged <19 years with SARS-CoV-2 infection including COVID-19, Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS) and Kawasaki-like disease TS infection (KD-TS) treated at a PAEDS site from 24 March 2020 to 31 December 2020. INTERVENTION Laboratory-confirmed SARS-CoV-2 infection. MAIN OUTCOME Incidence of severe disease among children with COVID-19, PIMS-TS and KD-TS. We also compared KD epidemiology before and during the COVID-19 pandemic. RESULTS Among 386 children with SARS-CoV-2 infection, 381 (98.7%) had COVID-19 (median 6.3 years (IQR 2.1-12.8),53.3% male) and 5 (1.3%) had multisystem inflammatory syndromes (PIMS-TS, n=4; KD-TS, n=1) (median 7.9 years (IQR 7.8-9.8)). Most children with COVID-19 (n=278; 73%) were Australian-born from jurisdictions with highest community transmission. Comorbidities were present in 72 (18.9%); cardiac and respiratory comorbidities were most common (n=32/72;44%). 37 (9.7%) children with COVID-19 were hospitalised, and two (0.5%) required intensive care. Postinfective inflammatory syndromes (PIMS-TS/KD-TS) were uncommon (n=5; 1.3%), all were hospitalised and three (3/5; 60%) required intensive care management. All children recovered and there were no deaths. KD incidence remained stable during the pandemic compared with prepandemic. CONCLUSIONS Most children with COVID-19 had mild disease. Severe disease was less frequent than reported in high prevalence settings. Preventative strategies, such as vaccination, including children and adolescents, could reduce both the acute and postinfective manifestations of the disease.
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Affiliation(s)
- Danielle Wurzel
- Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Alissa McMinn
- Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Monsurul Hoq
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia, Australia
| | - David Burgner
- Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Shidan Tosif
- Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Jim Buttery
- Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jeremy Carr
- Department of Infection and Immunity, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Julia E Clark
- Infectious Diseases, Children's Health Queensland Hospital and Health Service, Herston, Queensland, Australia
| | - Allen C Cheng
- Infectious Disease Epidemiology Unit - School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Nicole Dinsmore
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, New South Wales, Australia
| | - Joshua Reginald Francis
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Department of Paediatrics, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Anne Kynaston
- Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ryan Lucas
- General Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Helen Marshall
- Discipline of Paediatrics, Adelaide Medical School and The Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Vaccinology and Immunology Research Trials Unit, The Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- National Centre for Infections in Cancer, University of Melbourne, Melbourne, Victoria, Australia
| | - Davinder Singh-Grewal
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Rheumatology, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
- Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, The Children's Hospital, Westmead, New South Wales, Australia
- The Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristine Macartney
- Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- National Centre for Immunisation Research and Surveillance, The Children's Hospital, Westmead, New South Wales, Australia
- Department Infectious Diseases and Microbiology, Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Phil N Britton
- Department Infectious Diseases and Microbiology, Children's Hospital Westmead, Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Nigel W Crawford
- Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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25
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Williams PC, Bartlett AW, Howard-Jones A, McMullan B, Khatami A, Britton PN, Marais BJ. Impact of climate change and biodiversity collapse on the global emergence and spread of infectious diseases. J Paediatr Child Health 2021; 57:1811-1818. [PMID: 34792238 DOI: 10.1111/jpc.15681] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 12/29/2022]
Abstract
The reality of climate change and biodiversity collapse is irrefutable in the 21st century, with urgent action required not only to conserve threatened species but also to protect human life and wellbeing. This existential threat forces us to recognise that our existence is completely dependent upon well-functioning ecosystems that sustain the diversity of life on our planet, including that required for human health. By synthesising data on the ecology, epidemiology and evolutionary biology of various pathogens, we are gaining a better understanding of factors that underlie disease emergence and spread. However, our knowledge remains rudimentary with limited insight into the complex feedback loops that underlie ecological stability, which are at risk of rapidly unravelling once certain tipping points are breached. In this paper, we consider the impact of climate change and biodiversity collapse on the ever-present risk of infectious disease emergence and spread. We review historical and contemporaneous infectious diseases that have been influenced by human environmental manipulation, including zoonoses and vector- and water-borne diseases, alongside an evaluation of the impact of migration, urbanisation and human density on transmissible diseases. The current lack of urgency in political commitment to address climate change warrants enhanced understanding and action from paediatricians - to ensure that we safeguard the health and wellbeing of children in our care today, as well as those of future generations.
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Affiliation(s)
- Phoebe Cm Williams
- The University of Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, New South Wales, Australia.,Department of Infectious Diseases and Microbiology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,The School of Women's and Children's Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Adam W Bartlett
- Department of Infectious Diseases and Microbiology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,The School of Women's and Children's Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Annaleise Howard-Jones
- The University of Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, New South Wales, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Brendan McMullan
- Department of Infectious Diseases and Microbiology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,The School of Women's and Children's Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Ameneh Khatami
- The University of Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, New South Wales, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Philip N Britton
- The University of Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, New South Wales, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Ben J Marais
- The University of Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, New South Wales, Australia.,Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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26
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Fraile Navarro D, Tendal B, Tingay D, Vasilunas N, Anderson L, Best J, Burns P, Cheyne S, Craig SS, Erickson SJ, Fancourt NS, Goff Z, Kapuya V, Keyte C, Malyon L, McDonald S, White H, Wurzel D, Bowen AC, McMullan B. Clinical care of children and adolescents with COVID-19: recommendations from the National COVID-19 Clinical Evidence Taskforce. Med J Aust 2021; 216:255-263. [PMID: 34689329 PMCID: PMC8661691 DOI: 10.5694/mja2.51305] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The epidemiology and clinical manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are different in children and adolescents compared with adults. Although coronavirus disease 2019 (COVID-19) appears to be less common in children, with milder disease overall, severe complications may occur, including paediatric inflammatory multisystem syndrome (PIMS-TS). Recognising the distinct needs of this population, the National COVID-19 Clinical Evidence Taskforce formed a Paediatric and Adolescent Care Panel to provide living guidelines for Australian clinicians to manage children and adolescents with COVID-19 and COVID-19 complications. Living guidelines mean that these evidence-based recommendations are updated in near real time to give reliable, contemporaneous advice to Australian clinicians providing paediatric care. MAIN RECOMMENDATIONS To date, the Taskforce has made 20 specific recommendations for children and adolescents, including definitions of disease severity, recommendations for therapy, respiratory support, and venous thromboembolism prophylaxis for COVID-19 and for the management of PIMS-TS. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES The Taskforce currently recommends corticosteroids as first line treatment for acute COVID-19 in children and adolescents who require oxygen. Tocilizumab could be considered, and remdesivir should not be administered routinely in this population. Non-invasive ventilation or high flow nasal cannulae should be considered in children and adolescents with hypoxaemia or respiratory distress unresponsive to low flow oxygen if appropriate infection control measures can be used. Children and adolescents with PIMS-TS should be managed by a multidisciplinary team. Intravenous immunoglobulin and corticosteroids, with concomitant aspirin and thromboprophylaxis, should be considered for the treatment of PIMS-TS. The latest updates and full recommendations are available at www.covid19evidence.net.au.
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Affiliation(s)
- David Fraile Navarro
- Cochrane Australia, Monash University, Melbourne, VIC.,Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
| | - Britta Tendal
- Cochrane Australia, Monash University, Melbourne, VIC
| | - David Tingay
- Murdoch Children's Research Institute, Melbourne, VIC.,Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Nan Vasilunas
- Women's and Children's Health Network, Women's and Children's Hospital Adelaide, Adelaide, SA
| | - Lorraine Anderson
- Kimberley Aboriginal Medical Services Council, Broome, WA.,Junction Street Family Practice, Sydney, NSW
| | - James Best
- Junction Street Family Practice, Sydney, NSW
| | - Penelope Burns
- Australian National University, Canberra, ACT.,Northern Beaches Hospital, Sydney, NSW.,Western Sydney University, Sydney, NSW
| | - Saskia Cheyne
- Cochrane Australia, Monash University, Melbourne, VIC.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW
| | - Simon S Craig
- Monash University, Melbourne, VIC.,Monash Medical Centre, Monash Health, Melbourne, VIC
| | | | | | - Zoy Goff
- Perth Children's Hospital, Perth, WA
| | - Vimbai Kapuya
- Charles Darwin University, Darwin, NT.,Australian College of Rural and Remote Medicine, Brisbane, QLD
| | - Catherine Keyte
- Queensland Children's Hospital, Brisbane, QLD.,Australian College of Nursing, Canberra, ACT
| | - Lorelle Malyon
- College of Emergency Nursing Australasia, Melbourne, VIC
| | | | - Heath White
- Cochrane Australia, Monash University, Melbourne, VIC
| | - Danielle Wurzel
- Murdoch Children's Research Institute, Melbourne, VIC.,Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Asha C Bowen
- Perth Children's Hospital, Perth, WA.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Brendan McMullan
- Sydney Children's Hospital, Randwick, Sydney, NSW.,University of New South Wales, Sydney, NSW
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27
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Al Abdali K, McMullan B, Toofanian S, Manoharan N, Palasanthiran P. Kingella kingae sternal osteomyelitis presenting as chest lump in a child. J Paediatr Child Health 2021; 57:1686-1688. [PMID: 33464674 DOI: 10.1111/jpc.15335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Khalfan Al Abdali
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,School of Women's and Child Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sara Toofanian
- Kids Cancer Centre, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Neevika Manoharan
- Kids Cancer Centre, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Pamela Palasanthiran
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,School of Women's and Child Health, University of New South Wales, Sydney, New South Wales, Australia
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28
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Olijve L, Amarasena L, Best E, Blyth C, van den Boom M, Bowen A, Bryant PA, Buttery J, Dobinson HC, Davis J, Francis J, Goldsmith H, Griffiths E, Hung TY, Huynh J, Kesson A, Meehan A, McMullan B, Nourse C, Palasanthiran P, Penumarthy R, Pilkington K, Searle J, Stephenson A, Webb R, Williman J, Walls T. The role of Kingella kingae in pre-school aged children with bone and joint infections. J Infect 2021; 83:321-331. [PMID: 34265316 DOI: 10.1016/j.jinf.2021.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/20/2021] [Accepted: 06/28/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The Pre-school Osteoarticular Infection (POI) study aimed to describe the burden of disease, epidemiology, microbiology and treatment of acute osteoarticular infections (OAI) and the role of Kingella kingae in these infections. METHODS Information about children 3-60 months of age who were hospitalized with an OAI to 11 different hospitals across Australia and New Zealand between January 2012 and December 2016 was collected retrospectively. RESULTS A total of 907 cases (73%) were included. Blood cultures grew a likely pathogen in only 18% (140/781). The peak age of presentation was 12 to 24 months (466/907, 51%) and Kingella kingae was the most frequently detected microorganism in this age group (60/466, 13%). In the majority of cases, no microorganism was detected (517/907, 57%). Addition of PCR to culture increased detection rates of K. kingae. However, PCR was performed infrequently (63/907, 7%). CONCLUSIONS This large multi-national study highlights the need for more widespread use of molecular diagnostic techniques for accurate microbiological diagnosis of OAI in pre-school aged children. The data from this study supports the hypothesis that a substantial proportion of pre-school aged children with OAI and no organism identified may in fact have undiagnosed K. kingae infection. Improved detection of Kingella cases is likely to reduce the average length of antimicrobial treatment.
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Affiliation(s)
- Laudi Olijve
- Department of Paediatrics, University of Otago, Christchurch School of Medicine, New Zealand; Sheffield Teaching Hospitals, UK; Sydney Children's Hospital Randwick, 61 High Street, Randwick, NSW 2031, Australia
| | - Lahiru Amarasena
- Department of Paediatrics; Child and Youth Health, National Immunisation Advisory Centre, The University of Auckland, New Zealand
| | - Emma Best
- Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand; Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Grafton, Auckland, New Zealand; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Australia
| | - Christopher Blyth
- School of Medicine, University of Western Australia, Australia; School of Medicine, University of Western Australia, Australia; Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; Department of Microbiology, Pathwest Laboratory Medicine, QEII Medical Centre, Australia; Department of Paediatrics, Christchurch Hospital, Canterbury District Health Board, University of Otago, PO Box 4345, Christchurch Mail Centre, Christchurch 8140, New Zealand
| | - Mirjam van den Boom
- Starship Children's Hospital, Auckland, New Zealand; Starship Children's Hospital, Auckland, New Zealand; Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Avenue, Nedlands WA 6009, Locked Bag 2010, Nedlands WA 6909, Australia
| | - Asha Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Australia; National Health and Medical Research Council, Australia; Division of Paediatrics, School of Medicine, University of Western Australia, Australia; Menzies School of Health Research, Charles Darwin University, Australia; Institute for Health Research, The University of Notre Dame Australia, Australia; Dept of General Medicine, The Royal Children's Hospital Melbourne, Victoria, Australia
| | - Penelope A Bryant
- Infectious Diseases and Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Australia; Infectious Diseases and Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Australia; Infection, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; Department of Infection and Immunity, Monash Children's Hospital, Australia
| | - Jim Buttery
- Monash Centre for Health Care Research and Implementation, Department of Paediatrics, Monash University, Melbourne, 246 Clayton Rd, Clayton 3168, Victoria, Australia; Monash Centre for Health Care Research and Implementation, Department of Paediatrics, Monash University, Melbourne, 246 Clayton Rd, Clayton 3168, Victoria, Australia; Wellington Regional Hospital, Capital and Coast District Health Board, Department of Paediatrics and Child Health, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Hazel C Dobinson
- Global Health Division, Menzies School of Health Research, Darwin, Australia
| | - Joshua Davis
- Infectious Diseases, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2300, Australia; Infectious Diseases, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2300, Australia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Joshua Francis
- Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Dr Tiwi NT 0810, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Dr Tiwi NT 0810, Darwin, Australia; John Hunter Children's Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia
| | - Heidi Goldsmith
- Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Australia
| | - Elle Griffiths
- Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi 0810, Northern Territory, Australia
| | - Te-Yu Hung
- Departments of Infectious Disease and Microbiology, The Children's Hospital at Westmead, Westmead New South Wales, Australia
| | - Julie Huynh
- Discipline of Child and Adolescent health, University of Sydney, Australia; Discipline of Child and Adolescent health, University of Sydney, Australia; Centre for tropical medicine, 764 Vo Van Kiet, District 5 Ho Chi Minh City, Viet Nam; Departments of Infectious Disease and Microbiology, The Children's Hospital at Westmead, Westmead New South Wales, Locked Bag 4001, Westmead 2145, Australia
| | - Alison Kesson
- Discipline of Child and Adolescent health, University of Sydney, Australia; Discipline of Child and Adolescent health, University of Sydney, Australia; The Marie Bashir Institute of Infectious Diseases and Biosecurrity, University of Sydney, Australia; Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Locked Bag 2010, Nedlands WA 6909, Australia
| | - Andrea Meehan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, Randwick, NSW 2031, Australia
| | - Brendan McMullan
- National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia; National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia; Queensland Children's Hospital, Children's Health Queensland, Level 12, South Brisbane, QLD 4101, Australia
| | - Clare Nourse
- Faculty of Medicine, University of Queensland, Australia; Faculty of Medicine, University of Queensland, Australia; Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Randwick, High Street, Randwick, NSW 2031, Australia
| | - Pamela Palasanthiran
- University of New South Wales, UNSW, Kensington, NSW, Australia; University of New South Wales, UNSW, Kensington, NSW, Australia; Counties manukau district health board, Middlemore Hospital, 100 hospital road, Otahuhu 2025, Auckland, New Zealand
| | - Rushi Penumarthy
- Monash Children's Hospital, Monash Health, 101/71 Abinger Street, Richmond, VIC 3121, Australia
| | - Katie Pilkington
- Department of Paediatrics, the University of Melbourne, Australia; Department of Paediatrics, the University of Melbourne, Australia; Department of General Medicine, The Royal Children's Hospital Melbourne, 50 Flemington Road, Melbourne 3052, Australia
| | - Janine Searle
- Starship Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Anya Stephenson
- University of Auckland, Middlemore Hospital, 100 hospital road, Otahuhu, 2025 Auckland, New Zealand
| | - Rachel Webb
- Starship Children's Hospital and KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand; Starship Children's Hospital and KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand; Biostatistics and Computation Biology Unit, University of Otago, 2 Riccarton Avenue, Christchurch, 8140, New Zealand
| | - Jonathan Williman
- Department of Paediatrics, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch School of Medicine, New Zealand.
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29
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Campbell AJ, Al Yazidi LS, Phuong LK, Leung C, Best EJ, Webb RH, Voss L, Athan E, Britton PN, Bryant PA, Butters CT, Carapetis JR, Ching NS, Coombs GW, Daley D, Francis J, Hung TY, Mowlaboccus S, Nourse C, Ojaimi S, Tai A, Vasilunas N, McMullan B, Blyth CC, Bowen AC. Pediatric Staphylococcus aureus bacteremia: clinical spectrum and predictors of poor outcome. Clin Infect Dis 2021; 74:604-613. [PMID: 34089594 DOI: 10.1093/cid/ciab510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Staphylococcus aureus is a common cause of bacteremia, yet the epidemiology, and predictors of poor outcome remain inadequately defined in childhood. METHODS ISAIAH is a prospective, cross-sectional study of S. aureus bacteremia (SAB), in children hospitalized in Australia and New Zealand, over 24-months (2017-2018). RESULTS Overall, 552 SABs were identified, (incidence 4.4/100,000/yr [95% confidence interval (CI) 2.2-8.8]), with methicillin-susceptible (84%), community onset (78%) infection predominating. Indigenous children (8.1/100,000/yr [CI 4.8-14.4]), those from lower-socioeconomic areas (5.5/100,000/yr [CI 2.8-10.2]) and neonates (6.6/100,000/yr (CI 3.4-11.7) were over-represented. Although 90-day mortality was infrequent, one-third experienced the composite of: length of stay >30 days (26%), ICU admission (20%), relapse (4%), or death (3%).Predictors of mortality included prematurity (aOR 16.8 [CI 1.6-296.9]), multifocal infection (aOR 22.6 [CI 1.4-498.5]), necrotizing pneumonia (aOR 38.9 [CI 1.7 - 1754.6]), multiorgan dysfunction (aOR 26.5 [CI 4.1-268.8]) and empiric-vancomycin (aOR 15.7 [CI 1.6-434.4]); whilst Infectious Diseases (ID) consultation (aOR 0.07 [CI 0.004-0.9]) was protective. Neither MRSA nor vancomycin trough-targets impacted survival; however, empiric-vancomycin was associated with significant nephrotoxicity (OR 3.1 [CI 1.3-8.1]). CONCLUSIONS High SAB incidence was demonstrated, with at-risk populations identified for future prioritized care. For the first time in a pediatric setting, necrotizing pneumonia and multifocal infection were predictors of mortality, whilst ID consultation was protective. The need to re-evaluate pediatric vancomycin trough-targets and limit unnecessary empiric-vancomycin exposure, to reduce poor outcomes and nephrotoxicity is highlighted. One in three children experienced considerable SAB morbidity, therefore pediatric inclusion in future SAB comparator trials is paramount to improve outcomes.
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Affiliation(s)
- Anita J Campbell
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.,School of Medicine, University of Western Australia, Perth, Australia
| | - Laila S Al Yazidi
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman.,Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia.,The Children's Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, NSW, Australia
| | - Linny K Phuong
- Department of General Medicine, Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Australia.,Infection and Immunity Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Clare Leung
- Department of Paediatrics, Wagga Wagga Base Hospital, New South Wales, Australia
| | - Emma J Best
- Department of Paediatrics; Child and Youth Health, The University of Auckland.,The National Immunisation Advisory Centre, The University of Auckland.,Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Rachel H Webb
- Department of Paediatrics; Child and Youth Health, The University of Auckland.,Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand.,Department of Paediatrics, Kidz First Hospital, Auckland, New Zealand
| | - Lesley Voss
- Department of Paediatrics; Child and Youth Health, The University of Auckland.,Department of Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Eugene Athan
- Department of Infectious Disease, Barwon Health, Geelong, Australia.,School of Medicine, Deakin University, Geelong, Australia
| | - Philip N Britton
- Sydney Medical School and Marie Bashir Institute, University of Sydney, NSW, Australia.,Department of Infectious Diseases and Microbiology, the Children's Hospital at Westmead, Sydney, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Coen T Butters
- Infectious Diseases Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jonathan R Carapetis
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia.,University of Western Australia. School of Medicine, Perth, Western, Australia
| | - Natasha S Ching
- Department of General Paediatrics, Monash Children's Hospital, Monash Health, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Australia
| | - Geoffrey W Coombs
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Royal Perth Hospital and Fiona Stanley Hospital, Western Australia.,Antimicrobial Resistance and Infectious Diseases Research (AMRID) Laboratory, Murdoch University, Perth, Western Australia
| | - Denise Daley
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Royal Perth Hospital and Fiona Stanley Hospital, Western Australia.,The Australian Group on Antimicrobial Resistance (AGAR)
| | - Joshua Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Te-Yu Hung
- Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.,Doherty Institute of Infection and Immunity, The Royal Melbourne Hospital, The University of Melbourne
| | - Shakeel Mowlaboccus
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch.,School of Biomedical Sciences, University of Western Australia, Nedlands
| | - Clare Nourse
- Queensland Children's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Australia
| | - Samar Ojaimi
- Infection & Immunity, Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia.,Department of Pediatrics, Monash University, Clayton, Australia
| | - Alex Tai
- Department of Infectious Disease, Barwon Health, Geelong, Australia
| | - Nan Vasilunas
- Infectious Diseases Department, Women's and Children's Hospital, Adelaide
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia.,National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia.,Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, Western Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute.,School of Medicine, University of Western Australia, Subiaco.,Menzies School of Health Research, Charles Darwin Hospital, Darwin, NT
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30
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Haeusler GM, De Abreu Lourenco R, Bakos C, O'Brien T, Slavin MA, Clark JE, McMullan B, Borland ML, Babl FE, Krishnasamy M, Vanevski M, Thursky KA, Hall L. Managing low-risk febrile neutropenia in children in the time of COVID-19: What matters to parents and clinicians. J Paediatr Child Health 2021; 57:826-834. [PMID: 33533525 PMCID: PMC8013774 DOI: 10.1111/jpc.15330] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022]
Abstract
AIM The Australian 'There is no place like home' project is implementing a paediatric low-risk febrile neutropenia (FN) programme across eight paediatric hospitals. We sought to identify the impact of the coronavirus disease 2019 (COVID-19) pandemic on programme implementation. METHODS Paediatric oncology, infectious diseases and emergency medicine health-care workers and parent/carers were surveyed to explore the impact of the COVID-19 pandemic on home-based FN care. Online surveys were distributed nationally to health-care workers involved in care of children with FN and to parents or carers of children with cancer. RESULTS Surveys were completed by 78 health-care workers and 32 parents/carers. Overall, 95% of health-care workers had confidence in the safety of home-based FN care, with 35% reporting changes at their own hospitals in response to the pandemic that made them more comfortable with this model. Compared to pre-pandemic, >50% of parent/carers were now more worried about attending the hospital with their child and >80% were interested in receiving home-based FN care. Among both groups, increased telehealth access and acceptance of home-based care, improved patient quality of life and reduced risk of nosocomial infection were identified as programme enablers, while re-direction of resources due to COVID-19 and challenges in implementing change during a crisis were potential barriers. CONCLUSION There is strong clinician and parent/carer support for home-based management of low-risk FN across Australia. Changes made to the delivery of cancer care in response to the pandemic have generally increased acceptance for home-based treatments and opportunities exist to leverage these to refine the low-risk FN programme.
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Affiliation(s)
- Gabrielle M Haeusler
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia,NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,The Paediatric Integrated Cancer ServiceMelbourneVictoriaAustralia,Infection Diseases Unit, Department of General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia,Department of Infectious DiseasesMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and EvaluationUniversity of Technology SydneySydneyNew South WalesAustralia
| | | | - Tracey O'Brien
- Kids Cancer CentreSydney Children's HospitalSydneyNew South WalesAustralia,School of Women's and Children's Health, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Monica A Slavin
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia,NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia
| | - Julia E Clark
- Infection Management ServiceQueensland Children's Hospital and Centre for Children's Health Research, CHQBrisbaneQueenslandAustralia
| | - Brendan McMullan
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,School of Women's and Children's Health, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia,Department of Immunology and Infectious DiseasesSydney Children's HospitalSydneyNew South WalesAustralia
| | - Meredith L Borland
- Department of Emergency MedicinePerth Children's HospitalPerthWestern AustraliaAustralia,Emergency DepartmentPerth Children's HospitalNedlandsPerthWestern AustraliaAustralia,Divisions of Paediatrics and Emergency Medicine, School of MedicineUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Franz E Babl
- Department of Infectious DiseasesMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of Emergency MedicineRoyal Children's HospitalMelbourneVictoriaAustralia,Department of Paediatrics, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | - Meinir Krishnasamy
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Academic Nursing UnitPeter MacCallum Cancer CentreMelbourneVictoriaAustralia,Department of NursingUniversity of MelbourneMelbourneVictoriaAustralia
| | - Marijana Vanevski
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia,NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Department of Infectious DiseasesMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Karin A Thursky
- Department of Infectious DiseasesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia,NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,Department of MedicineUniversity of MelbourneMelbourneVictoriaAustralia,NHMRC National Centre for Antimicrobial StewardshipThe Peter Doherty Institute for Infection and ImmunityMelbourneVictoriaAustralia
| | - Lisa Hall
- NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVictoriaAustralia,School of Public Health, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
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31
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Ewe YH, Palasanthiran P, Rawlinson WD, McMullan B. Importance of vaccine history in suspected measles. J Paediatr Child Health 2020; 56:804-805. [PMID: 31613030 DOI: 10.1111/jpc.14647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/09/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Yean H Ewe
- Department of Paediatric Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Pamela Palasanthiran
- Department of Paediatric Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - William D Rawlinson
- Virology Division, Department of Microbiology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Brendan McMullan
- Department of Paediatric Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia
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32
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Britton PN, Walker K, McMullan B, Galea C, Burrell R, Morgan B, Honan I, Teutsch S, Smithers-Sheedy H, Fairbairn N, Mattick R, Hutchinson D, Jones CA. Early Life Parechovirus Infection Neurodevelopmental Outcomes at 3 Years: A Cohort Study. J Pediatr 2020; 219:111-117.e1. [PMID: 32005541 DOI: 10.1016/j.jpeds.2019.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/30/2019] [Accepted: 12/12/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the long-term developmental and behavioral outcomes in an established cohort of children hospitalized as infants with human parechovirus (HPeV) infection and sepsis-like illness. STUDY DESIGN The HPeV cohort was composed of children 3 years of age after HPeV infection and hospitalization in early infancy that occurred during a well-documented HPeV genotype 3 outbreak in Australia. We assessed neurodevelopmental and behavioral outcomes using the Bayley Scales of Infant and Toddler Development-III and the Child Behavior Checklist. We compared their outcomes with a subsample of healthy control infants drawn from the independently sampled Triple B Pregnancy Cohort Study. RESULTS Fifty children, with a mean age of 41 months, were followed for 3 years after hospital admission with HPeV infection. There were 47 children whose original illness was fever without source or sepsis-like illness and 3 who had encephalitis. All children in the HPeV cohort showed age-specific development within the population normal range on the Bayley Scales of Infant and Toddler Development-III. There was no difference in developmental attainment compared with 107 healthy control infants after adjusting for measured confounders. The HPeV cohort showed higher average scores on the Child Behavior Checklist and a higher frequency of clinical range scores compared with healthy controls. CONCLUSIONS Although HPeV sepsis-like illness did not result in neurodevelopmental delay at 3 years of age, it was associated with increased behavioral problems compared with healthy controls. The behavioral problems reached a clinical threshold in a minority of children. Results inform clinical management and planning for children after severe HPeV infection in infancy.
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Affiliation(s)
- Philip N Britton
- Discipline of Child and Adolescent Health and Marie Bashir Institute Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, Australia.
| | - Karen Walker
- Discipline of Child and Adolescent Health and Marie Bashir Institute Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, Australia; The George Institute for Global Health, Sydney, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Sydney Children's Hospitals Network, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Claire Galea
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Rebecca Burrell
- Discipline of Child and Adolescent Health and Marie Bashir Institute Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Bronte Morgan
- Discipline of Child and Adolescent Health and Marie Bashir Institute Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ingrid Honan
- Discipline of Child and Adolescent Health and Marie Bashir Institute Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Suzy Teutsch
- Discipline of Child and Adolescent Health and Marie Bashir Institute Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Hayley Smithers-Sheedy
- Discipline of Child and Adolescent Health and Marie Bashir Institute Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Natalie Fairbairn
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, Australia
| | - Richard Mattick
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Delyse Hutchinson
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; Deakin University, Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Geelong, Australia; Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Cheryl A Jones
- Discipline of Child and Adolescent Health and Marie Bashir Institute Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
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Grimshaw A, Palasanthiran P, Huynh J, Marais B, Chen S, McMullan B. Cryptococcal infections in children: retrospective study and review from Australia. Future Microbiol 2020; 14:1531-1544. [PMID: 31992070 DOI: 10.2217/fmb-2019-0215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Cryptococcosis causes significant morbidity and mortality worldwide, but pediatric data are limited. Methods: A retrospective literature review of Australian pediatric cryptococcosis and additional 10-year audit of cases from a large pediatric network. Results: 22 cases of cryptococcosis in children were identified via literature review: median age was 13.5 years (IQR 7.8-16 years), 18/22 (82%) had meningitis or central nervous system infection. Where outcome was reported, 11/18 (61%) died. Of six audit cases identified from 2008 to 2017, 5 (83%) had C. gattii disease and survived. One child with acute lymphoblastic leukemia and C. neoformans infection died. For survivors, persisting respiratory or neurological sequelae were reported in 4/6 cases (67%). Conclusion: Cryptococcosis is uncommon in Australian children, but is associated with substantial morbidity.
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Affiliation(s)
- Alice Grimshaw
- University of New South Wales, Kensington, New South Wales, 2052, Australia
| | - Pamela Palasanthiran
- Department of Immunology & Infectious Disease, Sydney Children's Hospital, Randwick, New South Wales, 2031, Australia.,School of Women's & Children's Health, University of New South Wales, Randwick, New South Wales, 2031, Australia
| | - Julie Huynh
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, New South Wales, 2145, Australia.,Discipline of Child & Adolescent Health, The University of Sydney, Children's Hospital Westmead, New South Wales, 2145, Australia
| | - Ben Marais
- The Children's Hospital at Westmead Clinical School, Westmead, New South Wales, 2145, Australia.,Marie Bashir Institute for Infectious Diseases & Biosecurity, The University of Sydney, Westmead, New South Wales, 2145, Australia.,The Children's Hospital at Westmead, Westmead, New South Wales, 2145, Australia
| | - Sharon Chen
- Marie Bashir Institute for Infectious Diseases & Biosecurity, The University of Sydney, Westmead, New South Wales, 2145, Australia.,Clinical Mycology Reference Laboratory, Centre for Infectious Diseases & Microbiology Laboratory Services, ICPMR - New South Wales Health Pathology, Westmead Hospital, New South Wales, 2145, Australia
| | - Brendan McMullan
- Department of Immunology & Infectious Disease, Sydney Children's Hospital, Randwick, New South Wales, 2031, Australia.,School of Women's & Children's Health, University of New South Wales, Randwick, New South Wales, 2031, Australia
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McMullan B, Cooper C, Spotswood N, James R, Jones C, Konecny P, Blyth C, Karen T. Antibiotic prescribing in neonatal sepsis: an Australian nationwide survey. BMJ Paediatr Open 2020; 4:e000643. [PMID: 32232180 PMCID: PMC7101048 DOI: 10.1136/bmjpo-2020-000643] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate quality and variation in antibiotic prescribing for neonatal sepsis. DESIGN We analysed prescribing in hospitalised neonates using the National Antimicrobial Prescribing Survey in Australian neonates from 1 January 2014 to 31 December 2018. SETTING Data from antibiotic point prevalence surveys performed in hospitals, ranging from rural hospitals to tertiary paediatric and maternity hospitals within Australia. PATIENTS Admitted neonates <28 days of age from participating hospitals. MAIN OUTCOME MEASURES Variation and appropriateness in prescribing for neonatal sepsis and variation in dosing for gentamicin and benzylpenicillin across hospitals. RESULTS A total of 415 prescriptions among 214 neonates from 39 different hospitals were included. The majority of prescriptions (342, 82.4%) were for neonates <7 days of age. The most commonly prescribed antibiotics were gentamicin and benzylpenicillin, with 323 (77.8%) prescriptions. Dosing variability was substantial, with doses ranging from 2 to 8 mg/kg for gentamicin (median 5 mg/kg, IQR 4-5) and from 45 to 72 mg/kg for benzylpenicillin (median 60 mg/kg, IQR 50-60), although only 13 (3.2%) and 19 (4.6%) prescriptions were locally assessed as inappropriate or non-compliant with guidelines, respectively. At time of audit, 22% of antibiotics had been given for more than 48 hours and 9% more than 72 hours, although microbiologically confirmed infection was documented in only nine (4.2%) neonates. CONCLUSIONS Prescribing for neonatal sepsis was dominated by use of benzylpenicillin and gentamicin with substantial variation in dosing. A small minority had culture-confirmed infection. Efforts to standardise antibiotic dosing and duration for suspected neonatal sepsis are recommended.
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Affiliation(s)
- Brendan McMullan
- Immunology and Infectious Diseases, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia.,National Centre for Infections in Cancer, University of Melbourne, Melbourne, Victoria, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Celia Cooper
- Department of Infectious Diseases, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Naomi Spotswood
- Burnet Institute, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Rodney James
- National Centre for Antimicrobial Stewardship, Melbourne, Victoria, Australia
| | - Cheryl Jones
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Pamela Konecny
- Infectious Diseases, Immunology and Sexual Health, St George Hospital, Kogarah, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Blyth
- School of Paediatrics and Child Health, University of Western Australia, Subiaco, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia.,Department of Paediatric Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Thursky Karen
- National Centre for Infections in Cancer, University of Melbourne, Melbourne, Victoria, Australia.,Infectious Diseases Service and Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Mohamed Rizvi Z, Palasanthiran P, Wu C, Mostaghim M, McMullan B. Adherence to surgical antibiotic prophylaxis guidelines in children: A cohort study. J Paediatr Child Health 2020; 56:34-40. [PMID: 31033069 DOI: 10.1111/jpc.14484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/28/2019] [Accepted: 04/10/2019] [Indexed: 11/29/2022]
Abstract
AIMS Surgical antimicrobial prophylaxis (SAP) is an important measure to reduce post-operative infections. Guidelines exist, but their efficacy and performance in children is poorly understood compared with adults. To review adherence to SAP guidelines, this study assesses risk factors for non-adherence and rate of early post-surgical infections. METHODS A retrospective cohort study of paediatric surgical cases (0-<18 years) at a tertiary children's hospital was performed. Patient characteristics, surgical factors and antimicrobial details were evaluated against hospital guidelines for overall adherence and domains of: antimicrobial choice, dose, re-dosing, timing and duration. Multiple regression analysis was used to determine risk factors for non-adherence. Hospital records were reviewed for post-operative infections at 7 and 30 days. RESULTS Among 326 cases, overall guideline adherence was 39.6% but varied by domain and surgical subspecialty. Incorrect wound classification was associated with overall non-adherence on multivariate regression (odds ratio (OR): 2.59; P < 0.001). Incorrect antimicrobial choice was more likely in children with penicillin hypersensitivity (OR 138.34, P = 0.004) and incorrect dosing more likely in adolescent patients (OR 4.33; P = 0.004). Presence of invasive devices was associated with prolonged duration of antimicrobials (OR 2.92, P = 0.016). Only two post-operative infections were documented by 30 days, but data were insufficient to exclude mild infections managed in the community. CONCLUSIONS SAP was suboptimal in children, with areas for improvement including better guidance on wound classification, allergy management and care for adolescent patients. Documented infections were rare, but mild infections were unable to be excluded due to limited post-discharge information.
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Affiliation(s)
| | - Pamela Palasanthiran
- University of New South Wales, Sydney, New South Wales, Australia.,Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Camille Wu
- University of New South Wales, Sydney, New South Wales, Australia.,Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Mona Mostaghim
- Sydney Children's Hospital, Sydney, New South Wales, Australia.,University of Technology Sydney, Sydney, New South Wales, Australia
| | - Brendan McMullan
- University of New South Wales, Sydney, New South Wales, Australia.,Sydney Children's Hospital, Sydney, New South Wales, Australia
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36
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Gwee A, Cranswick N, McMullan B, Bolisetty S, Hunt RW, Curtis N, Duffull SB. Defining Target Vancomycin Trough Concentrations for Treating Staphylococcus aureus Infection in Infants Aged 0 to 90 Days. JAMA Pediatr 2019; 173:791-793. [PMID: 31180478 PMCID: PMC6563592 DOI: 10.1001/jamapediatrics.2019.1488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study analyzes data from a randomized clinical trial in infants 90 days and younger to develop a pharmacokinetic model to aid physicians in maintaining minimum inhibitory concentrations of vancomycin in young infants with Staphylococcus aureus infection.
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Affiliation(s)
- Amanda Gwee
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia,Department of General Medicine, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia,Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Noel Cranswick
- Department of General Medicine, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia,Murdoch Children’s Research Institute, Parkville, Victoria, Australia,Department of Pharmacology, The University of Melbourne, Parkville, Victoria, Australia
| | - Brendan McMullan
- Department of Infectious Diseases, Sydney Children’s Hospital, Randwick, New South Wales, Australia,School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Srinivas Bolisetty
- School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia,Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Rodney W. Hunt
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia,Murdoch Children’s Research Institute, Parkville, Victoria, Australia,Department of Neonatal Medicine, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia,Department of General Medicine, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia,Murdoch Children’s Research Institute, Parkville, Victoria, Australia
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37
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Al Yazidi LS, Mitchell R, Palasanthiran P, O'Brien TA, McMullan B. Management and prevention of cytomegalovirus infection in paediatric hematopoietic stem cell transplant (HSCT) recipients: A binational survey. Pediatr Transplant 2019; 23:e13458. [PMID: 31081265 DOI: 10.1111/petr.13458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/24/2019] [Accepted: 04/01/2019] [Indexed: 11/26/2022]
Abstract
CMV infection is an important cause of morbidity and mortality among HSCT recipients. Optimal strategies for prevention and management of CMV disease following haematopoietic stem cell transplantation remain uncertain. We conducted an online survey of Australasian paediatric allogeneic HSCT centres on management and prevention of CMV disease in this patient group. We asked for one response from a representative of the HSCT team and one from a representative of the ID team at each centre. All Australasian paediatric HSCT centres responded to our survey. Management of CMV in pre-transplant setting was consistent between centres. All centres used a pre-emptive strategy to prevent CMV disease, guided by quantitative CMV PCR. In the post-transplant post engraftment setting, all centres recommended using ganciclovir (5mg/kg/dose twice daily) as a first-line therapy for CMV reactivation or disease, with treatment duration of 14 days, provided declining CMV quantitative PCR. There was substantial variability of practice between centres in post-transplant management of CMV reactivation, especially during the pre-engraftment phase. Similarly, there was lack of uniformity in indication, dosing and duration of maintenance therapy. Divergence was noted between responses from HSCT and ID physicians within centres. This study identifies areas of uniformity and others of great variability in prevention and management strategies for CMV in paediatric HSCT. Data on CMV infection and management in HSCT patients should be routinely collected as part of prospective trials to inform guidelines and improve prevention and treatment of this important complication.
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Affiliation(s)
- Laila S Al Yazidi
- Immunology and Infectious Diseases Department, Sydney Children's Hospital, Sydney, New South Wales, Australia.,The School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Richard Mitchell
- The School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Pamela Palasanthiran
- Immunology and Infectious Diseases Department, Sydney Children's Hospital, Sydney, New South Wales, Australia.,The School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Tracey A O'Brien
- The School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Brendan McMullan
- Immunology and Infectious Diseases Department, Sydney Children's Hospital, Sydney, New South Wales, Australia.,The School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,National Centre for Infections in Cancer, University of Melbourne, Melbourne, Victoria, Australia
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Al Yazidi LS, Marais BJ, Wickens M, Palasanthiran P, Isaacs D, Outhred A, McMullan B, Britton PN. Overview of paediatric tuberculosis cases treated in the Sydney Children's Hospitals Network, Australia. Public Health Res Pract 2019; 29:28231807. [PMID: 31384887 DOI: 10.17061/phrp28231807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sydney has a large and highly mobile immigrant community. The pattern of paediatric tuberculosis (TB) disease in this highly cosmopolitan city is not well documented. METHODS We reviewed data on all children notified with TB in New South Wales (NSW), Australia, from January 2014 to December 2015, complemented by an expanded dataset for children managed within the Sydney Children's Hospitals Network (SCHN). RESULTS Over the 2-year study period, 921 TB cases were identified in NSW, including 26 (2.8%) children younger than 15 years of age. Of 23 children and adolescents treated for TB in the SCHN, 21 (91.3%) had a history of recent immigration from, or travel to, a country with high TB incidence, and 7 (30.4%) reported contact with an infectious TB case in Australia. Fourteen (60.9%) children had microbiologically confirmed TB; of these, 5 (21.7%) had acid-fast bacilli on microscopy, 8 (34.8%) were positive by polymerase chain reaction and 11 (47.8%) were positive by culture. All Mycobacterium tuberculosis isolates were susceptible to first-line drugs. Ten (43.5%) cases were not vaccinated with bacille Calmette-Guérin (BCG), including all cases with severe disease: 2 with disseminated (miliary) TB and 3 with tuberculous meningitis. CONCLUSION Our findings emphasise the need for improved TB prevention and surveillance in children at high risk of exposure, particularly young children travelling to areas of high TB incidence.
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Affiliation(s)
- Laila S Al Yazidi
- Immunology and Infectious Diseases Department, Sydney Children's Hospital, NSW, Australia; School of Women's and Children's Health, UNSW Sydney, Australia; Infectious Diseases and Microbiology Department, The Children's Hospital at Westmead, Sydney, NSW, Australia,
| | - Ben J Marais
- Infectious Diseases and Microbiology Department, The Children's Hospital at Westmead, Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia
| | | | - Pamela Palasanthiran
- Immunology and Infectious Diseases Department, Sydney Children's Hospital, NSW, Australia; School of Women's and Children's Health, UNSW Sydney, Australia
| | - David Isaacs
- Infectious Diseases and Microbiology Department, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Alexander Outhred
- Infectious Diseases and Microbiology Department, The Children's Hospital at Westmead, Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia
| | - Brendan McMullan
- Immunology and Infectious Diseases Department, Sydney Children's Hospital, NSW, Australia; School of Women's and Children's Health, UNSW Sydney, Australia
| | - Philip N Britton
- Infectious Diseases and Microbiology Department, The Children's Hospital at Westmead, Sydney, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia
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Karelehto E, Brouwer L, Benschop K, Kok J, Basile K, McMullan B, Rawlinson W, Druce J, Nicholson S, Selvarangan R, Harrison C, Lankachandra K, van Eijk H, Koen G, de Jong M, Pajkrt D, Wolthers KC. Seroepidemiology of Parechovirus A3 Neutralizing Antibodies, Australia, the Netherlands, and United States. Emerg Infect Dis 2019; 25:148-152. [PMID: 30561318 PMCID: PMC6302606 DOI: 10.3201/eid2501.180352] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Recent parechovirus A3 (PeV-A3) outbreaks in Australia suggest lower population immunity compared with regions that have endemic PeV-A3 circulation. A serosurvey among populations in the Netherlands, the United States, and Australia before and after the 2013 Australia outbreak showed high PeV-A3 neutralizing antibody prevalence across all regions and time periods, indicating widespread circulation.
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Koirala A, McMullan B, Wargon O, Yates K, Goldberg H, Palasanthiran P. A Lower-limb Skin Lesion in a 10-year-old Girl. Pediatr Infect Dis J 2019; 38:e79. [PMID: 30882748 DOI: 10.1097/inf.0000000000002127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Archana Koirala
- From the Sydney Children's Hospital, Randwick, New South Wales, Australia
- The University of New South Wales, New South Wales, Australia
| | - Brendan McMullan
- From the Sydney Children's Hospital, Randwick, New South Wales, Australia
- The University of New South Wales, New South Wales, Australia
| | - Orli Wargon
- From the Sydney Children's Hospital, Randwick, New South Wales, Australia
- The University of New South Wales, New South Wales, Australia
| | - Kylie Yates
- The University of New South Wales, New South Wales, Australia
- St George Hospital, Kogarah, New South Wales, Australia
| | - Hazel Goldberg
- St George Hospital, Kogarah, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
- Sydney Eye Hospital, Sydney, Australia
| | - Pamela Palasanthiran
- From the Sydney Children's Hospital, Randwick, New South Wales, Australia
- The University of New South Wales, New South Wales, Australia
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41
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Mostaghim M, Snelling T, McMullan B, Ewe YH, Bajorek B. Impact of clinical decision support on empirical antibiotic prescribing for children with community-acquired pneumonia. J Paediatr Child Health 2019; 55:305-311. [PMID: 30161269 DOI: 10.1111/jpc.14191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/08/2018] [Accepted: 07/08/2018] [Indexed: 12/13/2022]
Abstract
AIM To assess the impact of a computerised clinical decision support system (CDSS) on antibiotic use in hospitalised children with a presumptive diagnosis of uncomplicated community-acquired pneumonia (CAP). METHODS Codes associated with lower respiratory tract infection were used to identify cases of presumed uncomplicated CAP requiring admission to a tertiary paediatric hospital. Random sampling of the periods between 1 October 2010 and 30 September 2012 (pre-CDSS) and 1 October 2012 and 30 September 2014 (post-CDSS) determined the sequence of case assessment by two independent investigators. Initial antibiotic therapy, associated CDSS approvals and documented signs of clinical deterioration prior to antibiotic decision-making were recorded. RESULTS Statistically significant differences between cases pre- and post-CDSS implementation were minimal. High fever was observed in 57.5% (77/134) cases pre-CDSS and 45.8% (49/107) cases post-CDSS (P = 0.07). Supplemental oxygen was used in 30.6% pre-CDSS and 54.2% post-CDSS cases (P < 0.001). Narrow-spectrum penicillins were prescribed most often, with no statistically significant change post-CDSS implementation (81.3% pre-CDSS, 77.6% post-CDSS, P = 0.47). Macrolides were used consistently throughout the study period (53.7% pre-CDSS, 61.7% post-CDSS; P = 0.21). CONCLUSION CDSS implementation did not reduce already low rates of broad-spectrum antibiotic use for uncomplicated CAP.
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Affiliation(s)
- Mona Mostaghim
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia.,Pharmacy Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Tom Snelling
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yean H Ewe
- Junior Medical Unit, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Beata Bajorek
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Al Yazidi LS, Badran SA, Sandaradura I, Swil K, McMullan B. Flucloxacillin therapeutic drug monitoring in a neonate on extracorporeal membrane oxygenation. J Paediatr Child Health 2019; 55:246-247. [PMID: 30746879 DOI: 10.1111/jpc.14333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Laila S Al Yazidi
- Immunology and Infectious Diseases Department, Sydney Children's Hospital, Sydney, New South Wales, Australia.,The School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Sultan Qaboos University, College of Medicine, Muscat, Sultanate of Oman
| | - Sofia A Badran
- Infectious Diseases and Microbiology Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Indy Sandaradura
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, New South Wales, Australia.,St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Kevin Swil
- The School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Intensive Care Unit, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Brendan McMullan
- Immunology and Infectious Diseases Department, Sydney Children's Hospital, Sydney, New South Wales, Australia.,The School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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Gwee A, Cranswick N, McMullan B, Perkins E, Bolisetty S, Gardiner K, Daley A, Ward M, Chiletti R, Donath S, Hunt R, Curtis N. Continuous Versus Intermittent Vancomycin Infusions in Infants: A Randomized Controlled Trial. Pediatrics 2019; 143:peds.2018-2179. [PMID: 30700564 DOI: 10.1542/peds.2018-2179] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In adults, continuous infusions of vancomycin (CIV) are associated with earlier attainment of target drug concentrations, require fewer blood samples for monitoring, and may reduce drug toxicity. We aimed to determine, in young infants, if CIV or intermittent infusions of vancomycin (IIV) better achieves target vancomycin concentrations at the first steady-state level and to compare the frequency of drug-related adverse effects. METHODS In a multicenter randomized controlled trial in 2 tertiary neonatal units over a 40-month period, young infants aged 0 to 90 days requiring vancomycin therapy for at least 48 hours were randomly assigned to CIV and IIV. RESULTS Of 111 infants randomized, 104 were included in the intention-to-treat analysis. Baseline characteristics were similar for both groups. The proportion of infants achieving target concentrations at the first steady-state level was higher for CIV compared with IIV (45 in 53 [85%] vs 21 in 51 [41%]; P < .001). Fewer dose adjustments were required in the CIV group (median 0; range 0-1) compared with the IIV group (median 1; range 0-3; P < .001). The mean daily dose required to achieve target concentrations was lower with CIV compared with IIV (40.6 [SD 10.7] vs 60.6 [SD 53.0] mg/kg per day, respectively; P = .01). No drug-related adverse effects occurred in either group. CONCLUSIONS In young infants, CIV is associated with earlier and improved attainment of target concentrations compared with IIV. Lower total daily doses are required to achieve target levels with CIV. There is no difference in the rate of drug-related adverse effects.
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Affiliation(s)
- Amanda Gwee
- Department of Paediatrics, The University of Melbourne, Parkville, Australia; .,The Royal Children's Hospital Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Noel Cranswick
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,The Royal Children's Hospital Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Brendan McMullan
- Sydney Children's Hospital, Randwick, Australia.,Department of Paediatrics, University of New South Wales, Sydney, Australia; and
| | | | - Srinivas Bolisetty
- Department of Paediatrics, University of New South Wales, Sydney, Australia; and.,Royal Hospital for Women, Randwick, Australia
| | - Kaya Gardiner
- Murdoch Children's Research Institute, Parkville, Australia
| | - Andrew Daley
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,The Royal Children's Hospital Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Meredith Ward
- Department of Paediatrics, University of New South Wales, Sydney, Australia; and.,Royal Hospital for Women, Randwick, Australia
| | - Roberto Chiletti
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Susan Donath
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Rodney Hunt
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,The Royal Children's Hospital Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.,The Royal Children's Hospital Melbourne, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
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Macdonald-Laurs E, Koirala A, Britton PN, Rawlinson W, Hiew CC, Mcrae J, Dale RC, Jones C, Macartney K, McMullan B, Pillai S. CSF neopterin, a useful biomarker in children presenting with influenza associated encephalopathy? Eur J Paediatr Neurol 2019; 23:204-213. [PMID: 30316638 PMCID: PMC7128712 DOI: 10.1016/j.ejpn.2018.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/07/2018] [Accepted: 09/23/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Neurological complications of influenza cause significant disease in children. Central nervous system inflammation, the presumed mechanism of influenza-associated encephalopathy, is difficult to detect. Characteristics of children presenting with severe neurological complications of influenza, and potential biomarkers of influenza-associated encephalopathy are described. METHODS A multi-center, retrospective case-series of children with influenza and neurological complications during 2017 was performed. Enrolled cases met criteria for influenza-associated encephalopathy or had status epilepticus. Functional outcome at discharge was compared between groups using the Modified Rankin Scale (mRS). RESULTS There were 22 children with influenza studied of whom 11/22 had encephalopathy and 11/22 had status epilepticus. Only one child had a documented influenza immunization. The biomarker CSF neopterin was tested in 10/11 children with encephalopathy and was elevated in 8/10. MRI was performed in all children with encephalopathy and was abnormal in 8 (73%). Treatment of children with encephalopathy was with corticosteroids or intravenous immunoglobulin in 9/11 (82%). In all cases oseltamivir use was low (59%) while admission to the intensive care unit was frequent (14/22, 66%). Clinical outcome at discharge was moderate to severe disability (mRS score > 2) in the majority of children with encephalopathy (7/11, 64%), including one child who died. Children with status epilepticus recovered to near-baseline function in all cases. CONCLUSION Raised CSF neopterin was present in most cases of encephalopathy, and along with diffusion restriction on MRI, is a useful diagnostic biomarker. Lack of seasonal influenza vaccination represents a missed opportunity to prevent illness in children, including severe neurological disease.
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Affiliation(s)
- Emma Macdonald-Laurs
- Sydney Children's Hospital Network (SCHN), Australia; The University of New South Wales, Australia.
| | - Archana Koirala
- Sydney Children's Hospital Network (SCHN), Australia; The University of New South Wales, Australia
| | - Philip N Britton
- Sydney Children's Hospital Network (SCHN), Australia; The University of Sydney, Discipline of Child and Adolescent Health, Australia
| | | | - Chee Chung Hiew
- Sydney Children's Hospital Network (SCHN), Australia; Prince of Wales Hospital, Sydney, Australia
| | | | - Russell C Dale
- Sydney Children's Hospital Network (SCHN), Australia; The University of Sydney, Discipline of Child and Adolescent Health, Australia
| | - Cheryl Jones
- Sydney Children's Hospital Network (SCHN), Australia; The University of Sydney, Discipline of Child and Adolescent Health, Australia; The Royal Children's Hospital, Melbourne, Australia; The University of Melbourne, Department of Paediatrics, Australia
| | - Kristine Macartney
- Sydney Children's Hospital Network (SCHN), Australia; The University of Sydney, Discipline of Child and Adolescent Health, Australia
| | - Brendan McMullan
- Sydney Children's Hospital Network (SCHN), Australia; The University of New South Wales, Australia
| | - Sekhar Pillai
- Sydney Children's Hospital Network (SCHN), Australia; The University of New South Wales, Australia
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Bryant P, Morgan N, Clifford V, McMullan B, Bowen A. 257. A Whole of Country Analysis of Antimicrobial Stewardship Resources, Activities, and Barriers for Children in Hospitals in Australia. Open Forum Infect Dis 2018. [PMCID: PMC6255599 DOI: 10.1093/ofid/ofy210.268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background We aimed to assess antimicrobial stewardship (AMS) resources and activities for children in hospitals throughout Australia, to identify gaps in services. Methods Every public hospital in Australia with paediatric beds was identified via the Australian Institute of Health and Welfare. The director of pharmacy or most senior paediatrician was asked to complete an online evaluation in 2017 regarding their AMS resources and activities. For analysis, tertiary (7) and major metropolitan hospitals (50) were combined (metropolitan) and compared with hospitals in regional (42) and rural towns (7) combined (rural). Results We identified 106 hospitals and received 106 (100%) responses. Paediatric bed numbers ranged from 3 to 360. In metropolitan hospitals, 17 (35%) had a paediatric AMS team or representation, compared with 5 (9%) for rural (P = 0.001) There was an AMS pharmacist in 42 (86%) metropolitan hospitals compared with 37 (65%) rural (P = 0.1) although the majority of these were not paediatric. Fifty-one (48%) hospitals had locally adapted empirical antibiotic prescribing guidelines (metropolitan 28 (57%) vs. rural 23 (40%)(P = 0.06)), although fewer had specialty-specific guidelines (figure). One hundred two (96%) hospitals had restrictions on broad-spectrum antimicrobials, but formal approval systems were fewer: metropolitan 44 (90%) vs. rural 35 (66%) (P = 0.004)). Auditing methods differed but were mostly ad hoc, with results fed back in an untargeted way with only 22 (34%) providing direct physician feedback. There was a paucity of AMS education: only 25 (24%) provided education for senior medical staff, and 24 (23%) had no education for any staff (metropolitan 8 (17%) vs. rural 16 (29%)(P = 0.1)). The commonest perceived barriers to successful AMS for all hospitals were lack of dedicated infectious diseases and microbiology services (64 (60%)), lack of dedicated pharmacy resources (62 (59%)), and a lack of education for clinicians in antibiotic use (53 (50%)). Conclusion Australian hospitals have implemented some AMS activities for children, but most lack resources—this was much more evident in regional/rural than metropolitan hospitals. Barriers to successful AMS include a lack of infectious diseases and pharmacy resources and education, which need to be addressed in workforce planning. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Penelope Bryant
- University of Melbourne, Parkville, Australia
- Infectious Diseases Unit, Department of General Medicine, The Royal Children’s Hospital, Parkville, Australia
- Rch@Home, Royal Children’s Hospital, Parkville, Australia
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Natalie Morgan
- General Medicine, Royal Children’s Hospital Melbourne, Parkville, Australia
| | | | | | - Asha Bowen
- Telethon Kids Institute, Subiaco, Australia
- Princess Margaret Hospital, Subiaco, Australia
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Bartlett AW, Hall BM, Palasanthiran P, McMullan B, Shand AW, Rawlinson WD. Recognition, treatment, and sequelae of congenital cytomegalovirus in Australia: An observational study. J Clin Virol 2018; 108:121-125. [PMID: 30300787 DOI: 10.1016/j.jcv.2018.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/18/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Australian national surveillance data was used to assess recognition, sequelae, and antiviral therapy for congenital cytomegalovirus (CMV) cases. STUDY DESIGN Data from congenital CMV cases reported through the Australian Paediatric Surveillance Unit born January 1999 to December 2016 were described and Chi-square tests used to characterise trends and associations in case reporting, maternal CMV serology testing, and antiviral therapy. Descriptive analyses for hearing loss and developmental delay were reported for cases born ≥2004, following introduction of universal neonatal hearing screening. RESULTS There were 302 congenital CMV cases (214 symptomatic, 88 asymptomatic). Congenital CMV was suspected in 70.6% by 30 days of age, with no differences across birth cohorts. Maternal CMV serology testing was associated with maternal illness during pregnancy but not birth cohort. There was increasing antiviral use for symptomatic cases, being used in 14% born 1999-2004, 19.6% born 2005-2010, and 44.4% born 2011-2016 (p < 0.001). For those born ≥2004, hearing loss was reported in 42.1% of symptomatic and 26.6% of asymptomatic cases; while developmental delay was reported in 16.9% of symptomatic and 1.3% of asymptomatic cases. CONCLUSION There appears to be under-reporting and under-recognition of congenital CMV despite increasing use of antiviral therapy. Universal newborn CMV screening should be considered to facilitate follow-up of affected children and targeted linkage into hearing and developmental services, and to provide population-level infant CMV epidemiology to support research and evaluation of antiviral and adjunctive therapies.
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Affiliation(s)
- Adam W Bartlett
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia; Biostatistics and Databases Program, The Kirby Institute, University of New South Wales, Sydney, Australia; Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Australia
| | - Beverley M Hall
- Serology & Virology Division, SEALS Microbiology, Prince of Wales Hospital, Sydney, Australia
| | - Pamela Palasanthiran
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia; Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Australia
| | - Brendan McMullan
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia; Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, Australia
| | - Antonia W Shand
- Biostatistics and Databases Program, The Kirby Institute, University of New South Wales, Sydney, Australia; Menzies Centre for Health Policy, University of Sydney, Sydney, Australia; Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, Australia
| | - William D Rawlinson
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia; Serology & Virology Division, SEALS Microbiology, Prince of Wales Hospital, Sydney, Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia; School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia.
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47
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Raman G, McMullan B, Taylor P, Mallitt KA, Kennedy SE. Multiresistant E. coli urine infections in children: a case-control study. Arch Dis Child 2018; 103:336-340. [PMID: 28899877 DOI: 10.1136/archdischild-2017-312831] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/06/2017] [Accepted: 08/10/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Urinary tract infections (UTIs) caused by resistant organisms are increasing which poses challenges when selecting empirical antimicrobial therapy. The aim of this study is to determine risk factors for multiresistant Escherichia coli UTIs in children. DESIGN We included all reported urinary isolates from a children's hospital collected between January 2010 and June 2013. Patients who had multiresistant E. coli UTIs were identified and a retrospective review of medical records performed. Patient-specific clinical and demographic factors were compared with age-matched and gender-matched controls with non-multiresistant E. coli UTIs. Univariable and multivariable statistical analysis were performed to determine significant risk factors for multiresistant organism E.coli UTIs. RESULTS In total, there were 2692 positive urine cultures, 1676 (62.3%) from 1169 patients were E. coli. Multiresistant E. coli was isolated from 139 (8.3% of all E. coli) cultures in 99 patients. Thirteen incomplete medical records were excluded, leaving 86 patients, matched with 86 controls. In multivariable regression, the only significant risk factor was antibiotic use in the previous month (adjusted OR 3.0, 95% CI 1.4 to 6.2), but not previous hospital admission (adjusted OR 1.4, 95% CI 0.6 to 2.9), being an inpatient at the time of diagnosis (adjusted OR 2.4, 95% CI 0.8 to 7.4) and previous instrumentation (adjusted OR 1.0, 95% CI 0.4 to 2.4). CONCLUSIONS This is the first case-control study to examine multiresistant UTI in Australian children. Clinicians should be judicious in the use of antibiotics in treatment and prophylaxis of UTIs. In children presenting with UTI and recent antibiotic exposure, amoxicillin-clavulanic acid appears to be an appropriate empiric antibiotic choice in our population.
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Affiliation(s)
- Gayathri Raman
- Department of Paediatric Nephrology, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's & Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Brendan McMullan
- Department of Paediatric Infectious Diseases, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Peter Taylor
- SEALS Pathology, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Kylie-Ann Mallitt
- School of Women's & Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Sean E Kennedy
- Department of Paediatric Nephrology, Sydney Children's Hospital, Randwick, New South Wales, Australia.,School of Women's & Children's Health, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
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48
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McMullan B. Infections and diagnostic dilemmas in immunocompromised children. Pathology 2018. [DOI: 10.1016/j.pathol.2017.12.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Chapman B, Slavin M, Marriott D, Halliday C, Kidd S, Arthur I, Bak N, Heath CH, Kennedy K, Morrissey CO, Sorrell TC, van Hal S, Keighley C, Goeman E, Underwood N, Hajkowicz K, Hofmeyr A, Leung M, Macesic N, Botes J, Blyth C, Cooley L, George CR, Kalukottege P, Kesson A, McMullan B, Baird R, Robson J, Korman TM, Pendle S, Weeks K, Liu E, Cheong E, Chen S. Changing epidemiology of candidaemia in Australia. J Antimicrob Chemother 2017; 72:1103-1108. [PMID: 28364558 DOI: 10.1093/jac/dkw422] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/07/2016] [Indexed: 01/07/2023] Open
Abstract
Objectives Knowledge of contemporary epidemiology of candidaemia is essential. We aimed to identify changes since 2004 in incidence, species epidemiology and antifungal susceptibilities of Candida spp. causing candidaemia in Australia. Methods These data were collected from nationwide active laboratory-based surveillance for candidaemia over 1 year (within 2014-2015). Isolate identification was by MALDI-TOF MS supplemented by DNA sequencing. Antifungal susceptibility testing was performed using Sensititre YeastOne™. Results A total of 527 candidaemia episodes (yielding 548 isolates) were evaluable. The mean annual incidence was 2.41/105 population. The median patient age was 63 years (56% of cases occurred in males). Of 498 isolates with confirmed species identity, Candida albicans was the most common (44.4%) followed by Candida glabrata complex (26.7%) and Candida parapsilosis complex (16.5%). Uncommon Candida species comprised 25 (5%) isolates. Overall, C. albicans (>99%) and C. parapsilosis (98.8%) were fluconazole susceptible. However, 16.7% (4 of 24) of Candida tropicalis were fluconazole- and voriconazole-resistant and were non-WT to posaconazole. Of C. glabrata isolates, 6.8% were resistant/non-WT to azoles; only one isolate was classed as resistant to caspofungin (MIC of 0.5 mg/L) by CLSI criteria, but was micafungin and anidulafungin susceptible. There was no azole/echinocandin co-resistance. Conclusions We report an almost 1.7-fold proportional increase in C. glabrata candidaemia (26.7% versus 16% in 2004) in Australia. Antifungal resistance was generally uncommon, but azole resistance (16.7% of isolates) amongst C. tropicalis may be emerging.
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Affiliation(s)
- Belinda Chapman
- Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Monica Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Infectious Diseases Service at the Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Debbie Marriott
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Catriona Halliday
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Sarah Kidd
- National Mycology Reference Centre, SA Pathology, Adelaide, SA, Australia
| | - Ian Arthur
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Narin Bak
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Christopher H Heath
- Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Department of Microbiology, PathWest Laboratory Medicine Fiona Stanley Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Karina Kennedy
- Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, VIC, Australia
| | - Tania C Sorrell
- Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Sebastian van Hal
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Caitlin Keighley
- Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
| | - Emma Goeman
- Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia
| | - Neil Underwood
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Krispin Hajkowicz
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Ann Hofmeyr
- Department of Microbiology and Infectious Diseases, Liverpool Hospital, Sydney, NSW, Australia
| | - Michael Leung
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, WA, Australia
| | - Nenad Macesic
- Department of Infectious Diseases, Austin Hospital, Heidelberg, VIC, Australia and Division of Infectious Diseases, Columbia University Medical Center, New York City, NY, USA
| | - Jeannie Botes
- Department of Microbiology, SEALS South Pathology, Wollongong Hospital, Wollongong, NSW, Australia
| | - Christopher Blyth
- School of Paediatrics and Child Health, University of Western Australia, Subiaco, WA, Australia and Department of Infectious Diseases, Princess Margaret Hospital, Subiaco, WA, Australia
| | - Louise Cooley
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - C Robert George
- Department of Microbiology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Pankaja Kalukottege
- Department of Microbiology, Pathology -North, Hunter, Newcastle, NSW, Australia
| | - Alison Kesson
- Department of Infectious Diseases and Microbiology, The Children's Hospital, Westmead and Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Robert Baird
- Department of Microbiology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Jennifer Robson
- Sullivan and Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Tony M Korman
- Monash Infectious Diseases, Monash University and Monash Health, Melbourne, VIC, Australia
| | - Stella Pendle
- Department of Microbiology, Australian Clinical Laboratories, Sydney, NSW, Australia
| | - Kerry Weeks
- Department of Microbiology, Pathology North, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Eunice Liu
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW, Australia
| | - Elaine Cheong
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, NSW, Australia
| | - Sharon Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, Sydney, NSW, Australia.,Centre for Infectious Diseases and Microbiology Westmead Institute for Medical Research, Westmead Hospital and the Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
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Bartlett AW, McMullan B, Rawlinson WD, Palasanthiran P. Hearing and neurodevelopmental outcomes for children with asymptomatic congenital cytomegalovirus infection: A systematic review. Rev Med Virol 2017; 27:e1938. [PMID: 28876493 DOI: 10.1002/rmv.1938] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Congenital CMV is one of the commonest congenital infections and a recognised cause of sensorineural hearing loss and neurodevelopmental impairment. Ninety percent are clinically inapparent at birth but are reported to be at risk of developing such abnormalities throughout childhood, the extent of which requires further elucidation. METHODS A systematic literature review was conducted using Medline and Embase databases, manual citation review, and personal libraries for articles reporting primary data on hearing and neurodevelopmental outcomes for children with asymptomatic congenital CMV. PROSPERO registration number CRD42015025407. RESULTS Thirty-seven of 480 articles identified between 1969 and 2016 met the eligibility criteria. Twenty-nine of these contributed primary data on hearing outcomes and 20 on neurodevelopmental outcomes (12 of the 37 studies contributed data on both). Cumulative incidence of sensorineural hearing loss with follow-up to at least 5 years was 7% to 11%, which is more than healthy controls but less than children with symptomatic congenital CMV (34%-41%). The onset, course, and severity of hearing loss was variable with no reliable virological prognostic marker. In comparison to controls, children with asymptomatic congenital CMV did not perform worse than controls in neurodevelopmental assessments and performed better than children with symptomatic congenital CMV. CONCLUSIONS Studies show children with asymptomatic congenital CMV are at increased risk of developing hearing loss but perform equally well on neurodevelopmental assessments when compared with healthy controls. There is no reliable virological marker to determine which infants will develop sequelae. Regular follow-up until school entry is supported by the literature.
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Affiliation(s)
- Adam W Bartlett
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia
- Biostatistics and Databases Program, The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Brendan McMullan
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - William D Rawlinson
- Serology and Virology Division, SEALS Microbiology, Prince of Wales Hospital, Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Pamela Palasanthiran
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia
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